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Almost half a million veterans gained health care coverage during the first two years of the Affordable Care Act, a report finds.

In the years leading up to the implementation of the ACA’s major coverage provisions, from 2010 to 2013, nearly 1 million of the nation’s approximately 22 million veterans didn’t have health insurance. Almost half of all veterans are enrolled in the VA health system; others get health care through employers or Medicare. But some don’t quality for those options, and others don’t know that they have them.

Two years after the ACA’s implementation, 429,000 veterans under the age of 65 gained coverage, which is a 40 percent drop in vets without insurance from 2013 to 2015. The vets were covered for the most part through Medicaid expansion, privately purchased plans and marketplace coverage, according to the report.

The number of insured veterans rose across demographics like age, gender, race and education level. “The gains in coverage were really broad,” says Jennifer Haley, a research associate at the Urban Institute, a research group based in Washington, D.C., who was an author on the report.

Veterans with the lowest incomes saw the greatest increase in coverage, especially in states that adopted Medicaid expansion. Vets with incomes up to 138 percent of the federal poverty level, or $16,394 a year for an individual, became eligible for Medicaid in expansion states, the report notes.

In 2015, just 4.8 percent of veterans were uninsured in states that participated in Medicaid expansion, compared to 7.1 percent in states that did not.

One in 5 uninsured vets live in states that did not expand Medicaid and would have been eligible for coverage had their state chosen to expand the program, the report found. Haley says these are key data points when considering changes to policy.

“If states would adopt the expansion, more vets would qualify for publicly supported coverage,” she says. Currently, 31 states and the District of Columbia have expanded Medicaid programs, including California, New York, Pennsylvania and Illinois. Another 19 states, including Florida and Texas, have not expanded access to the program.

Veterans weren’t the only ones to benefit from expanded insurance access. Their family members had access to more coverage, too, and by a similar margin.

The overall rate of uninsurance among relatives sank from 9.2 percent in 2013 to 4.5 percent in 2015. For children, the rates fell from 4.5 to 2.9 percent. Overall, 730,000 fewer vets and their family members were lacking health insurance from 2013 to 2015.

The report, published by the Urban Institute, used data from the American Community Survey, which is performed annually by the U.S. Census Bureau. It surveys around 100,000 veterans and 100,000 family members of veterans. The report also considered data from the National Health Interview Survey which is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

A repeal of the ACA or a rollback of Medicaid could negate these coverage increases and leave more vets without health insurance coverage, the authors note in their report. The VA health system continues to struggle with delays in delivery of services to veterans.

On Wednesday, President Donald Trump signed a law extending the Veterans Choice program, which allows some vets get health care from private providers paid for by the VA and was created to help improve access to timely care.

The $10 billion program has been riddled with problems, as Montana Public Radio’s Eric Whitney reports, including long waits, a confusing, complicated system and delayed payments to providers.

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The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation’s hospitals that put patients’ health and safety at risk, under a groundbreaking proposal from federal health officials.

The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.

There’s increasing concern among regulators that private accreditors aren’t picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.

In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity “raises serious concerns regarding the [accrediting organizations’] ability to appropriately identify and cite health and safety deficiencies” during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.

The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.

Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.

But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS’ proposed rules are designed to fix this.

“We believe it is important to continue to lead the effort to make information regarding a health care facility’s compliance with health and safety requirements” publicly available, CMS officials wrote.

“It’s huge, absolutely,” says Rosemary Gibson, a patient safety expert who wrote a book, Wall of Silence, about medical errors. “Right now the public has very little information about the places where they’re putting their life on the line, and that’s just not acceptable. If you’re a good place, what are they afraid of?”

Medical errors are a leading cause of death and injuries in U.S. hospitals. A 1999 report by the Institute of Medicine estimated that up to 98,000 people a year die because of mistakes in hospitals; subsequent reports have said the number is much higher.

To qualify for federal funding, health facilities have to meet minimum requirements, known as Medicare conditions of participation. If a health facility has problems and doesn’t fix them, it stands to lose its Medicare funding. Though this rarely happens, it can be crippling for an institution and could force it to close.

State health departments get funding from CMS to inspect facilities to ensure they comply with these requirements. But the law also allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight. The Joint Commission conducts unannounced inspections at hospitals at least once every 39 months, and more often if complaints arise.

Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,018 hospitals listed on the The Joint Commission’s website, more than 99 percent have full accreditation and only seven are on track to lose their “gold seal of approval.”

