MACRA and Your Medicare Supplement Plan

MACRA, or the Medicare Access and CHIP Reauthorization Act, is changing the structure of Medicare payments to health care providers, with the goal of incentivizing higher quality care. This change will affect the coverage provided by some Medigap plans.

Medigap Plan C and Plan F are Medicare Supplement plans that cover some health care expenses left over after Medicare pays its share. These plans, including Medigap High-Deductible Plan F, will be impacted by MACRA starting January 1, 2020.

Other options, like Medicare Advantage will remain unchanged by MACRA.

Impact to Medigap Plans F, High-Deductible F, and C New Enrollment Due to MACRA

For new Medicare enrollees who become eligible in 2020 or later, Medigap Plan F, Medigap High-Deductible Plan F, and Medigap Plan C will not be available for purchase.

If you already have Plan F, High-Deductible F, or C, you can stay in your plan, and you can keep it as long as you make your monthly premium payment.

The 2020 deadline is for eligibility, not enrollment. If you become eligible for Medicare before January 1, 2020 and delay enrolling in Medicare Supplement coverage (for example, because you are still covered under an employer's plan), Plans F, High-Deductible F and C will still be available to you when you enroll*.

Will the Impacts to Plan F Affect Costs?

The MACRA elimination of plans does not guarantee that rates will increase for Plans F, High F, and C, even if you are not yet enrolled in Medicare.

However, Medicare deductibles and copayments are reviewed and updated annually by CMS. All Medicare costs associated are subject to change each year as updated figures from the federal government are received.

Comparable Alternative - Plan F to Plan G

For many people who will not be able to purchase Medicare Plan F, Medicare Plan G may be a good alternative. Medicare Plan G covers everything that Plan F used to cover, except for the initial Medicare Part B deductible.

Medicare Plan G will pay for:

  • Coinsurance for hospital coverage provided by Medicare Part A.
  • The Medicare Part A deductible for hospital care.
  • All hospital costs up to 365 days after Medicare Parts A and B have run out.
  • Copayments and coinsurance for care covered by Medicare Part B.
  • Coinsurance for care in a skilled nursing facility.
  • Extra charges from a doctor or specialist who does not accept Medicare reimbursement rates (also known as balance billing).
  • The first three pints of blood if a hospital buys blood for a medical procedure.
  • Foreign travel emergency care coverage, up to a limit.

If you are not eligible for Plan F, High-Deductible F, or Plan C, don't worry. Medicare Part B’s deductible is $198 for 2020, a relatively low dollar amount. When comparing costs and benefits, it is possible your Plan G monthly premium may be less than a Plan F option—and save you enough to offset the cost of the Part B deductible.

To save on monthly payments, consider High-Deductible Plan G

If you are interested in Medigap coverage but need a lower monthly payment than Plan G, you may want to consider High-Deductible G, a plan similar to High-Deductible F. High-Deductible G offers a lower monthly payment in exchange for a higher deductible you must pay every year before your supplemental plan begins covering health care costs.

Learn more about your Medicare Supplement options, so you can make confident choices regarding your health care coverage.

* Acceptance will be based on medical underwriting or applicant must be in a guaranteed issue period.