Listed below are a few questions we often receive about MACRA. Keep reading to nip these in the bud and save yourself a little time during this busy AEP!

1. What is the Medicare Access and CHIP

Reauthorization Act of 2015? (MACRA)

MACRA has many components, one of which is a limit on first dollar coverage in certain Medicare supplement insurance plans for individuals considered “newly eligible” and a transition away from using Social Security numbers as identifiers. It also includes a change to the way Medicare pays healthcare professionals. Currently, healthcare professionals are paid based on the number of services they perform. MACRA allows for healthcare professionals to be compensated on quality of care as opposed to the number of services they perform.

2. Who is considered newly eligible?

“Newly eligible” is defined as anyone who is turning 65 on or after January 1, 2020 or anyone who is eligible for Medicare benefits due to age or disability as defined by the Centers for Medicare and Medicaid Services (CMS) on or after January 1, 2020.

3. What does MACRA require?

As of January 1, 2020 MACRA does the following:

  • Prohibits first dollar Part B deductible coverage on Medicare Supplement so Plans C and F cannot be sold to those “newly eligible” for Medicare.
  • Makes Plans D and G the new guaranteed issue plans for those who are “newly eligible” within the guaranteed acceptance rules for Medicare Supplement plans.
  • Mandates that a Social Security number can no longer be used as an identifier.

4. How are enrollees in current Plans C and F affected?

No change. Plans C and F can still be sold after January 1, 2020 BUT only to Medicare beneficiaries who were age 65 prior to 1/1/2020 or first became eligible for Medicare prior to 1/1/2020 regardless of what plan they had previously.

  • Plans C and F are not going away. Current policyholders can continue with their Plan C or Plan F and may continue to buy Plans C and F beyond January 1, 2020.

Example: A customer who bought Plan F (or any other plan) in 2018 can purchase any plan, including C and F, prior to January 1, 2020 or thereafter.

Stay Informed! Be on the lookout for upcoming webinars during and after the Annual Enrollment Period.


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