[Congressional Record Volume 142, Number 124 (Wednesday, September 11, 1996)]
[Extensions of Remarks]
[Page E1583]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          KASSEBAUM-KENNEDY PORTABILITY FOR MEDIGAP INSURANCE

                                 ______
                                 

                         HON. NANCY L. JOHNSON

                             of connecticut

                    in the house of representatives

                     Wednesday, September 11, 1996

  Mrs. JOHNSON of Connecticut. Mr. Speaker, a few weeks ago, the 
Congress passed and President Clinton signed into law Federal 
guarantees that workers with health insurance cannot be denied coverage 
when changing or leaving jobs because of a preexisting condition. This 
is an important first step to improving access to health care for those 
who play by the rules and pay their premiums.
  We owe the same guarantees to our senior and disabled constituents, 
and so today we are introducing a targeted portability bill for Medigap 
insurance.
  People on Medicare who have a Medigap plan, or are in an HMO or 
Medicare Select plan should be able to purchase the same level of 
coverage without regard to a preexisting condition when they move out 
of the service area or if the insurer goes out of business.
  Seniors and the disabled who want to try a managed care plan or a 
Medicare Select policy should have the peace of mind that they can 
return to their Medigap plan if they change their mind during the first 
year of their enrollment and have not tried these choices before.
  As employers grapple with rising health care costs, their valued 
retirees should not be left out in the cold if their health plan 
coverage is terminated.
  And very importantly, disabled individuals around the country should 
have the access to all Medigap choices that Medicare enrollees who are 
fortunate enough to live in Connecticut have, where we were smart 
enough to guarantee this access.
  Proposals have been made to do more--just as have been made for 
health insurance reform.
  My colleagues in the House and Senate who join me today in this 
initiative began this process with me last year when Senator Chafee and 
I helped make available nation-wide the Medicare Select option which 
helps seniors save money on their Medigap insurance by using a network 
of participating providers. During that debate, worthwhile proposals to 
improve Medigap equity were made, and I am pleased that this bill moves 
this debate forward.
  Like Kassebaum-Kennedy, our Medigap portability proposal is a first 
step to create fairness for people on Medicare who play by the rules to 
cover the costs Medicare does not.

                               H.R. 4047


                       medigap amendments of 1996

       Insurers must guarantee issue Medigap insurance--with no 
     preexisting condition limitations--to Medicare beneficiaries 
     provided:
       They have had continuous coverage (no break in coverage 
     longer than 2 months/63 days); and
       The policy in which they wish to enroll has a comparable or 
     less generous benefits package.
       This portability protection would apply to the following 
     Medicare beneficiaries:
       Individuals enrolled in a Medicare HMMO or Medicare Select 
     plan and who move outside the plan service area, or if the 
     plan goes out of business or withdraws from the market;
       Individuals with Medigap policies who move to a state where 
     their carrier is not licensed to do business, or whose 
     carrier withdraws from the market;
       Individuals with retiree health plans providing benefits 
     supplemental to Medicare and whose employer terminates or 
     substantially reduces plan benefits; and
       Individuals enrolled in a Medicare HMO or Medicare Select 
     plan who, during their first 12 months of enrollment in 
     either plan type, choose to return to Medicare fee-for-
     service. In these situations, the following may apply:
       Medicare beneficiaries will have a one-time option to try 
     both a Medicare HMO and a Medicare Select plan.
       Individuals electing HMO or Select coverage when first 
     eligible for full Medicare benefits have up to 12 months to 
     change their minds. During the first 6 months of their 
     Medicare eligibility, they retain their current law ability 
     to enroll in any Medigap plan without regard to preexisting 
     conditions. Between 7 and 12 months, they will be able to 
     obtain coverage comparable to the benefits offered by the 
     plan in which they have been enrolled.
       Individuals with coverage from a Medicare HMO or retiree 
     health plan often have supplemental benefits which do not 
     neatly fit one of the standard Medigap ``A through J'' policy 
     definitions. In these cases, the state insurance commissioner 
     will evaluate the plan to determine the most equivalent 
     Medigap policy into which the individual could transfer.
       Insurers may impose no preexisting condition limitation 
     during the initial six-month enrollment period after a 
     beneficiary first becomes eligible for Medicare.
       All Medigap plan choices will be guaranteed for the 
     Medicare disabled. Anyone will be able to enroll in a Medigap 
     plan of their choosing without discrimination during the 
     first six months of their eligibility for Medicare benefits, 
     regardless of age. Current Medicare disabled beneficiaries 
     will have a one-time open enrollment period to guarantee 
     their access to all Medigap plan options.
       Private organizations will be able to prepare consumer 
     education and information materials through HHS grants funded 
     by an assessment on Medigap insurers and managed care 
     organizations. Information would be made available to 
     Medicare beneficiaries and their families about the Medicare 
     HMOs, Medicare Select policies, and Medigap insurance offered 
     in their areas. Materials would include a comparison of 
     benefits, cost, quality, and performance and the results of 
     consumer satisfaction surveys of each plan.
     
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