The Democratic chair of the House Ways and Means Committee is looking for ideas to expand long-term care through Medicare supplemental plans.
Rep. Richard Neal (D-Mass.) on Monday asked the head of the National Association of Insurance Commissioners for specific ideas about how Congress could design a long-term care benefit for supplemental Medicare plans known as Medigap.
"Offering a front-end LTSS benefit to seniors through a Medigap plan, even if limited to a modest lifetime cap, could provide some relief to family caregivers and might delay or prevent many seniors from spending down their savings to access Medicaid LTSS," Neal said in a letter to NAIC President Eric Cioppa.
The committee wants Cioppa's input before potentially calling a hearing, according to an aide. The association works with insurance commissioners across the country. The design of Medigap plans, as well as their enrollment numbers, vary dramatically from state to state.
In his letter, Neal noted that some states have used Medigap for long-term care coverage, and asked Cioppa to give specifics for how a federal policy could work without causing adverse selection. He is seeking recommendations on lifetime and daily caps for Medigap enrollees, waiting periods, and other ways to keep the plans affordable while also guaranteeing robust coverage.
Neal also requested insights on setting eligibility for a long-term care benefit, the design of the benefit, and enrollment forecasts.
Talk of long-term care coverage and Medicare has been buzzing this year in Congress. Even the Medicare for All plan from Sen. Bernie Sanders (I-Vt.) included long-term care when he reintroduced his legislation in March.
Last month, Washington Gov. Jay Inslee, a Democrat, signed a law to help subsidize long-term care. The program is slated to start in 2025 and adds a payroll tax to fund a per-person benefit for those who pay into it. The benefit has a lifetime cap of $36,500 per person.
Nationally about one-quarter of people in Medicare purchase Medigap, according to the Kaiser Family Foundation. But only four states require either continuous coverage or guaranteed issue for people in traditional Medicare. Medigap plans in other states can technically deny applicants who have chronic disease or pre-existing conditions.
Federal law only secures guaranteed issue for the first six months of enrollment in Medicare Part B and other circumstances, during which Medigap plans can't deny a policy to applicants.