Medicare supplement benefit coverage.

Existing federal law provides for the Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. Existing federal law specifies different parts of Medicare that cover specific services, such as Medicare Part B, which generally covers medically necessary services and supplies and preventive services. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the issuance of Medicare supplement policies or certificates, as defined, which are advertised, marketed, or designed primarily as a supplement to reimbursements under the Medicare Program for the hospital, medical, or surgical expenses of persons eligible for the Medicare Program, including coverage of Medicare deductible, copayment, or coinsurance amounts, as specified. Existing law requires supplement benefit plans to be uniform in structure, language, designation, and format to specified standard benefit plans, including plans C, F, and high deductible F, which, among other things, cover 100% of the Medicare Part B deductible, and plans D, G, and high deductible G. Existing federal law prohibits, on or after January 1, 2020, the sale of a Medicare supplemental policy that provides coverage of the Medicare Part B deductible to a newly eligible beneficiary. This bill would, for policies or certificates sold or issued on or after January 1, 2020, to newly eligible Medicare beneficiaries, redesignate standardized Medicare supplement benefit plans C, F, and high deductible F as plans D, G, and high deductible G, respectively, for purposes of conforming state law to federal law. The bill would require standardized Medicare supplement benefit plans D, G, and high deductible G to provide the same coverage as required for plans C, F, and high deductible F, respectively, with the exception of coverage of 100%, or any portion, of the Medicare Part B deductible. The bill would prohibit the sale of standardized Medicare supplement benefit plans C, F, and high deductible F to newly eligible beneficiaries. The bill would define a newly eligible beneficiary as an individual who becomes eligible for Medicare on or after January 1, 2020, because the individual attained 65 years of age on or after January 1, 2020, or the individual became eligible for Medicare benefits on or after January 1, 2020, by reason of disability, as specified. The bill would make related conforming changes. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. This bill would declare that it is to take effect immediately as an urgency statute.