Medicare reforms and financing under scrutiny, focusing on healthcare access, payments, and costs
The Medicare Access and CHIP Reauthorization Act (MACRA), passed in April 2015, has significantly impacted the availability and costs of Medigap (Medicare Supplement) plans. This legislation, aimed at encouraging patient-focused care and reducing Medicare spending, has had noticeable effects on new Medicare enrollees, particularly those who became eligible from 2020 onwards.
One of the key changes is the restriction on Medigap Plans C and F for new enrollees. As of January 1, 2020, these plans are no longer available to individuals who join Medicare from this date. This is due to MACRA's ban on new Medigap policies covering the Part B deductible for new enrollees[1][3].
### Impact on Medigap Plan Availability:
This restriction means that new Medicare beneficiaries must now choose from other plans, such as Plan G, which offers similar benefits to Plan F but does not cover the Part B deductible. Those who were eligible for Medicare before 2020 can still enroll in Plans F and C, but those who became eligible after that date must primarily opt for Plan G[3][4].
### Impact on Costs:
Plans C and F generally had higher premiums due to their comprehensive coverage, which included the Part B deductible, a significant out-of-pocket expense. With MACRA's removal of these plans for new enrollees, individuals opting for Plan G may face premiums slightly lower than Plan F but will be responsible for paying the Part B deductible out-of-pocket[1][3].
This means for new enrollees, there might be a slight increase in out-of-pocket costs depending on their medical needs, although Plan G is often considered a cost-effective alternative overall. The changes aimed to control Medicare spending and reduce the cost burden on the program by eliminating coverage of the Part B deductible through Medigap for new enrollees[1][3].
### Additional Notes:
It's important to note that some states have additional enrollment rules, allowing for more options, but the federal MACRA rules still govern the availability of Plans C and F for new enrollees[1][4]. The overall number of standardized Medigap plans remains at 10, but usage and availability of specific plans like C and F have changed due to MACRA[1][4].
In conclusion, MACRA has restricted new Medicare beneficiaries from enrolling in Medigap Plans C and F by disallowing coverage of the Part B deductible, which has reduced the availability of certain high-coverage plans and slightly shifted cost burdens toward beneficiaries, who must now pay the Part B deductible out-of-pocket or choose alternative plans like Plan G[1][3][4].
References: [1] Medicare.gov. (n.d.). Medigap Plans C and F no longer available to new beneficiaries. Retrieved from https://www.medicare.gov/supplements-other-insurance/medigap-policy-changes/when-medigap-policies-can-be-changed/when-can-medigap-policies-be-changed-due-to-changes-in-the-law
[2] Centers for Medicare & Medicaid Services. (2021). Medigap Policies. Retrieved from https://www.cms.gov/Medicare/Supplemental-Insurance/Medigap/Medigap-Policies
[3] Medicare Interactive. (2021). Medigap Plans C and F are no longer available to new beneficiaries. Retrieved from https://www.mymedicarematters.org/learn-about-medicare/medicare-costs/medigap-policies/medigap-changes/medigap-plans-c-f-no-longer-available-to-new-beneficiaries/
[4] AARP. (2021). Medigap Plans C and F are no longer available to new beneficiaries. Retrieved from https://www.aarp.org/health/medicare-insurance/info-2021/medigap-plans-c-f-no-longer-available.html
- Health organizations have cited the impact of the Medicare Access and CHIP Reauthorization Act (MACRA) on health insurance, specifically the restriction of Medigap Plans C and F for new enrollees, as a significant change in health-and-wellness coverage for Medicare beneficiaries.
- As a result of MACRA, new Medicare enrollees must primarily opt for alternative Medigap plans, such as Plan G, due to the prohibition on new policies covering the Part B deductible for new enrollees, which has led to an increase in out-of-pocket costs for new beneficiaries.
- In light of these changes, science and medical-conditions research may need to consider the additional costs borne by new Medicare beneficiaries and how it could impact their overall health and wellness.
