The Affordable Care Act Does Not Make An Insurer Of Last Resort Any Less Necessary.
BCBSM argues that the Affordable Care Act makes it unnecessary for Michigan to have an 'insurer of last resort.' For Medicare, this is simply not true. The Affordable Care Act did nothing to make the BCBSM Legacy Plans less necessary. Indeed, if anything, it made having an affordable Medigap option for Michiganders even more necessary.
The rules for when an individual is entitled to a Medigap plan without underwriting are here (pages 22-23). The Affordable Care Act does nothing to change these rules. You are generally only entitled to a Medigap plan without underwriting when you are 65 and first enroll in Medicare, your insurer goes bankrupt or no longer offers Medigap insurance, or the first year you switch to a Medicare Advantage plan.
You are not guaranteed enrollment in a Medigap plan when:
- You are under 65 and disabled.
- Your insurance company significantly increases your Medigap rates and you can no longer afford that company's plan.
- You have a retirement plan and your former employer significantly reduces your retirement health benefits.
- You have been in a Medicare Advantage plan for over a year and want to return to having a Medigap policy.
- You have an issue-aged policy and your fixed income can no longer support the increases to your Medigap rates because of your age.
- You want to switch to a different type of Medigap plan.
These are common situations that the BCBSM Legacy plans have historically been available to help Michiganders get effective Medicare coverage. If the current legislation passes, a safety-net Medigap plan will go away for all Michiganders.
While it is true that Medicare Advantage plans do not have such underwriting, these plans almost always provide inferior health coverage. Furthermore, these plans have been around for over a decade and it is misleading to say the Affordable Care Act did anything to make BCBSM's Legacy Medigap plans less necessary. If anything, the Affordable Care Act made BCBSM Legacy plans more necessary because the act cuts the 14% more that the government pays Medicare Advantage plans than Original Medicare. This may lead to increased Medicare Advantage premiums or cuts to Medicare Advantage benefits, making an affordable Medigap plan even more attractive.
Also, with BCBSM Legacy plans, many individuals who are disabled can get good, comprehensive insurance, while staying off Medicaid. Without the BCBSM Legacy plan, many of these individuals will be relying on Medicaid and taxpayer supported insurance.
The rules for when an individual is entitled to a Medigap plan without underwriting are here (pages 22-23). The Affordable Care Act does nothing to change these rules. You are generally only entitled to a Medigap plan without underwriting when you are 65 and first enroll in Medicare, your insurer goes bankrupt or no longer offers Medigap insurance, or the first year you switch to a Medicare Advantage plan.
You are not guaranteed enrollment in a Medigap plan when:
- You are under 65 and disabled.
- Your insurance company significantly increases your Medigap rates and you can no longer afford that company's plan.
- You have a retirement plan and your former employer significantly reduces your retirement health benefits.
- You have been in a Medicare Advantage plan for over a year and want to return to having a Medigap policy.
- You have an issue-aged policy and your fixed income can no longer support the increases to your Medigap rates because of your age.
- You want to switch to a different type of Medigap plan.
These are common situations that the BCBSM Legacy plans have historically been available to help Michiganders get effective Medicare coverage. If the current legislation passes, a safety-net Medigap plan will go away for all Michiganders.
While it is true that Medicare Advantage plans do not have such underwriting, these plans almost always provide inferior health coverage. Furthermore, these plans have been around for over a decade and it is misleading to say the Affordable Care Act did anything to make BCBSM's Legacy Medigap plans less necessary. If anything, the Affordable Care Act made BCBSM Legacy plans more necessary because the act cuts the 14% more that the government pays Medicare Advantage plans than Original Medicare. This may lead to increased Medicare Advantage premiums or cuts to Medicare Advantage benefits, making an affordable Medigap plan even more attractive.
Also, with BCBSM Legacy plans, many individuals who are disabled can get good, comprehensive insurance, while staying off Medicaid. Without the BCBSM Legacy plan, many of these individuals will be relying on Medicaid and taxpayer supported insurance.