On May 28, 2013, U.S. Health and Human Services Secretary Kathleen Sebelius accepted the National Association of Insurance Commissioners’ (NAIC) recommendations against imposing “nominal” cost-sharing on Medigap Plans C and F due to the lack of evidence in peer-reviewed studies or managed care practices to support such changes.
The NAIC's Section 3210 letter notes that Medigap has served Medicare eligible consumers well for many years, offering them security and financial predictability with regard to their Medicare costs. The NAIC disagrees with accusations that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. Medigap plans pay benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot change Medicare’s coverage determination. The assertion that Medigap coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services.
NAIFA commends Reps. Lee Terry, Marsha Blackburn and Tom Latham for weighing in on the issue with a letter to colleagues titled, “Some Facts About Private Medicare and Supplemental Insurance.”