Nebraska Regulators Fight Medicare Supplement Policy Underpricing

News March 13, 2024 at 10:21 AM
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Two Nebraska regulators say making sure that an issuer of a new Medicare supplement insurance policy sets sustainable rates is important.

In some cases, the regulators warn, newcomers to a market may set prices too low because of weak actuarial work or a desire to gain market share.

"Such underpricing will lead to rates that are not sustainable, requiring large rate increases greater than trend and aging in later years," according to a slide deck prepared by Michael Muldoon, the chief actuary at the Nebraska Department of Insurance, and Margaret Garrison, an examiner at the department.

Muldoon and Garrison will present the slide deck March 15 in Phoenix, during a Health Actuarial Task Force session at the National Association of Insurance Commissioners' spring meeting.

What it means: Unrealistically low insurance prices can hurt your clients.

Medicare supplement insurance: The original Medicare program exposes enrollees to deductibles, coinsurance bills and co-payment charges.

Some Medicare enrollees use Medicare Advantage plans to fill the holes. Others fill the holes with Medicare supplement insurance, or Medigap, policies. About 14 million people have Medigap coverage, according to the American Association for Medicare Supplement Insurance.

Medicare enrollees of any age can sign up for Medicare Advantage plans during an annual enrollment period that runs from Oct. 1 through Dec. 7 without going through medical underwriting.

Underwriting rules for Medigap policies are different. In most cases, once a consumer's open enrollment period has ended, the consumer can buy a Medigap policy without going through medical underwriting only if the consumer moves to a new state.

Pricing issues: Some insurers that entered Nebraska's Medigap market from 2017 through 2022 set prices 15% to 45% below what established players were charging, Muldoon and Garrison report.

The insurers ended up increasing rates 12% to 25% every year to cope with the initial underpricing.

Because of the way Medigap underwriting rules work, some older, unhealthy policyholders who cannot get through underwriting are trapped in Medigap policies with escalating rate increases.

Solving the problem is difficult, because any rules that let the unhealthy policyholders move to more stable, sustainably priced policies could drive up medical claims at the issuers of the stable policies and destabilize those issuers, Muldoon and Garrison note.

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