Bill would raise Medigap rate‑review trigger to 10% and remove independent actuarial review

The Vermont House Committee on Health Care on May 20 reviewed proposed changes to state law governing Medicare supplement (Medigap) rate review that would raise the threshold that triggers extra review from 3% to 10%, eliminate a separate independent actuarial review coordinated by the Department of Disabilities, Aging, and Independent Living (DAIL), and require the Department of Financial Regulation (DFR) to post detailed rate‑filing information online and solicit public comment.

Jen Harvey, legislative counsel, told the committee the proposal would streamline a process that currently creates a separate DAIL‑led independent actuarial analysis when a carrier with at least 5,000 Vermont lives requests a composite average rate increase above a statutory threshold. “So that is what is being proposed to go away, that whole additional process,” Harvey said, explaining the draft moves the threshold from 3% to 10% and adds online posting and public‑comment requirements.

The draft would keep the 5,000 covered‑lives trigger and the DFR review but remove the additional third actuarial review that DAIL previously coordinated. Under the bill language discussed, within five business days of receiving any request to increase Medicare supplement premiums, DFR must post the insurer name, the requested composite average increase, increases by plan type, the proposed effective date, the SERFF tracking number, a link to the filing, and instructions and a deadline for public comment. For filings that request a composite average increase exceeding 10% and affect 5,000 or more Vermont lives, DFR would solicit public comment and must hold a public hearing if requested by DAIL, the Office of the Health Care Advocate (OHA), or at least 25 policyholders; the commissioner may hold a hearing in other cases at their discretion and may conduct hearings remotely.

Mike Fisher, chief of the Office of the Health Care Advocate, said his office had reviewed the draft and supported the change. “This is old statute and doesn't make a lot of sense today,” Fisher said, adding that while the posting may not reach every Vermonter, it will reach the subset of consumers who follow rate filings and contact OHA. Fisher also emphasized larger drivers of rate changes: “It's the cost of care.”

Sarah (last name not provided), a representative of Blue Cross and Blue Shield of Vermont, told the committee the carrier had supported the language because rate filings under the current process are often not final by the time consumers shop during open enrollment. “The process is too complicated. It takes too long, and the rates are not available for consumers when they're going to make the purchase,” she said.

Mary Black, representing the Department of Financial Regulation, said DFR supports the change, described operational steps the agency already takes to post filings and run hearings, and said the department will make the website posting more findable on its consumer services page. Black said the bill intends that for plans with a Jan. 1 effective date insurers must file no later than July 1 of the preceding year to give consumers timely information; the remainder of the underlying Commerce bill currently in the House Commerce Committee has a July 1 effective date while these Medicare supplement provisions would take effect Jan. 1.

Committee members and staff asked how the public would learn about filings beyond website postings; DFR and OHA said they coordinate with State Health Insurance Assistance Programs (SHIPs) such as Senior Solutions and with consumer groups and that consumers can submit written comments to trigger hearings or be counted among 25 policyholders requesting a hearing. Committee members also asked whether DFR has the capacity to post and manage hearings; DFR said it already conducts hearings and will prepare to manage additional public comment and remote hearing logistics.

After discussion, the committee took a straw poll to “report back” to the House Commerce Committee on the vehicle carrying the amendments; the chair recorded the tally as 9 yes, 0 no, 2 absent (straw poll). The draft remains subject to further action in Commerce and to any changes made before final passage.

The changes under discussion would remove the DAIL‑coordinated independent expert actuarial review and replace it with expanded transparency and a public‑comment/hearing pathway for significant filings. Supporters said the aim is to make final rates available to consumers during open enrollment; questions from the committee focused on consumer notice and the logistics of public engagement.