Legislation Recently Endorsed By TSCL: Protecting Patients with Pre-Existing Conditions & Improving Medigap Coverage

From the office of Representative Lloyd Doggett (TX-35)

Legislation that would prohibit discriminatory pricing and coverage denials for patients seeking supplemental Medigap coverage was recently introduced by Representative Lloyd Doggett (TX-35), Chair of the U.S. House Ways & Means Health Subcommittee, and joined by over 30 Members of Congress.  Nearly 13 million Medicare beneficiaries purchase supplemental Medigap policies to help reduce out-of-pocket costs and provide benefits not currently covered by Medicare.  The Close the Medigap Act will improve existing federal laws governing the Medigap market to guarantee that all beneficiaries have access to high-quality, affordable supplemental coverage.

“Building on the promise of the Affordable Care Act to protect all patients with pre-existing conditions from insurance discrimination, the Close the Medigap Act ensures Medigap plans offering relief for out-of-pocket costs don’t come at an extra cost for the most vulnerable patients,” said Congressman Doggett. “We can close these gaps by ensuring that Medicare beneficiaries can purchase a Medigap policy at any time without being denied coverage or subject to higher premiums based on their health status.”

The Close the Medigap Act would:

  • Strengthen consumer protections to ensure that Medicare beneficiaries with pre-existing conditions can purchase a Medigap policy at any time without being denied coverage or subjected to higher premiums based on their health status.
  • Extend protections to other individuals, including those enrolled in Medicare Advantage for more than 12 months, who wish to switch back to the traditional Medicare program.
  • Call on the National Association of Insurance Commissioners (“NAIC”) to review and improve medical loss ratio rules, which limit what percentage of premium dollars insurers can spend on administration, overhead, and profits.
  • Call on the NAIC to review pricing standards for the Medigap market and prohibit the sale of policies that discriminate based on the age of individuals.
  • Require the HHS Secretary to conduct a comprehensive review of the Plan Finder website to ensure that beneficiaries are able to make informed decisions regarding their coverage. This will ensure that consumers have access to complete and understandable information regarding tradeoffs between coverage options, including differences in out-of-pocket costs and Medicare Advantage provider networks.
  • Restore access to the two most popular Medigap policies (Plans C and F) eliminated January 1, 2020, which provide first-dollar coverage of the Part A and B deductibles.
  • Require issuers to disclose payments made to Medigap brokers and agents.  This information will be available to the public through the Open Payments database created by the Affordable Care Act.