The Joint Commission said it is reviewing the CMS proposal and couldn’t comment further. A smaller competitor, the Healthcare Facilities Accreditation Program, said it supports the goal of transparency but is studying what the change would mean in practice, both in terms of staffing and costs. “We haven’t talked to our hospital partners,” says Gary Ley, its executive director. “It would be a major change for them also. It’s hard not to support the goals but we have to look at the execution.”

For its part, the American Hospital Association said it supports providing the public “useful information” about hospital quality, but has doubts that detailed inspection reports fit that description.

“It’s important that the information shared with consumers has a clear purpose, is transparent and is readily understood by folks from all walks of life, not just those with deep expertise in health care,” says Nancy Foster, AHA’s vice president of quality and patient safety, in a statement. “We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public.”

Foster says it might be more useful to provide a one- or two-page “accurate summary” of inspection findings, with “key takeaways” and why they are important. “This summary could also draw from the plan of correction the hospital creates and summarize how the hospital plans to address the findings,” Foster says.

For years, accreditors have been accused of putting the interests of the facilities that pay them ahead of patient safety. In 2002, the Chicago Tribune reported how The Joint Commission gave its seal of approval to “medical centers riddled by life-threatening problems and underreporting of patient deaths due to infections and hospital errors.”

Last week, BuzzFeed News reported how an Oklahoma psychiatric hospital was named a “Top Performer in Key Quality Measures” by The Joint Commission even though police records, state inspection reports and lawsuit records showed that it “is a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as 5 are separated from their parents and held in dangerous situations, and where wards lack adequate staffing and staff lack adequate training.”

In a response to BuzzFeed, the company that runs the hospital, Universal Health Services, said it “is proud of the care it provides patients at Shadow Mountain Behavioral Health.”

On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information of what went wrong, even when hospitals are described as receiving a “preliminary denial of accreditation.” For one hospital, the explanation is: “Existence at time of survey of a condition, which in The Joint Commission’s view, poses a threat to patients or other individuals served.” The threat itself is not disclosed.

Consumers Union’s Safe Patient Project and other patient safety organizations have been pushing for years for more information about hospital inspections. Lisa McGiffert, who directs the Safe Patient Project, hopes this may be the opportunity for change. “The information that’s available now is so minimal and would not really inform anyone about real quality of a hospital,” she says.

Comments on the proposal may be submitted from April 28 to June 13 through the CMS website.

Disclosure: Ornstein was previously president of the Association of Health Care Journalists. While he served in that position, AHCJ called for The Joint Commission to make its inspection reports public. The Joint Commission declined to do so. Have you complained about a hospital to The Joint Commission or another accrediting body? We’d like to hear from you. Email Charles.ornstein@propublica.org. ProPublica is an independent nonprofit newsroom based in New York.

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Hannah Berkowitz is 20 years old. When she was a senior in high school her life flew off the rails.

She was getting high on whatever drugs she could get her hands on. She was suicidal. Berkowitz moved into a therapeutic boarding school to get sober, but could only stay sober while she was on campus during the week.

“I’d come home and try to stay sober really hard — really, really hard,” says Berkowitz. “Sometimes I’d make it through the weekend, and sometimes I just couldn’t make it. It was white-knuckling it, just holding on.”

The transition back home always triggered a relapse for Berkowitz.

“I thought it was just my fault and there was no hope,” she says.

No hope — but Berkowitz did have luck. She had private health insurance and she lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah was struggling to stay sober: her home.

A chronic disease approach

Treating addiction is a growing business, but a lot of the treatment that’s available is expensive and patients often relapse. Fortunately, there is a way to help some people pay less for better results, says Matt Eacott, vice president of Aware Recovery Care.

“Ninety-nine percent of the industry really treats addiction as an acute problem — like a rash on your arm that you rub lotion on and you’re done,” says Eacott.

Instead, Aware treats addiction as a chronic illness — it doesn’t disappear just because symptoms are temporarily under control. The approach is a cost-effective way of treating addiction, Eacott says, with better results than most competitors achieve.

Aware comes into clients’ homes and connects them with a nurse, a primary care doctor, a therapist, peer support, 12-step meetings and a case manager. Clients hooked on opioids can get medication-assisted treatment. They can also submit to urine screening and GPS tracking, if that helps them stick with the program.

Hannah’s mother, Lois Berkowitz, says the program is intense at first. But as Hannah built coping skills the supports faded into the background.

“It’s not like they’re doing the work for the addict,” says Lois Berkowitz, “they’re just basically taking them by the hand and saying, ‘Here are the places you need to go that will help you. And I’m going to go with you to start, so it doesn’t feel that uncomfortable. And then we’re going to let you fly.’ “

Before they “fly,” Aware clients have a pretty long runway. The treatment lasts for a full year.

