Medicare Access and Chip Reauthorization Act of 2015 (MACRA) FAQs


Written by Jessica Adkins

January 8, 2020

The Medicare Access and Chip Reauthorization Act of 2015, known as MACRA, is a bipartisan bill passed in 2015 and does many things impacting healthcare.

MACRA marks a milestone in efforts to improve and reform the healthcare system and develops a coordinated framework for providers to successfully take part in the CMS Quality Payment Program with a focus on the quality and value of care delivered to beneficiaries. While there are many changes with the implementation of MACRA, one important change directly impacting insurance agents and beneficiaries involve Medicare Supplement insurance plans.

Our Compliance team has reviewed the nearly 2,400-page final rule to help guide insurance agents through the final MACRA rule from the Centers for Medicare & Medicaid Services (CMS.) Here are answers to some of the frequently asked questions we’ve received regarding MACRA.

  1. What is the Medicare Access and CHIP Reauthorization Act of 2015?
    MACRA has several components affecting healthcare. However, one is a limit on first-dollar coverage in certain Medicare supplement insurance plans for individuals considered “newly eligible” and a transition away from using Social Security numbers as the unique identifier for beneficiaries (i.e., replacement of the Medicare ID number.) It also includes a change in the way Medicare pays healthcare professionals. Currently, healthcare professionals are paid based on the number of services performed. MACRA allows healthcare professionals to be compensated based on the quality of care, as opposed to the ‘quantity’ of services performed.
  2. Who is considered newly eligible?
    “Newly eligible” is anyone who is turning 65-years old on or after January 1, 2020, or anyone who is eligible for Medicare due to age or disability as defined by the Centers for Medicare and Medicaid Services (CMS) on or after January 1, 2020.
  3. What does MACRA require?
    As of January 1, 2020, the following changes are in effect:

    MACRA prohibits first dollar Part B deductible coverage on Medicare Supplements. This means Plan C and Plan F cannot be sold to those “newly eligible” for Medicare;
    MACRA makes Plan D and Plan G the new guaranteed issue plans for those who are “newly eligible” within the guaranteed acceptance rules for Medicare Supplement plans;
    MACRA mandates that a Social Security number can no longer be used as an identifier

  4. How are enrollees in a current Plan C and/or Plan F impacted?
    Current beneficiaries enrolled in Plan C and/or Plan F will see no change and Plans C and F Medicare Supplements can still be sold after January 1, 2020, but ONLY to Medicare beneficiaries who were age 65 prior to January 1, 2020, or first became eligible for Medicare prior to January 1, 2020, regardless of what plan they had previously. For example, a beneficiary who bought Plan F (or any other plan) in 2018 can purchase any plan, including Plan C or Plan F, prior to January 1, 2020, or thereafter.

If you have any other questions, feel free to reach out to Agent Pipeline’s Compliance Department, or speak with your Regional representative by calling 800-962-4693

Sources: CMS Quality Payment Program, CMS Press Release, Executive Summary

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