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Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare plans. One of the key issues currently limiting choice and coverage for Medicare beneficiaries is limited access to Medigap plans.

Medicare Supplement Insurance, more commonly referred to as Medigap, is insurance that helps pay for “gaps” in Medicare payment. Medigap does not generally pay for gaps in services not covered by traditional Medicare, but rather for cost-sharing when coverage is provided by Medicare Parts A and B. Given the high costs of health care and Medicare cost-sharing, Medigap policies are key to affording care for people in traditional Medicare.

Unfortunately, however, there are limitations on accessing these important plans:

  • Federal law requires Medigap “guaranteed issue” protections for people age 65 and older only during the first six months of their Medicare Part B enrollment and certain other limited situations, including during a “trial” Medicare Advantage enrollment period. Beneficiaries who miss these windows of opportunity may not be able to purchase a Medigap policy later in life if their needs or priorities change.
  • Beneficiaries under age 65 with disabilities who qualify for Medicare have no guaranteed issue at all. (Individual states may offer varying degrees of consumer protection, but many do not).

Rights to purchase Medigap supplemental insurance policies should be expanded to people under 65 and should include ongoing access for all in order to provide real, meaningful choices for all Medicare beneficiaries.

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