50 Ill. Adm. Code 2008.63
Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020
Section 2008.63 Standard Medicare Supplement Benefit
Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or
Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on
or after January 1, 2020
The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) (P.L. 114-10, added 42 USC 1395ss(z)), which imposes the following
standards on all Medicare supplement policies or certificates delivered or
issued for delivery in this State to individuals newly eligible for Medicare on
or after January 1, 2020. No policy or certificate that provides coverage of
the Medicare Part B deductible may be advertised, solicited, delivered, or
issued for delivery in this State as a Medicare supplement policy or
certificate to individuals newly eligible for Medicare on or after January 1,
2020. All policies must comply with the following benefit plan standards.
Benefit plan standards applicable to Medicare supplement policies and
certificates issued to individuals eligible for Medicare before January 1, 2020
remain subject to the requirements of Section 2008.70 for Pre-Standardized
Plans, Section 2008.71 for 1990 Plans, or Section 2008.64 for 2010 Plans.
a) Benefit
Requirement. The standards and requirements of Section 2008.67 shall apply to
all Medicare supplement policies or certificates delivered or issued for
delivery to individuals newly eligible for Medicare on or after January 1,
2020, with the following exceptions:
1) Standardized
Medicare Supplement Benefit Plan C is redesignated as Plan D and shall provide
the benefits contained in Section 2008.67(f)(3) but shall not provide coverage
for 100% or any portion of the Medicare Part B deductible.
2) Standardized
Medicare Supplement Benefit Plan F is redesignated as Plan G and shall provide
the benefits contained in Section 2008.67(f)(5) but shall not provide coverage
for 100% or any portion of the Medicare Part B deductible.
3) Standardized
Medicare Supplement Benefit Plans C, F and F with High Deductible may not be
offered to individuals newly eligible for Medicare on or after January 1, 2020.
4) Standardized
Medicare Supplement Benefit Plan F with High Deductible is redesignated as Plan
G with High Deductible and shall provide the benefits contained in Section 2008.67(f)(6)
but shall not provide coverage for 100% or any portion of the Medicare Part B
deductible. In addition, the Medicare Part B deductible paid by the beneficiary
shall be considered an out-of-pocket expense in meeting the annual high
deductible.
5) The
reference to Plans C or F contained in Section 2008.67(b) is deemed a reference
to Plans D or G, respectively, for purposes of this Section.
b) Applicability
to Certain Individuals. This Section applies only to individuals that are newly
eligible for Medicare on or after January 1, 2020:
1) By
reason of attaining age 65 on or after January 1, 2020; or
2) By
reason of entitlement to benefits under Part A pursuant to section 226(b) or
226A of the Social Security Act or being deemed eligible for benefits under section
226(a) of the Social Security Act on or after January 1, 2020.
c) Guaranteed
Issue for Eligible Persons. For purposes of Section 2008.75(e), in the case of
any individual newly eligible for Medicare on or after January 1, 2020, any
reference to a Medicare supplement policy C or F (including F with High
Deductible) shall be deemed to be a reference to Medicare supplement policy D
or G (including G with High Deductible), respectively, that meets the
requirements of this Section.
d) Offer
of Redesignated Plans to Individuals Other Than Newly Eligible. On or after
January 1, 2020, the standardized benefit plans described in subsection (a)(4)
may be offered to any individual who was eligible for Medicare prior to January
1, 2020, in addition to the standardized plans described in Section 2008.67(f).