Medigap Policies Face New Federal Nondiscrimination Rule

[kgmom219]

And look what KFF just posted. I think we are ok.

The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA | KFF

This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump...

www.kff.org

 

[Newby]

Drastic changes, such as those proposed by CMS, will most likely require filing and approval by the respective states DOI . . . which could take months.

New rates. New pricing structure (unisex). Community rating.




Private insurers write the policies, based on standardized templates included in federal statutes. State insurance regulators oversee the insurers.


In the introduction to the new regulations, HHS officials say section 1557 applies to all forms of health insurance, including Medigap policies and excepted benefits policies.


The section also applies to Medicare Advantage plans, Medicare Part D prescription drug coverage and Affordable Care Act public health insurance exchange plans, officials say.

HHS is planning to publish the final rule in the Federal Register, an official regulatory publication, May 6.

The rule is set to take effect 60 days after the official publication date.




Or else . . . .???

What the politicians never understand when they require uni-sex rates is that just means everyone pays the higher male rates. If they require that smokers and non-smokers pay the same rate then everyone pays the smoker rates. If they require no underwriting then everyone just has to pay GI rates. If all ages have to pay the same then the 20-year olds will have to pay the 60-year old's rates.
It doesn't work the other direction.
Well they sure fixed it! lol
But it won't matter to them anyway because they aren't going to go off their cushy health plan paid by us to only have the crappy coverage that they put us on.

 

[Special Agent]

And look what KFF just posted. I think we are ok.

The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA | KFF

This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump...

www.kff.org

View attachment 12719

What do mean that we will be ok- that nothing in this will affect med supp rates?
I wonder since part B payments to providers are now considered financial assistance and subject to all the new non discrimination laws,if they will say part B co insurance payments by carriers to providers will be subject to new laws.



2. Medicare Part B is now considered federal financial assistance.

For nearly 40 years, HHS took the position that Medicare Part B funding did not meet the definition of “federal financial assistance” for purposes of Section 1557, as well as other federal statutes. In the 2022 NPRM, HHS proposed to change its interpretation to provide that Medicare Part B payments constitute federal financial assistance when received by providers and suppliers.

In the final rule, HHS finalizes this interpretation but amends the applicability date to allow newly covered recipients additional time to comply. HHS describes that some recipients do not currently receive any federal financial assistance other than Part B funds; therefore, these recipients will be newly required to comply with Section 1557 and other federal civil rights laws. While HHS’s revised interpretation is effective upon publication of the final rule, HHS will permit a one-year delayed applicability date. Entities whose federal program participation has been limited to Part B must comply with Section 1557 and other applicable federal laws no later than May 6, 2025.

 

[somarco]

What the politicians never understand when they require uni-sex rates is that just means everyone pays the higher male rates.

What the politicians know about the real world, especially insurance, might fill a thimble if it is raining.

 

[kgmom219]

What do mean that we will be ok- that nothing in this will affect med supp rates?
I wonder since part B payments to providers are now considered financial assistance and subject to all the new non discrimination laws,if they will say part B co insurance payments by carriers to providers will be subject to new laws.



2. Medicare Part B is now considered federal financial assistance.

For nearly 40 years, HHS took the position that Medicare Part B funding did not meet the definition of “federal financial assistance” for purposes of Section 1557, as well as other federal statutes. In the 2022 NPRM, HHS proposed to change its interpretation to provide that Medicare Part B payments constitute federal financial assistance when received by providers and suppliers.

In the final rule, HHS finalizes this interpretation but amends the applicability date to allow newly covered recipients additional time to comply. HHS describes that some recipients do not currently receive any federal financial assistance other than Part B funds; therefore, these recipients will be newly required to comply with Section 1557 and other federal civil rights laws. While HHS’s revised interpretation is effective upon publication of the final rule, HHS will permit a one-year delayed applicability date. Entities whose federal program participation has been limited to Part B must comply with Section 1557 and other applicable federal laws no later than May 6, 2025.

