For Professionals: Medicare and Other Health Insurance

Snapshot of Changes to Medigap Policies

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Published: Nov. 16, 2009

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Federal law required changes to the standard Medigap benefit packages. California incorporated those changes in AB 1543.

Changes to Medigap Benefit packages:

  1. Added Hospice benefit to the basic benefits of all Medigap plans
  2. Eliminated Medigap plans E, H, I, and J (including high deductible Plan J and its rider)
  3. Eliminated benefits for preventive care and home recovery
  4. Changed the 80 percent excess charge benefit in Plan G to 100 percent
  5. Added two new Medigap plans
    1. Plan M with 50 percent benefit for the Part A deductible
    2. Plan N with $20 copayment for Part B office visits, and up to a $50 copay for emergency room care when not admitted to the hospital

None of the new standard Medigap plans can be issued with effective dates before June 1, 2010.

Other Changes

These changes took effect on July 2, 2009 when AB 1543 was signed by Governor Schwarzenegger

  • Specifies which of the new standard Medigap plans is equal to one of the old standard Medigap plans when switching Medigap coverage during the 30 day period each year following a birthday.
  • Adds COBRA and CalCOBRA to the loss of employer coverage that allows a guaranteed right to purchase a Medigap policy.
  • Adds Medi-Cal Share of Cost to the loss of Medi-Cal that allows a guaranteed right to purchase a Medigap policy. (The individual must certify he or she has not met the Share of Cost during the month of application for a Medigap policy.)
  • Adds language that allows individuals to get a guaranteed issue Medigap when an employer stops providing a full benefit for Medicare’s 20 percent coinsurance.
  • Prohibits the collection of health information when an individual is guaranteed the right to a Medigap policy, except when the individual seeking coverage is first enrolled in Medicare Part B.

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