CurrentKentucky Department of InsurancePolicy N/A

Advisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

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Advises health insurers writing Medicare supplement business in Kentucky on the Department's interpretation of 806 KAR 17:570 regarding guaranteed-issue Medicare supplement enrollment rights for applicants whose Medicaid eligibility changes during the Medicaid Unwinding; affects insurers, their agents, and applicants in Kentucky.

Policy Summary

PayerKentucky Department of Insurance

PolicyAdvisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

Policy CodePolicy N/A

Change TypeAdvisory interpretation (no material coverage changes)

Effective DateApr 1, 2023

Next Review DateN/A

Key ActionAccept CHFS verification of a Kentucky Medicaid eligibility change and offer guaranteed-issue enrollment with an enrollment period beginning on the CHFS notification date and continuing for 63 days.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

63 daysguaranteed-issue enrollment period after CHFS notification

6 monthsstandard initial open enrollment period

04-01-2023advisory opinion effective date

Advisory Opinion 2023-05document identifier

Guaranteed-Issue Enrollment Criteria

Guaranteed-issue enrollment criteria following Medicaid eligibility change

Covered when ALL of the following are met:

Applicant provides CHFS verification of a Kentucky Medicaid eligibility change.

Insurer treats the applicant as an 'eligible person' pursuant to 806 KAR 17:570 Section 14(2).

Insurer permits enrollment in a Medicare supplement policy with guaranteed-issue rights beginning on the date of the CHFS notification of Medicaid eligibility change and continuing for 63 days thereafter.

Insurers must not sell Medicare supplement policies to individuals currently on Medicaid as prohibited by federal law (42 U.S.C. § 1395ss(d)(3)(B)(iii)).

Licensees must notify their agents and employees of the Department's interpretation; this Advisory Opinion does not constitute legal advice.

Insurer and Agent Actions Required

Prior Authorization

Accept CHFS verification and open a 63‑day guaranteed‑issue enrollment period

Accept CHFS verification that an applicant experienced a Kentucky Medicaid eligibility change and offer guaranteed-issue enrollment in a Medicare supplement policy beginning on the CHFS notification date and continuing for 63 days.

Applicant must provide verification from CHFS of the Medicaid eligibility change.
Treat the applicant as an "eligible person" under 806 KAR 17:570 Section 14(2).
Permit enrollment with guaranteed-issue rights starting on the CHFS notification date and continuing for sixty-three (63) days.

Key Definitions

Guaranteed issue rights

DefinitionRequirement under 806 KAR 17:570 to offer Medicare supplement policies without health-status discrimination and to treat eligible applicants as entitled to enroll.

Regulatory citationReferenced in 806 KAR 17:570 Section 14(1)(b) and Section 14(2) as the basis for guaranteed-issue treatment.

ScopeApplies to applicants who exhausted initial six-month Medicare supplement open enrollment due to continued Medicaid enrollment during the PHE.

Practical effectInsurers must offer Medicare supplement policies on a guaranteed-issue basis to eligible applicants and cannot price-discriminate based on health status.

LimitationInsurers remain prohibited from selling Medicare supplement policies to individuals currently on Medicaid under federal law (42 U.S.C. § 1395ss(d)(3)(B)(iii)).

PHE Medicaid Unwinding

DefinitionThe CMS-directed process to resume regular Medicaid and CHIP eligibility reviews beginning April 1, 2023.

CHFS action during PHECHFS previously stopped disenrollments to prevent lapses in coverage during the COVID-19 PHE (approved by CMS).

Impact on beneficiariesMany beneficiaries who became Medicare-eligible during the PHE may have exhausted their six-month Medicare supplement open enrollment period.

OperationAs part of unwinding, CHFS will be required to move qualifying members into Medicare savings programs when they meet Medicare eligibility requirements.

CHFS verification

DefinitionDocumentation from the Kentucky Cabinet for Health and Family Services evidencing a Kentucky Medicaid eligibility change required from applicants seeking guaranteed-issue Medicare supplement enrollment.

UseInsurers must accept CHFS verification as proof that an applicant's Medicaid eligibility changed and start the guaranteed-issue enrollment period on the CHFS notification date.

