State Insurance Chiefs Tell Congress Don’t Make Seniors Pay More for Medicare Medigap Policies
‘…will also cause serious confusion for seniors with fixed incomes who rely on Medigap insurance to protect
By Susan Jaffee, Kaiser Health News
16, 2011 - State insurance commissioners are preparing some stern words of advice for members of Congress trying to reduce the federal
deficit: don’t touch Medicare supplemental insurance.
Next week, the bipartisan National Association of Insurance Commissioners is expected to send a letter to Congress
opposing changes that would require beneficiaries to pay a higher share of the cost of their supplemental Medigap insurance. Seven million
Medicare beneficiaries already pay monthly premiums for these policies that cover a portion of medical expenses Medicare doesn't.
The letter will warn Congress that such proposals – geared to saving the federal government money – could cause various
problems for beneficiaries and insurers and may even be illegal, said Mary Beth Senkewicz, Florida’s deputy insurance commissioner, who heads
the association’s senior issues task force and is shepherding the letter through the approval process.
She provided several points from the letter, which was approved unanimously by the senior issues group on Thursday but
cannot be released to the public until final approval next week.
Increasing cost-sharing for current Medigap policyholders would be a benefit change that violates state and federal laws
requiring guaranteed, renewable benefits, said Senkewicz.
It will also cause "serious confusion" for seniors with fixed incomes who rely on Medigap insurance to protect them from
unanticipated medical costs. In the past, Medigap changes have applied only to new policies, she said.
Shifting some costs to Medigap beneficiaries has emerged as one of several proposals to reduce the federal deficit by
cutting Medicare spending. In addition, the 2010 health overhaul calls for some cost shifting in the two most popular and generous Medigap
plans but leaves the details to be ironed out by the NAIC and federal health officials.
The Congressional Budget Office estimates that shifting some costs to beneficiaries could save the government as much as
$53 billion in Medicare spending over a decade, according to a
report published last March. If beneficiaries have to reach into their own
pockets to pay for medical care, CBO predicts they will use less services and Medicare will have fewer claims to pay.
Medigap plans have been targeted because some studies have shown that beneficiaries with the plans tend to use more
Medicare services. Consumer advocates counter that those seniors may be sicker than the average Medicare patient, which is why they purchased
the extra coverage.
If Medigap cost-sharing rises, insurers will have "a monumental massive change in payment systems," said Senkewicz,
requiring them to recalculate monthly premiums and their future costs based on whether beneficiaries will qualify for full coverage or avoid
Under one proposal analyzed by CBO, seniors would pay $550 before Medigap coverage kicks in, and then half of the next
$4,950 costs not covered by Medicare – for a total of $3,025 – before the Medigap policy would cover all remaining medical bills during a
Insurance regulators are also worried about what happens when a patient in the middle of a treatment regime is hit with
new co-payments or other cost-sharing fees.
"If I have to start paying for something that had been paid for by the insurance company, if I can't afford it, I may
have to stop treatment," said Senkewicz.
NAIC's Medigap working group also has
questioned the cost-sharing proposals, said its chairman Guenther Ruch, an
administrator at Wisconsin’s insurance department. The group, comprised of consumer and insurance representatives as well as state regulators,
is preparing a background paper with more details about the issue.
Ruch and Senkewicz expressed little doubt that the letter to Congress will be approved next week.
"This is one of those rare instances where everyone seems to be in agreement,” said Senkewicz.
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