Medigap law change Eligibility has expanded for TennCare disenrollees

December 15, 2010
by: 
Dwayne Page

The Department of Commerce and Insurance (TDCI) wants Tennessee insurance consumers to be aware of changes in the law relating to the regulation of the sale of Medicare Supplement insurance products ("Medigap") in this state. This week it has posted a bulletin addressing eligibility expansions for the State-required offer of Medigap policies to persons under 65 eligible for Medicare due to disability or end-stage renal disease (ESRD).

“Beginning January 1, 2011, as a result of an amendment to State law,” says TDCI Commissioner Leslie A. Newman, “insurance carriers who offer Medigap plans to individuals 65 and older must also offer those same plans to eligible individuals under 65. “An individual under 65 must be eligible for Medicare due to a disability or end-stage renal disease (ESRD) to enjoy this expanded mandated offering of coverage,” she says.

Pursuant to the 2010 Tennessee Public Acts, Chapter 978, the following persons are eligible for a six-month open enrollment period under the new law:

•A person who has been enrolled in Medicare Part B since before January 1, 2011, will have until June 30, 2011 to purchase a policy;

•A person who becomes enrolled in Medicare Part B after January 1, 2011, will have six months from the date of enrollment to purchase a policy;

•A person who becomes retroactively enrolled in Medicare Part B due to a retroactive eligibility decision made by the Social Security Administration will have six months from the date of the notice of retroactive enrollment to purchase a policy;

•A person who loses access to alternative forms of health insurance coverage such as accident and sickness policies, employer-sponsored group health coverage or Medicare Advantage plans due to termination or cancellation of such coverage because of the individual's employment status, or due to an action by a health insurer or employer that is unrelated to the individual's status, conduct, or failure to pay premiums will have six months from the date of loss of that coverage to purchase a policy; or

•A person who is involuntarily disenrolled from Title XIX (Medicaid) or Title XXI (State Children's Health Insurance Program) of the Social Security Act will have six months from the date of disenrollment to purchase a policy.

The bulletin can be found on the Insurance Division web page at http://tennessee.gov/
commerce/insurance/documents/120110.pdf. Consumers with questions should contact the TDCI Insurance Division at 615-741-2176, www.tn.gov/commerce/insurance/ or by mailing correspondence to:

TDCI Insurance Division, Fourth Floor
Davy Crockett Tower, Fourth Floor,
500 James Robertson Parkway
Nashville, TN 37243

The Department of Commerce and Insurance works to protect consumers while ensuring fair competition for industries and professionals who do business in Tennessee. www.tn.gov/commerce/

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