The New Jersey Department of Banking & Insurance Issues Guidance on Implementation of the Medicare Access and CHIP Reauthorization Act of 2015

Insurance Law Alert

July 12, 2019

Cynthia J. Borrelli

Cynthia J. Borrelli

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The Bulletin linked here provides guidance with respect to the action carriers must take to comply with the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) which was signed into law on April 16, 2015. Section 401 of MACRA prohibits the sale of Medigap policies that cover Part B deductibles to “newly eligible” Medicare beneficiaries defined as those individuals who: (a) have attained age 65 on or after January 1, 2020; or (b) first become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, 2020. Medicare Supplement Plans C and F cover the Medicare Part B deductible. Medicare Supplement Plans D and G do not cover the Medicare Part B deductible but are otherwise identical to Medicare Supplement Plans C and F.

To comply with MACRA, and applicable New Jersey law, carriers will be required to offer and renew Medicare Supplement Plan D for newly eligible Medicare beneficiaries who are New Jersey residents age 50 or older who are entitled to Medicare due to disability or ESRD. See N.J.S.A. 17B:26A-12 through 13 and N.J.A.C. 11:4-23B, as well as recently enacted P.L. 2019, c. 139, for guidance concerning specific eligibility for Medicare Supplement Plans C and D.

As a prerequisite to issuance of Medicare Supplement Plan D with an effective date of January 1, 2020 or later, carriers must promptly submit the following to the Department:

  • Medicare Supplement Plan D policy form filing with application
  • Medicare Supplement Plan D rate filing – rate filings must provide a demonstration of the development of Medicare Supplement Plans D rates
  • Medicare Supplement Plan D Outline of Coverage
  • Medicare Supplement Plan D Advertising

Carrier first offering Medicare Supplement Plan G for January 1, 2020 or later effective dates must similarly submit the above items for Medicare Supplement Plan G.

Questions may be directed to the Department’s Life and Health Unit at lifehealth@dobi.nj.gov.