Enrollment timing confirmed by CHFS noticeGuaranteed-issue enrollment period begins on the date of the person's Medicaid eligibility change as documented by CHFS and continues for 63 days afterwards.

Policy Summary

PayerKentucky Department of Insurance

PolicyAdvisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

Policy CodePolicy N/A

Change TypeAdvisory interpretation (no material coverage changes)

Effective DateApr 1, 2023

Next Review DateN/A

SourceLink

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CurrentKentucky Department of InsurancePolicy N/A

Advisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

Customize your policy alerts

Sign up for all Kentucky Department of Insurance policy alerts

Know when Kentucky Department of Insurance releases new policies or updates existing guidance.

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Policy Summary

PayerKentucky Department of Insurance

PolicyAdvisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

Policy CodePolicy N/A

Change TypeAdvisory interpretation (no material coverage changes)

Effective DateApr 1, 2023

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

63 daysguaranteed-issue enrollment period after CHFS notification

6 monthsstandard initial open enrollment period

04-01-2023advisory opinion effective date

Advisory Opinion 2023-05document identifier

Guaranteed-Issue Enrollment Criteria

Guaranteed-issue enrollment criteria following Medicaid eligibility change

Covered when ALL of the following are met:

Applicant provides CHFS verification of a Kentucky Medicaid eligibility change.

Insurer treats the applicant as an 'eligible person' pursuant to 806 KAR 17:570 Section 14(2).

Insurers must not sell Medicare supplement policies to individuals currently on Medicaid as prohibited by federal law (42 U.S.C. § 1395ss(d)(3)(B)(iii)).

Licensees must notify their agents and employees of the Department's interpretation; this Advisory Opinion does not constitute legal advice.

Insurer and Agent Actions Required

Prior Authorization

Accept CHFS verification and open a 63‑day guaranteed‑issue enrollment period

Applicant must provide verification from CHFS of the Medicaid eligibility change.
Treat the applicant as an "eligible person" under 806 KAR 17:570 Section 14(2).
Permit enrollment with guaranteed-issue rights starting on the CHFS notification date and continuing for sixty-three (63) days.

Key Definitions

Guaranteed issue rights

DefinitionRequirement under 806 KAR 17:570 to offer Medicare supplement policies without health-status discrimination and to treat eligible applicants as entitled to enroll.

Regulatory citationReferenced in 806 KAR 17:570 Section 14(1)(b) and Section 14(2) as the basis for guaranteed-issue treatment.

ScopeApplies to applicants who exhausted initial six-month Medicare supplement open enrollment due to continued Medicaid enrollment during the PHE.

Practical effectInsurers must offer Medicare supplement policies on a guaranteed-issue basis to eligible applicants and cannot price-discriminate based on health status.

LimitationInsurers remain prohibited from selling Medicare supplement policies to individuals currently on Medicaid under federal law (42 U.S.C. § 1395ss(d)(3)(B)(iii)).

PHE Medicaid Unwinding

DefinitionThe CMS-directed process to resume regular Medicaid and CHIP eligibility reviews beginning April 1, 2023.

CHFS action during PHECHFS previously stopped disenrollments to prevent lapses in coverage during the COVID-19 PHE (approved by CMS).

Impact on beneficiariesMany beneficiaries who became Medicare-eligible during the PHE may have exhausted their six-month Medicare supplement open enrollment period.

OperationAs part of unwinding, CHFS will be required to move qualifying members into Medicare savings programs when they meet Medicare eligibility requirements.

CHFS verification

UseInsurers must accept CHFS verification as proof that an applicant's Medicaid eligibility changed and start the guaranteed-issue enrollment period on the CHFS notification date.

Enrollment timing confirmed by CHFS noticeGuaranteed-issue enrollment period begins on the date of the person's Medicaid eligibility change as documented by CHFS and continues for 63 days afterwards.

Policy Summary

PayerKentucky Department of Insurance

PolicyAdvisory Opinion 2023-05 — Medicare Supplement Guaranteed-Issue Rights after Medicaid Unwinding

Policy CodePolicy N/A

Change TypeAdvisory interpretation (no material coverage changes)

Effective DateApr 1, 2023

Next Review DateN/A

SourceLink

On This Page