"Medigap" Coverage Policies and Categories in Tennessee

"Medigap" Coverage Policies and Categories in Tennessee

"Medigap" insurance can pay for non-covered services, deductibles, and co-payments not otherwise covered by Medicare Part A and Part B. Except for Minnesota, Massachusetts, and Wisconsin, U.S. territories, and D.C., states must limit the number of different Medicare supplemental insurance policies to 14 standard insurance plans (with a coverage date prior to June 1, 2010), and 11 standard plans (for coverage effective on or after June 1, 2010). In this Analysis, Timothy Takacs discusses "Medigap" coverage policies and categories in Tennessee. He writes:

     When federal requirements for Medigap policies were first enacted in 1980, Congress incorporated by reference into section 1882 of the Social Security Act standards developed by the National Association of Insurance Commissioners (NAIC). Since that time, the NAIC Model Regulation for Medicare Supplement Policies has served as the guidepost of the federal minimum standards for Medigap policies. The NAIC Model Regulation has been amended several times to take into account statutory changes that have been enacted to the Medicare program.

     The Act permits states to approve Medigap policies, but only in accordance with a state regulatory framework that meets certain federal requirements and standards. The Act specifically provides that no benefit packages may be offered under a Medigap policy unless it meets the NAIC standards. Although the Act permits "new or innovative benefits in addition to the benefits" provided in a standardized Medigap plan, CMS must certify that the policy meets the federal requirements.

     The Omnibus Budget Reconciliation Act of 1990 (OBRA'90) required all Medigap policies to be standardized. The NAIC, aided by an advisory committee of industry and consumer representatives and other interested parties, was given the opportunity to design no more than 10 standardized benefit packages. Generally, these policies would be the only ones that could be offered nationwide. From the time states implemented the OBRA'90 standards (generally by July 1992), it has been illegal to offer or sell any policy that does not conform to one of the 10 standardized packages, designated Medigap plans A to J.

     Effective July 1, 1992, the 10 standardized benefit plans for Medicare supplement insurance were implemented in Tennessee. Each plan was designated a letter, from "A" through "J." Plan A is the "basic" benefit package. Each of the other nine plans included the basic package plus a different combination of additional benefits, with Plan J providing the most coverage of the 10 plans. Medigap plans cover specific expenses either not covered or not fully covered by Medicare.

(citations omitted)

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