Medigap Non Discrimination Rules

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Here we go again…

How a New Federal Rule Could Curb Discrimination in Medigap Plans

Applying Affordable Care Act section 1557 to all Medigap plans, setting standard nationwide premiums, and expanding enrollment rights are necessary and overdue.

www.commonwealthfund.org

 

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The courts delayed 1557 from happening.

Federal Court Decisions Delaying the New Regulations

The new regulations were scheduled to take effect on July 5, 2024. However, on July 3, 2024, a Mississippi federal court postponed the effective date of certain provisions that include gender identity in the definition of sex discrimination and prohibited HHS from enforcing those provisions nationwide. That same day, another federal court prohibited HHS from enforcing a subset of provisions that include gender identity in the definition of sex discrimination in Florida, while a third federal court postponed the effective date of the new rule in its entirety in Texas and Montana. HHS can appeal these decisions. However, as noted multiple times in all three decisions, HHS's interpretation of section 1557 is no longer entitled to judicial deference, as a result of the Supreme Court's recent ruling in Loper Bright v. Raimondo. At best, full implementation of the section 1557 regulations will be delayed by years of litigation; at worst, section 1557 will fall far short of its potential to remedy health disparities resulting from discrimination.

New Regulations Counter Discrimination in Health Coverage and Care but Are Delayed by Courts

New federal regulations expand protections against discrimination under the ACA, but it’s unclear when — or whether — these regulations will take effect.

www.commonwealthfund.org

And if it does happen, seems the Allstate type carriers will win with a split regulated market.

"Medigaps are not federally funded. But many companies selling them offer products that are, like MA, ACA marketplace, and Medicaid managed care plans. For insurers that are primarily health-focused, section 1557 would apply to all their offerings, including Medigap.

This would prohibit discrimination by these insurers, but not broadly. Other Medigap plans, such as those from companies that primarily provide life, home, or auto coverage, would not be affected by 1557. They could continue discriminating based on age, disability, and sex.

The result could be a market with two sets of plans and rules. This landscape would likely increase consumer confusion, administrative burden, premium volatility, and plan instability."