The Medicare Access & CHIP Reauthorization Act | MACRA and Medigap Policies

We’ve been monitoring the rollout of various requirements tucked inside MACRA: The Medicare Access & CHIP Reauthorization Act of 2015. In regards to Medicare marketing and sales, the most significant is the ban on Medicare Supplement/Medigap policies that offer first-dollar coverage, beginning in 2020.

What You Need To Know
In short, starting in 2020, Medigap carriers can no longer offer two of their most popular plans, types C & F, to newly eligible beneficiaries. Existing membership in these plans will be grandfathered. However, with no new membership coming into plans C & F, the basic laws of underwriting dictate that cost pressure will force higher premiums for membership that remains. From our perspective, the Medicare Advantage market will have access to millions of newly eligible beneficiaries who may have been inclined to enroll in a Medigap plan, as well as an opportunity to encourage switchers who grow dissatisfied with higher Plan C/F premiums, or the lower benefit offering in Plan G.

What You Need To Do
If you haven’t incorporated the Medigap opportunity into your 2018 AEP strategy, you’re behind. Positioning has already begun and competition will only be more fierce in 2019 and 2020. Here are a few key questions to get you started:

  • Do you have the right plans? Plan design will be a key component, as this demographic will be shopping for benefit-rich PPO plans.
  • Do you have the right message? Do you have marketing campaigns that speak directly to Medigap shoppers? Do you have a mechanism to track marketing campaign results in real-time to see if your messages resonate?
  • Are your brokers happy? The broker community will play a large role since they own most of the relationships with these prospects. Is your CRM the easiest to use? Can brokers access leads, enroll a new member easily, and get visibility on application acceptance and commissions? Brokers will not jump through hoops; they’ll work with the health plan/s that give them the most user-friendly tools.
  • Is your sales experience polished? Do you have cohesion and ease-of-access across all of your sales channels including web, retail, broker, and call center?

If you’d like to discuss in more detail, please contact us at or 1-800-760-6915.

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