Purpose

Expand the availability of guaranteed issue Medicare supplement coverage for people who lose their current Medicare supplement policy due to specific events, including termination or insolvency of the issuer. The bill aims to ensure these individuals can obtain a Medicare supplement policy without being denied or charged higher rates due to health status or preexisting conditions.

Who is Eligible (Eligible Persons)

Eligible persons include individuals who: - Seek to enroll in a Medicare supplement policy during a defined period after their current policy is terminated or disenrolled, or after enrollment in Medicare Part D. - Are enrolled in certain other coverage that supplements Medicare (e.g., an employee welfare benefit plan that terminates, a Medicare Advantage plan that ends or is discontinued, or PACE under federal rules) and face circumstances similar to termination of that coverage. - Face involuntary loss of coverage due to insolvency, plan termination, or other specified events, or who disenroll from a plan and then enroll again under defined conditions.

What Issuers Must Do (Guaranteed Issue and Non-Discrimination)

• Issuers may not deny coverage, delay, or impose waiting periods or preexisting-condition exclusions for eligible persons.
• Issuers may not discriminate based on health status, claims experience, health conditions, or age when issuing a Medicare supplement policy to eligible persons.
• The eligible policy must be a Medicare supplement policy with a basic plan plus optional riders described in state law.
• If eligible, the policy must be offered by the issuer to new enrollees, with options to choose the same policy offered previously from the same issuer or an equivalent policy from another issuer (subject to specified limitations related to outpatient prescription drug coverage).

When Guaranteed Issue Applies (Guaranteed Issue Period)

• The guaranteed issue period is a defined window around the termination or disenrollment event. In most cases, it starts at the later of the termination notice or the date the coverage ended and lasts 63 days after that date.
• If an enrollee disenrolls voluntarily, the guaranteed issue period begins 60 days before the effective date of disenrollment and ends 63 days after that date.
• In cases involving specific Medicare Part D or Part C enrollment changes, the period may begin earlier (e.g., when the person receives certain notices) or be tied to the initial enrollment timing, with durations around 63 days.
• Some scenarios deem a subsequent enrollment after involuntary termination as an initial enrollment for purposes of guaranteed issue, effectively resetting eligibility.
• For certain involuntary terminations related to Part C, PACE, or similar arrangements, the start and end dates align with the relevant termination or notice dates and a 63-day window.

Policy Details and Coverage Options

• The eligible Medicare supplement policy is defined as the basic Medicare supplement plan (as described by state law) plus any combination of specific optional riders offered by the issuer.
• If the individual’s most recent policy included outpatient prescription drug coverage, the comparable new policy may be offered with or without that coverage, subject to maintaining eligibility rules and issuer offerings. The enrollee may retain other non-drug benefits from their current coverage with the same issuer, provided the policy is offered and available to new enrollees by that issuer.
• If the current policy is terminated due to insolvency, the new policy should be offered with similar terms, with allowances for adjustments to avoid duplicating benefits (like drug coverage) unless the enrollee opts to retain other benefits.

Notices and Communications

• The organization terminating the contract or policy, the issuer, or the plan administrator must notify the individual of their rights under these guaranteed issue provisions.
• This notice must be provided at or near the time of termination or disenrollment, and in some cases within a specified number of days after disenrollment (e.g., within ten working days).

Interaction with Other Rights

• The guaranteed issue rights in this subdivision are in addition to, and do not limit or modify, the individual’s existing rights under other parts of the law.

Open Enrollment and Enrollment Mechanics

• In certain situations, the guaranteed issue outcome may be tied to open enrollment periods, or to deem a subsequent enrollment as an initial enrollment for purposes of eligibility.
• The bill provides rules for preserving benefits and ensuring that the enrollee can select an appropriate Medicare supplement policy, with the option to maintain most of their current non-drug benefits.

Significant Changes to Existing Law

• Introduces guaranteed issue rights for a broader group of individuals following specific triggers (termination, disenrollment, insolvency, plan termination, or other involuntary events involving Medicare-related coverage).
• Requires issuers to offer a Medicare supplement policy to eligible persons without health status or preexisting-condition discrimination and to allow retention of most benefits when possible.
• Establishes defined guaranteed issue periods around termination, disenrollment, and certain enrollment events, with timing designed to provide a window to obtain coverage.
• Mandates notice requirements to ensure individuals are informed of their rights and the issuer’s obligations.

Implementation Notes

• The changes apply to Minnesota Statutes related to Medicare supplement policies and their guaranteed issue provisions.
• The bill lays out specific scenario-based rules, and it ties eligibility to events involving Medicare plans (Part C, Part D), PACE, or related employer-sponsored coverage.
• Rights granted are in addition to existing protections, not a replacement or limitation of current rights.

Relevant Terms - Medicare supplement policy - Guaranteed issue - Eligible persons - Involuntary termination - Insolvency - Bankrupt issuer - Medicare Part C (Medicare Advantage) - PACE (Program of All-Inclusive Care for the Elderly) - Medicare Part D - Preexisting condition exclusions - Health status discrimination - Eligibility period / guaranteed issue period - Open enrollment - Notice of termination or disenrollment - Basic Medicare supplement plan - Optional riders (per state law) - Disenrollment - Claims experience - Outpatient prescription drug coverage