On January 10, 2014, the federal Department of Health and Human Services (HHS) issued a bulletin indicating that individuals in high risk pools who were on Medicare due to disability could seek health insurance coverage in or outside of the health insurance marketplace. Companies that issued said coverage would not be penalized pursuant to the Social Security Act’s Anti-Duplication provision, specifically section 1882(d)(3)(A), for two years. HHS further indicated they would not enforce the anti-duplication law for that time period. The bulletin also indicated that health insurers had the option to permit coverage of these individuals and that the policies were not guaranteed issue policies. A copy of that bulletin can be found on the CMS website at: www.cms.gov/Medicare/Health-Plans/Medigap/Downloads/Sale-ofIndividual-M…
The bulletin indicated, for the purpose of these individuals, that the applicable state high risk pool was considered to be a pool that was closed or closing. The Department of Insurance received clarification from the federal government that this bulletin is also applicable to members of the Nebraska Comprehensive Health Insurance Pool (NECHIP) even though NECHIP is still statutorily open.
With this interpretation by HHS, the Department is hereby informing health insurers that the affected NECHIP population who has Medicare due to disability may seek coverage in health plans offered in the State of Nebraska, but it is up to the insurer to decide whether or not it wishes to accept these individuals into a health plan.
Questions concerning this notice may be directed to Martin Swanson, Health Policy Counsel, at martin.swanson@nebraska.gov.
