NJ State Legislature Seeking to Make Medicare Supplements Gurantee Issue

Feb 7, 2019

  1. Devin01
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    Devin01 Guru

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    State:
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    For agents that sell Med Supps in NJ the NJ State Legislature is trying to pass a bill that would make NJ a GI issue state like NY and CT for Medicare Supplement Insurance. We do not believe this is good for the consumer as we believe this bill will drive out competition and drive prices up on Medicare Supplement policies.

    Sponsored by:
    Senator JOSEPH F. VITALE District 19 (Middlesex) Senator SHIRLEY K. TURNER District 15 (Hunterdon and Mercer)

    SYNOPSIS

    Provides guaranteed issue rights to certain applicants for Medicare supplement insurance policies.

    1 AN ACT concerning Medicare supplement insurance coverage and

    2 supplementing P.L.1982, c.94 (C.17B:26A-1 et seq.). 3

    4 BE IT ENACTED by the Senate and General Assembly of the State

    5 of New Jersey:

    6

    7 1. a. No later than 60 days after the effective date of this act, no

    8 carrier issuing or renewing Medicare supplement insurance policies or

    9 contracts in this State shall: (1) deny or condition the effectiveness

    10 or issuance, or discriminate in the pricing, of Medicare supplement

    11 insurance policies or contracts based on the health status, claims

    12 experience, receipt of health care by, or medical condition of an

    13 applicant, and (2) exclude benefits based on an applicant’s

    14 preexisting medical conditions. The provisions of this act shall

    15 only apply when the application for Medicare supplement coverage

    16 is submitted on or after the first day of the first month in which the

    17 applicant is 65 years of age or older and the applicant is enrolled for

    18 benefits under Medicare Part B.

    19 b. As used in this act:

    20 “Carrier" means an insurance company, health service corporation,

    21 hospital service corporation, medical service corporation, or health

    22 maintenance organization authorized to issue health benefits plans in

    23 this State.

    24 "Health benefits plan" means a hospital and medical expense

    25 insurance policy; hospital service corporation contract, medical

    26 service corporation contract or health service corporation contract

    27 delivered or issued for delivery in this State. 28

    29 2. The Commissioner of Banking and Insurance shall adopt

    30 rules and regulations pursuant to the "Administrative Procedure

    31 Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the

    32 purposes of this act. 33

    34 3. This act shall take effect immediately. 35

    36

    37 STATEMENT

    38

    39 This bill prohibits health insurance companies, health service

    40 corporations, hospital service corporations, medical service

    41 corporations, and health maintenance organizations that issue

    42 Medicare supplement insurance policies or contracts in the State: (1)

    43 from denying or conditioning the effectiveness or issuance, or

    44 discriminating in the pricing, of Medicare supplement insurance

    45 policies or contracts based on the health status, claims experience,

    46 receipt of health care by, or medical condition of an applicant; and (2)

    47 from excluding benefits based on an applicant’s preexisting medical

    48 condition. Under the bill, these provisions only apply when the



    1 application for Medicare supplement coverage is submitted on or after

    2 the first day of the first month in which the applicant is 65 years of age

    3 or older and the applicant is enrolled for benefits under Medicare

    4 Part B.

    5 Medicare supplement insurance, also known as “medigap”

    6 insurance, is sold by private insurance companies and can help pay

    7 some of the out-of-pocket costs associated with Medicare Part A and

    8 Medicare Part B, such as copayments, coinsurance, deductibles and

    9 other fees.

    10 The types of consumer protections provided under this bill are

    11 collectively known as guaranteed issue rights and prohibit health

    12 insurance carriers from denying an applicant a Medicare supplement

    13 insurance policy or contract based on factors such as age, gender, or

    14 health status, and from varying premiums based on an applicant’s pre-

    15 existing medical conditions.

    16 Currently in New Jersey, applicants are provided guaranteed issued

    17 rights to Medicare supplement insurance during a one-time, six-month

    18 open enrollment period for beneficiaries ages 65 and older when

    19 enrolling in Medicare Part B, and for certain qualifying events which

    20 generally include instances when Medicare beneficiaries involuntarily

    21 lose supplemental coverage. Medicare beneficiaries who miss these

    22 enrollment opportunities may unknowingly forfeit the chance to

    23 purchase Medicare supplement insurance later in life. This bill

    24 addresses this issue by providing continuous guaranteed issue rights to

    25 applicants ages 65 and older who are also enrolled for benefits under

    26 Medicare Part B.
     
    Devin01, Feb 7, 2019
    #1
  2. Northeast Agent
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    Northeast Agent Guru

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    And Horizon BCBS, which had a GI Med Supp (#2 in NJ behind AARP/UHC) just pulled the plug on it Dec 1st....
     
  3. vic120
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    vic120 Guru

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    That's because they were losing money, Prices will go up. I just had a client $160 premium G moved to FL, Cant get plan N for less. I am going to have to Do AARP for more money near half the commission.

    NY is very high too but big plus there is you have easy to get approved epic ( state Pharm Assistance) to change any time a year
     
    vic120, Feb 7, 2019
    #3
  4. alldaytuesdays
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    alldaytuesdays Super Genius

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    North Carolina
    What a great idea

    NJ quotes.png NY quotes.png
     
  5. fed up
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    fed up Guru

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    Virginia
    Seems that some lawmakers believe that guarantee issued will lower the price playing field when in fact it raises the price for everyone. California just passed non gender auto insurance and guess what? All prices went up to level the field
     
    fed up, Feb 8, 2019
    #5
  6. Devin01
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    Devin01 Guru

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    We are in a very blue state NJ has a very liberal agenda. Instead of letting the market sort out price if this bill goes through prices have nowhere to go but up as we see in NY. I think the consumer has an obligation to educate themselves so they understand the difference between MAPD and Med Supp. Most good brokers spend 1 to 2 hours with our clients explaining the difference. Everybody loves MA until they get sick and then they feel like the insurance changes and they are getting screwed. The reality is MAPD is 0 Premium and has restrictions. In NJ up until Dec BCBCS was GI and we could move clients to them. It will be interesting to see what happens. We are hoping the insurance agents that do business in NJ will contact their state representatives and give feedback about what will happen to the market if this bill goes forward.
     
    Devin01, Feb 8, 2019
    #6
  7. fed up
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    fed up Guru

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    When I sold Supps and Ma plans I explained that MedAdv was great for little to no premium, could have the coverage reset as many as 6X in a year depending on the ailment, was great if you had a lot of money or no money at all. For the rest of us schmucks MeddSupps were the way to go. I discovered pretty quickly that PDP's were a waste of time since Walmart, CVS, and other merchants had their own plans and the customer could ask the pharmacist instead of calling me at all hours
     
    fed up, Feb 8, 2019
    #7
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