This week, I answered a reader鈥檚 question about how repealing the Affordable Care Act could affect congressional lawmakers鈥� insurance, along with a few other questions that had nothing to do with the health law drama that has engulfed the U.S. Capitol in recent weeks.
Q: What type of insurance do our elected representatives in Washington, D.C., have? Is it true that they鈥檙e insured on the ACA exchanges now and that any repeal and replacement will affect them too?
Under the Affordable Care Act, members of the U.S. House of Representatives, the Senate and their office staffs who want employer coverage generally . Before the law passed in 2010, they were eligible to be covered under the Federal Employees Health Benefits Program, or FEHB. (People working for congressional committees who are not on a member鈥檚 office staff .)
The members of Congress and their staffs choose from among 57 gold plans from four insurers this year. Approximately 11,000 are enrolled, according to Adam Hudson, a spokesman for the exchange. The government pays about three-quarters of the cost of the premium, and workers pay the rest. They aren鈥檛 eligible for premium tax credits.
For some members of Congress, declining exchange coverage was a political statement.
鈥淭here are several who, because of animus to Obamacare, rejected the offer of coverage and either buy on their own or get it through a spouse,鈥� said Sabrina Corlette, a research professor at Georgetown University鈥檚 Center on Health Insurance Reforms.
Proposed bills to replace the ACA do not address this provision of the law, said Timothy Jost, an emeritus professor at Washington and Lee University School of Law in Lexington,听Va., who is an expert on the health law.
Q: I am told by our insurance broker that in 2020 Medicare is eliminating Medigap Plan F. Having to switch to a new plan may be difficult for many seniors whose health has deteriorated. Should seniors act early, if needed, to switch Medigap plans while they still have good health?
You needn鈥檛 worry. As long as you continue to pay your Medigap Plan F premium you won鈥檛听lose that coverage.
鈥淭his guy can hang onto his F plan forever,鈥� said听Bonnie Burns, a training and policy specialist at California Health Advocates, a Medicare advocacy and education group.听鈥淎ll Medigaps are guaranteed renewable as long as the premiums are paid.鈥�
There are 10 standard Medigap plans sold by a variety of private insurers that pay for expenses that Medicare doesn鈥檛听include. These .听They cover 鈥斕齮o varying degrees 鈥斕齜eneficiaries鈥� out-of-pocket Medicare costs, including deductibles and coinsurance.听All the plans with the same letter offer the same basic benefit.
When seniors first enroll in Medicare, insurers must sell them a Medigap plan without taking their health into account. But if they wait or want to switch plans later, they .
As part of the 2015 Medicare Access and CHIP Reauthorization Act, Congress decided that starting in 2020 newly eligible Medicare beneficiaries would no longer be allowed to buy plans that pay the deductibles for Medicare Part B, which covers outpatient care such as doctor visits.
Medigap plans F and C cover all the Medicare costs that the program doesn鈥檛 pay for, including the deductible for Medicare Part B (which covers outpatient care, such as doctor visits). Generally, that Part B deductible in 2017 is $183. Plans F and C are the only two Medigap plans that cover it.
But the change doesn鈥檛 affect anyone who is听enrolled in those plans before 2020听or who will be eligible for Medicare by then even if they aren鈥檛 yet using it.
鈥淐ongress decided that people should have more 鈥榮kin in the game,鈥欌�� said Burns, referring to the idea that patients will make more prudent health care decisions if they鈥檙e on the hook for at least part of the cost.
Even though plans C and F will no longer be available to new beneficiaries, Medigap plans D and G will be good substitutes. They provide similarly comprehensive coverage, except for the Part B deductible.
Q: Can my spouse continue to cover me under her health insurance after we are divorced?
Once you鈥檙e divorced, it鈥檚 unlikely you鈥檒l be able to remain covered as a dependent on your ex-wife鈥檚 plan, said J.D. Piro, who leads the health and law group at benefits consultant Aon. A few states may allow it, and that could work in your favor if the plan is subject to state law. But many large employers pay their employees鈥� claims directly rather than buy insurance, and they鈥檙e generally not subject to state insurance rules.
However, you may be able to keep your ex-wife鈥檚 coverage for up to three years under the federal law .听The law applies to companies with 20 or more workers, and several states have similar laws that apply to smaller companies. The catch: You鈥檒l have to pay the full premium.
Correction: This story was听updated April 12 to correct the Part B deductible amount in 2017. It is $183, not $134.
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