Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 275 - Medicare Supplement Insurance › Section 031-275-9.2 - 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

Current through 2024-29, July 17, 2024
The Medicare Access and CHIP Reauthorization Act of 2015
				  (MACRA) requires the following standards to apply to 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 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
				  9.1.
A. Benefit Requirements. The standards and
				requirements of Section
				9.1 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
				9.1(E)(3) of this
				Rule but shall not provide coverage for one hundred percent (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
				9.1(E)(5) of this
				Rule but shall not provide coverage for one hundred percent (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
				9.1(E)(6)  of this
				Rule but shall not provide coverage for one hundred percent (100%) or any
				portion of the Medicare Part B deductible; provided further that, the Medicare
				Part B deductible paid by the beneficiary shall be considered an out-of-pocket
				expense in meeting the Plan's annual high deductible.
Drafting Note:
Subsection A(4), above, implements the High Deductible Plan G as a
				  redesignation of the prior High Deductible Plan F because federal law "deems"
				  any reference to Plan F to be a reference to Plan G for "newly eligible"
				  Medicare beneficiaries. High Deductible Plan G is the same as High Deductible
				  Plan F except that where the annual out-of-pocket expenses are met with
				  Medicare Part A expenses only, any subsequent Medicare Part B deductible
				  expense incurred by the beneficiary after the required annual out-of-pocket
				  expenses is met may not be paid for by High Deductible Plan G. Federal law
				  prohibits the sale or issuance of any Medicare supplement policy that provides
				  coverage of the Part B deductible to a "newly eligible" Medicare beneficiary
				  and was enacted for the purpose of increasing cost-sharing and reducing "first
				  dollar coverage." High Deductible plans meet this purpose. A beneficiary buying
				  such a plan has a reasonable expectation that the plan will begin providing
				  coverage after the beneficiary has paid the stated dollar amount in full, so
				  making the beneficiary satisfy two separate deductible requirements on a
				  cumulative basis would be a misleading description of the terms of the
				  plan.
(5) The
				reference to Plans C or F contained in Section
				9.1(A)(2) is deemed
				a reference to Plans D or G for purposes of this section.