Provides that individuals enrolled in Medicare Parts A and B guaranteed right to enroll in standardized plans.
Impact
If enacted, HB 5431 is expected to enhance the availability of Medicare Supplement policies for younger Medicare recipients, particularly aligning with the provisions of federal law that govern Medicare insurance. The bill seeks to eliminate the barriers of medical underwriting, which can prevent otherwise eligible individuals from obtaining necessary coverage. This shift may positively affect healthcare access for many vulnerable individuals, potentially increasing their ability to manage healthcare costs associated with their conditions.
Summary
House Bill 5431 proposes significant changes to the Medicare Supplement Insurance landscape in Rhode Island. The bill requires that individuals enrolled in Medicare Parts A and B receive guaranteed rights to enroll in standardized Medicare Supplement Plan A. This provision particularly benefits those under the age of 65 who qualify due to disability or end-stage renal disease, ensuring they can access necessary supplemental insurance during designated enrollment periods each year. This change aims to expand access to Medicare Supplement Plans for a demographic that often struggles with insurance coverage options due to their age and health status.
Contention
Notably, the bill encourages the insurance commissioner to establish regulations that ensure the fairness and transparency of policy provisions, particularly around premium rates and benefit standards. However, there could be concerns regarding how well the insurance market can adapt to the increased demand for these supplemental plans, and whether insurers might alter their pricing structures in response to these changes. Additionally, opponents may argue that such regulations should provide protections against potential abuses in the form of increased premiums or limited benefits, highlighting the need for robust oversight mechanisms.
Provides a special enrollment period for applicants for Medicare Part B. Also prohibits state insurance carriers from denying/imposing conditions on new enrollees or discriminate on price based upon health status/claims experience/preexisting conditions.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee's overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2025.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee's overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2025.
Creates the Rhode Island Individual Market Affordability Act of 2024 to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health insurance exchanges.