Harrisburg, PA – Pennsylvania Acting Insurance Commissioner Michael Humphreys alerts consumers who have had Medicaid coverage through the COVID-19 Public Health Emergency (PHE) and are eligible for Medicare that they have a limited opportunity to access Medicare Supplemental (Med Supp or Medigap) coverage enrollment options in Pennsylvania. Med Supp is Medicare supplemental insurance coverage that helps fill "gaps" in Original Medicare and is sold by private companies.
During the COVID-19 Public Health Emergency (PHE), some individuals in Pennsylvania may have stayed on Medicaid when they became eligible for Medicare because Medicaid was required to continue covering them regardless of eligibility. Since individuals on Medicaid may not be sold Med Supp coverage, these individuals may have missed their Med Supp open enrollment period. As the PHE winds down and Medicaid once again redetermines eligibility for Medicaid, individuals who lose Medicaid coverage and transition to Medicare coverage should now have a guaranteed issue enrollment period for Med Supp coverage.
"We expect insurers to work with these affected individuals and provide open enrollment period protections as they explore their Med Supp options," said Humphreys. "A guaranteed issue period means that a Med Supp insurer may not deny coverage or discriminate in the pricing of the Med Supp policy because of health status, claims experience, receipt of health care, or medical condition; or impose an exclusion of benefits based on a preexisting condition under the Med Supp policy."
A notice issued by PID sets forth in detail the Department's expectations for insurers issuing Med Supp coverage regarding this issue and provides an FAQ that elaborates on expectations for different situations that may arise.
This is a limited opportunity for consumers, so the Department encourages individuals losing Medicaid coverage and eligible for Medicare to act quickly if they are determined ineligible for Medicaid. The notice anticipates that the guaranteed issue enrollment opportunity will be consistent with the timeframes outlined in the Pennsylvania Medicare Supplement regulations, as if the individual were newly eligible for Med Supp enrollment at the time of the individual's Medicaid redetermination.
"The Pennsylvania Insurance Department is committed to ensuring that anyone who experiences loss of coverage following a Medicaid redetermination is able to find quality, comprehensive health insurance, either through the Pennie marketplace, their employer, or through Medicare, including Med Supp coverage," said Humphreys. "We want to make this process as smooth and seamless as possible, and we urge insurers to work toward the same goal. If any Pennsylvanian has any questions regarding their coverage, please know that the Department is here to help."
Consumers looking to learn more about health insurance should visit the department's dedicated Health Insurance page.
Pennsylvanians with insurance questions can contact the Insurance Department Consumer Services Bureau online or at 1-877-881-6388.
To learn more about Medicaid and CHIP renewals and access educational resources, visit www.dhs.pa.gov/phe.
For more information on health insurance options available to Pennsylvanians, visit https://www.pa.gov/guides/healthcare.