The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) requires that the following standards are applicable 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
Rules 120-2-8-.07,
120-2-8-.08, and
120-2-8-.09.
1.Benefit Requirements. The standards and
requirements of Rule
120-2-8-.09 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:
a.Standardized
Medicare supplement benefit Plan C is redesignated as Plan D and shall provide
the benefits contained in Rule
120-2-8-.09(8)(e)
but shall not provide coverage for one hundred percent (100%) or any portion of
the Medicare Part B deductible.
b.Standardized Medicare supplement benefit
Plan F is redesignated as Plan G and shall provide the benefits contained in
Rule
120-2-8-.09(8)(e)
but shall not provide coverage for one hundred percent (100%) or any portion of
the Medicare Part B deductible.
c.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.
d.Standardized Medicare supplement benefit
Plan F With High Deductible is redesignated as Plan G With High Deductible and
shall provide the benefits contained in Rule
120-2-8-.09(8)(e)
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 annual high deductible.
2.Applicability to Certain Individuals. Rule
120-2-8-.09.1 applies to only
individuals that are newly eligible for Medicare on or after January 1, 2020:
a.By reason of attaining age 65 on or after
January 1, 2020; or
b. By reason
of entitlement to benefits under part A pursuant to Section 226(b) or 226A of
the Social Security Act, or who is deemed to be eligible for benefits under
Section 226(a) of the Social Security Act on or after January 1,
2020.
3.Guaranteed Issue
for Eligible Persons. For purposes of Rule
120-2-8-.12, 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 meet the
requirements of Rule
120-2-8-.09(l)(A).
4.Applicability to Waivered States. In the
case of a State described in Section 1882(p)(6) of the Social Security Act
("waivered" alternative simplification states) MACRA prohibits the coverage of
the Medicare Part B deductible for any Medicare supplement policy sold or
issued to an individual that is newly eligible for Medicare on or after January
1, 2020.
5.Offer of Redesignated
Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020,
the standardized benefit plans described in Rule
120-2-8-.09.1(l)(d) above may be
offered to any individual who was eligible for Medicare prior to January 1,
2020, in addition to the standardized plans described in Rule
120-2-8-.09(5).
Notes
Ga. Comp. R.
& Regs. R.
120-2-8-.09.1
O.C.G.A.
ยงยง
33-2-9,
33-43-3 through
33-43-6.
Original
Rule entitled "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"
adopted. F. Mar. 20, 2020; eff.
Apr. 13, 2020, as
specified by the Agency.