|
Dear Avisery Members,
The Medicaid omnibus legislation of Public Act 103-0102 that took effect June 16, 2023, has added a new Medigap Special Enrollment Period (SEP) for those who lose their Medicaid coverage due to the end of Medicaid Continous Eligibilty (for more information click here) and are enrolled into Medicare or are Medicare eligible. This SEP is 63 days starting the day of Medicaid termination or date of notice of Medicaid termination and allows individuals to purchase a Medigap plan with guaranteed issue rights.
Background
Medigap or Medicare Supplement Insurance plans are plans sponsored by private insurance companies that help cover the “gaps” of Medicare such as daily hospital coinsurance, coverage for an additional 365 days in the hospital, 20% coinsurance for Part B services, 1st three pints of blood, and Part A hospice coinsurance. There are some Medigap plans that cover additional benefits as well. For more information on Medigap plans click here.
The timing that a person purchases a Medigap policy is important because it will depend on whether they have guaranteed issue rights. Guaranteed issue rights means that an insurance company cannot refuse to sell a person a policy, charge the person more due to a health condition, or make the person wait for coverage on a health condition. Medicare eligible individuals get a 6-month Medigap Open Enrollment Period once they enroll in Part B that gives them Guaranteed Issue Right regardless of whether they are eligible for Medicare due to age or disability. If a person would like to purchase a Medigap policy after their Medigap Open Enrollment Period, they will not have guaranteed issue right and insurance companies are allowed to refuse to sell a policy, charge a person more due to health condition, or make the person wait for coverage on a health condition. In Illinois, there is one company, Blue Cross Blue Shield, that will always offer a Medigap policy to those 65 and older.
During the Public Health Emergency (PHE), Medicaid coverage was not terminated, and individuals did not have to go through any redeterminations. During this time individuals were still able to enroll into Medicare due to age or be automatically enrolled into Medicare due to disability. If an individual with Medicaid enrolled in Medicare during the PHE, the fact that they had Medicaid affected their Medicare options because it is illegal to sell a person with Medicaid a Medigap policy.
These individuals missed their Medigap Open Enrollment Period and thus the chance to purchase a Medigap policy with guaranteed issue rights.
Medigap Special Enrollment Period
Under the Medicaid omnibus legislation of Public Act 103-0102, a Medigap Special Enrollment Period has been created for those who lose their Medicaid coverage during the Unwinding. This SEP lasts 63 days after the date of Medicaid termination or 63 days after the state of notice of termination. Eligible Individuals for the SEP are:
- Individuals who enrolled in Medicare during the PHE and have missed their Medigap Open Enrollment Period and have lost Medicaid Coverage
-
Individuals enrolling into Medicare for the first time using the Special Enrollment Period for loss of Medicaid Coverage. Click here for Avisery's alert on this SEP.
Depending on when a person enrolls into Part B, their Medigap Open Enrollment Period and Lose of Medicaid SEP may overlap. If an individual enrolls in Part B for the first time shortly before Medicaid termination, they may have a 6-month Medigap Open Enrollment Period in effect in addition to the 63-day Lose of Medicaid SEP.
The Illinois Department of Insurance has given guidance to insurance companies on this SEP. To read the guidance click here.
If you have any questions, please feel free to email avisery@ageoptions.org
| 
