CHA Supports Medi-Cal Expansion and Simplification of Eligibility Rules

CHA Supports Medi-Cal Expansion and Simplification of Eligibility Rules

Commissioner Scott Kipper, Chair
NAIC Senior Issues Task Force
Attn: Jane Sung, Health Policy Counsel
National Association of Insurance Commissioners
444 North Capitol Street, NW, Suite 701
Washington, D.C. 20001

Dear Commissioner Kipper:

California Health Advocates, Medicare Rights Center, and other consumer groups, have received many questions about the ACA from people who have Medicare coverage or who will soon be eligible for it.  We have jointly asked CMS for clarification on a number of issues involving the ACA, premium assistance, and entitlement, eligibility, and enrollment in Medicare.  While we wait for guidance from CMS on issues on which we sought clarification, we believe there is a particular issue that seems appropriate for the NAIC to address.

When a person is enrolled in an individual Qualified Health Plan (QHP) and subsequently becomes eligible for Medicare at age 65 there is no requirement that a plan advise them of their impending eligibility.  Since the age of eligibility for Social Security retirement benefits is no longer tied to the age of eligibility for Medicare, an individual might stay in a QHP and unwittingly use up their Initial Enrollment Period (IEP) and even incur a late enrollment penalty for Medicare later.

We think that states could require health plans to advise an insured of their impending eligibility for Medicare prior to an insured’s 65th birthday, since that is information a health plan would have and is one basis for the premiums a person pays.   We think this could be a simple but prominent notice at six months prior to age 65 and again at three months prior.  CMS has made it clear that it is illegal to sell someone who is eligible for Medicare a QHP, but the agency has not commented on a situation where someone stays in a QHP after they are eligible for Medicare.

We are not certain which NAIC Model if any would need to be amended but we request that the Senior Issues Task Force consider a requirement that health plans must notify their insured’s of their potential eligibility for Medicare, specify the timing of a notice, and the content of such a notice.  If the SITF is not the appropriate body to consider our request, we ask that you refer it to the appropriate committee for their consideration.



Bonnie Burns, Training and Policy Specialist Consultant, California Health Advocates
Phone: (831) 438-6677, Email:

David A. Lipschutz, Policy Attorney, Center for Medicare Advocacy, Inc.
Phone: (202) 293-5760, Email:

Stacy Sanders, Federal Policy Director, Medicare Rights Center
Phone: (202) 637-0961 ext. 5, Email:

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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