Get to the bottom of the article. It’s a chart and discusses rates, specifically

 

[Yagents]

I don't see it KG. Post the text?

Here is NAHU's interpretation:

NAHU Washington Update - 05/03/2024

The U.S. Department of Health and Human Services (HHS) has announced that Medicare supplement insurance policies, commonly known as Medigap policies, will now be subject to a new federal health nondiscrimination rule. This rule is part of the final regulations implementing section 1557 of the Affordable Care Act (ACA), which prohibits discrimination based on race, color, national origin, sex, age, or disability in health programs receiving federal funding.

Historically, Medigap policies, which are state-regulated and help approximately 14 million consumers cover costs not included in original Medicare like deductibles and co-payments, were not subjected to many ACA-related regulations. However, the new rule clarifies that section 1557 applies to all forms of health insurance, including Medigap and other excepted benefits policies.

The implications of this change are significant for agents and brokers dealing with Medigap coverage.
-------------
This expansion of nondiscrimination protections under the ACA represents a significant shift in the regulation of Medigap policies and could have a significant impact on the Medigap market on both availability and pricing of these products because it requires guaranteed issue for the under 65 population who are already sick. Depending on the outcome of the presidential election, and President Joe Biden is not reelected, his successor could potentially alter or reverse these new requirements through changes in HHS leadership.

 

[Special Agent]

I don't see it KG. Post the text?

Here is NAHU's interpretation:

NAHU Washington Update - 05/03/2024

The U.S. Department of Health and Human Services (HHS) has announced that Medicare supplement insurance policies, commonly known as Medigap policies, will now be subject to a new federal health nondiscrimination rule. This rule is part of the final regulations implementing section 1557 of the Affordable Care Act (ACA), which prohibits discrimination based on race, color, national origin, sex, age, or disability in health programs receiving federal funding.

Historically, Medigap policies, which are state-regulated and help approximately 14 million consumers cover costs not included in original Medicare like deductibles and co-payments, were not subjected to many ACA-related regulations. However, the new rule clarifies that section 1557 applies to all forms of health insurance, including Medigap and other excepted benefits policies.

The implications of this change are significant for agents and brokers dealing with Medigap coverage.
-------------
This expansion of nondiscrimination protections under the ACA represents a significant shift in the regulation of Medigap policies and could have a significant impact on the Medigap market on both availability and pricing of these products because it requires guaranteed issue for the under 65 population who are already sick. Depending on the outcome of the presidential election, and President Joe Biden is not reelected, his successor could potentially alter or reverse these new requirements through changes in HHS leadership.

This is dated 5/3 and KG posted final rule article which is dated 5/15 and said we were ok but i still don't see anything that indicates what that means here?

The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA | KFF

This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump...

www.kff.org

 

[somarco]

I missed this KEY point before in the post by @Yagents regarding the Think Advisor article authored by Allison Bell . . .



The new HHS final rule implements section 1557 of the Affordable Care Act. The section prohibits discrimination on the basis of race, color, national origin, sex, age or disability at health programs that receive federal funding.



Medigap does not (currently) receive federal dollars . . . but MAPD does . .


This is further amplified in the KFF summary posted by @kgmom219.



On April 27, 2024, the Biden Administration’s Department of Health and Human Services (HHS) finalized long-awaited revised regulations implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability, or sex and applies to health programs and activities receiving federal financial assistance

Section 1557 applies to health programs or activities that receive direct or indirect federal financial assistance from HHS,


considering Medicare Part B as receiving Federal financial assistance for the first time;

 

[Yagents]

I think they are tying part B funding to med supps believing since B is funded, technically carriers benefit from it too

 

[Special Agent]

I think they are tying part B funding to med supps believing since B is funded, technically carriers benefit from it too

Sooo..... the thinking is it may still affects med supp rates and underwriting because without part b there would be no medicare supplements? just got thrown off upthread when it was said by the poster there was something specific in the KFF report that made them think " we are ok"