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Your Guide to MACRA

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes some of the Medicare supplement plans people new to Medicare can purchase.

The rule says that as of January 1, 2020, newly-eligible Medicare beneficiaries won’t be able to purchase Medicare supplement plans that cover the Part B deductible. These are Medicare supplement Plans C, F, High-Deductible F and Minnesota and Wisconsin Part B deductible coverage.

For MACRA purposes, “newly-eligible” people are those who become eligible for Medicare on or after January 1, 2020.

How does this affect you?

If you’re Medicare-eligible before January 1, 2020

Your plan options covering the Part B deductible don’t change. That is, Medicare supplement Plans C, F and High-Deductible F will still be available to you where offered.

If you currently have a Medicare supplement insurance plan:

  • Your policy benefits don’t change
  • Your Medicare supplement Plan C, F or High-Deductible F will continue paying your Part B deductible
  • Your policy will continue as long as premiums are paid on time

If you’re eligible for Medicare on or after January 1, 2020

When you select Original Medicare for your health care coverage, you’ll be able to choose from many Medicare supplement plans available where offered. Benefits will vary, but no plan will cover the Medicare Part B calendar-year deductible ($185 in 2019).

Information provided by Mutual of Omaha.

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Medicare Insurance, MACRA Info, Medigap, Supplement Insurance Plans, Services, Costs and Quotes in East Texas

By choosing the right Medicare Supplement Insurance Plan you will have:

  • No Deductibles
  • No Co-Pays
  • No Network
  • No Referrals Necessary
  • No Complicated Claim Forms
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How to Compare Medigap Policies

Find out which insurance companies sell Medigap policies in your area.

Medigap policies are standardized

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters.
All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:

  • Don't have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plan
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Medigap Plans

Note: The Medigap policy covers coinsurance only after you've paid the deductible (unless the Medigap policy also pays the deductible).

Compare Medigap plans side-by-side

The chart below shows basic information about the different benefits Medigap policies cover.
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable

Medigap Benefits Medigap Plans
A B C D F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%***
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care coinsurance No No 100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible No 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible No No 100% No 100% No No No No No
Part B excess charges No No No No 100% 100% No No No No
Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $5,880 $2,940 N/A N/A

* Plan F also offers a high-deductible plan in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount determined by Medicaid, before your policy pays anything.  

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission. 

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The 2003 Medicare Modernization Act

Due to the 2003 Medicare Modernized Act, which went into effect in June 2010, there were some changes regarding the standardized Medicare Supplement Plans. These changes did not affect Medicare beneficiaries who are already enrolled in a Medigap Plan prior to that date, and only apply to people who enrolled effective June 1, 2010 and after.

Learn More About The 2003 Medicare Modernization Act