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.
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
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.
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
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.
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