NAIC Sends Letter to HHS Recommending No Additional Cost-Sharing for Medigap

A provision of the Affordable Care Act requires the Secretary of HHS to request that the National Association of Insurance Commissioners (NAIC) review and revise the benefit designs for Medigap Plans C and F to incorporate “nominal” cost-sharing.  The NAIC today sent HHS a letter and recommended no additional cost-sharing for Medigap.

From the letter:

  • “Medigap’s protections are now inappropriately being held responsible for encouraging the overuse of covered services and increasing costs in the Medicare program.”
  • “We do not agree with the assertion being made by some parties that Medigap is the driver of unnecessary medical care by Medicare beneficiaries.”
  • “… the Subgroup discovered that there is a limited amount of relevant peer-reviewed material on this topic. None of the studies provided a basis for the design of nominal cost sharing that would encourage the use of appropriate physicians’ services.”
  • “Many of the studies caution that added cost sharing would result in delayed treatments that could increase Medicare program costs later (e.g., increased expenditures for emergency room visits and hospitalizations) and result in adverse health outcomes for vulnerable populations (i.e., elderly, chronically ill and low-income).”
  • “Most of the studies do not consider the same population of health insurance beneficiaries as those that purchase Medigap products.”

For more information about the value of Medigap, be sure to check out our blog post from earlier this week, Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries.

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