The New Health Care Law and Medigap

The law also requires most private or employer insurance plans to remove limits on how much they will pay for medical care annually and over a member's lifetime. Medigap plans have no annual or lifetime limits on the amount they pay, says Burns, who serves on a medigap committee of the National Association of Insurance Commissioners. They have only a set limit on what portion of the beneficiary's bill they cover, not how much they will spend in any time period.

The new law also prohibits insurers from discriminating against people when they get sick or if they have a preexisting health condition. Insurers selling medigap coverage already have strict rules requiring them to accept anyone who applies at these times:

• if you involuntarily lost your health insurance.
• if you apply during the open enrollment period.
• if you apply within six months of enrolling in Medicare Part B and you are 65 years old or older.
  
  

At other times, the insurer can decline to cover medical care for a preexisting health condition but only for up to six months. If you have questions about your individual situation, contact your state health insurance assistance program.

People under age 65 in Medicare have no guaranteed right to buy medigap coverage unless the state where they live requires insurers to do so. (See a list of those states.)

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.