Benefits worth the initial cost, insurer says

Aware has now expanded from its base in Connecticut into New Hampshire. The program is expensive. It costs $38,000 a year. As of now, it’s only available to private-pay clients and people insured through Anthem health insurance in New Hampshire and Connecticut.

Anthem became the first insurer to pay Aware, because the treatment is based on hard science that’s yielding solid results for clients, says Dr. Steven Korn, Anthem’s behavioral health medical director. Science and results are rare in addiction treatment, he says.

“There are old, old notions that have hung pretty tough,” says Korn. “When I was young — when I was in training — as soon as substance abuse was mentioned, the response of physicians was, ‘Well, go to AA. That’s not our problem. We don’t treat that.’ “

For a year of treatment, Anthem says it’s paying Aware about the same as the cost of a month or two of inpatient treatment. Anthem also says 72 percent of Aware clients are either sober at the end of one year or still in active treatment.

That’s about twice the sobriety rate of people who check in to a facility for a month and then get no follow-up care, says Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.

Treating addiction at home makes sense because it’s the exact place where people learned all their bad habits, Gitlow says.

“It’s all based on this concept that addiction is not about the substance use,” he says, “but is about what led to the substance use in the first place. And you can’t really get there without getting to know the patient.”

Aware says it’s in negotiations with four more major insurers. The program hopes to have a couple hundred clients in New Hampshire by the end of the year.

This story is part of NPR’s reporting partnership with New Hampshire Public Radio and Kaiser Health News.

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For most of his life, Carl Goulden had near perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembers feeling, “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”

Wanda, chimes in: “Yellow eyes, gray-like skin.” His liver wasn’t working, she explains. “It wasn’t filtering.”

Carl was diagnosed with hepatitis B. Now 65 and on Medicare, he had a flower shop in Littlestown, Pa., back then, so had been buying health insurance for his family on the market for small businesses and the self-employed.

The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the further costs could be formidable. Thank goodness they had health insurance, the couple thought.

But then, Carl says, “the insurance renewals went way up.”

After a few years he could no longer afford to buy the coverage — more than $1,000 a month — and also maintain his business. So he dropped the health insurance.

“I was devastated,” he says, “because I didn’t know when my liver might fail.”

But that steep increase in his insurance rate was completely legal, says Pennsylvania insurance commissioner, Teresa Miller. And back then, before the Affordable Care Act became law, a patient like Carl Goulden might have had a very hard time buying another policy; he likely would have been turned down by other insurers because he now had what’s called a “pre-existing” medical condition.

A family like the Gouldens would “just have been out of luck,” Miller says.

Pennsylvania: The wild, wild West

Before the ACA, states had differing approaches to handling pre-existing conditions.

Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance was the wild, wild West.

Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them a lot more, even those whose chronic condition wasn’t all that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your pre-existing condition,” Miller says.

Insurers who did offer a policy to someone with a pre-existing medical condition might have done so with a catch — the plan could require a waiting period, or might exclude treatment for that condition.

“So, let’s say you had diabetes, for example,” Miller says. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”

From the perspective of the insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.

Pennsylvania did try to partially solve this problem. It created a more scaled-back health plan, called Adult Basic, for those with lower incomes who didn’t have any coverage. Lots of people signed up, but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller says, the strategy proved too expensive for the state.

“That program was spending $13 million to $14 million a month when it was shut down,” she says.

High-risk pools

More than 30 other states dealt with pre-existing conditions by setting up what are called “high-risk pools,” a separate insurance plan for individuals who couldn’t get health coverage in the private market.

These plans could be real lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.

The experiences with high risk pools varied, but states faced lots of challenges, says John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.

“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko says. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”

The pools also had catches; premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of pre-existing conditions for six months to a year after the patient bought the policy.

New Jersey: Pre-existing conditions were covered, but with a catch

Around that same time, across the Delaware River, the state of New Jersey was trying something different.

“Insurers could not take health status into account,” says Joel Cantor, director of Rutgers University’s Center for State Health Policy who has been analyzing the New Jersey experience.

Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with pre-existing conditions. Insurers also weren’t allowed to charge people a whole lot more for having a health issue, and the plans had to offer robust coverage of services.

There was a one-year waiting period for coverage of a pre-existing condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor says. Because there was no mandate to have health insurance coverage, those who signed up tended to really need it, and healthy people did not enroll.

And so, “the prices went up and up,” he says. And the premiums and enrollment “went down and down.”

The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor says.

“By that I mean very few benefits,” he explains. “It covered very, very limited services.”

The plan was affordable and really popular, especially among young and healthy people and about 100,000 people signed up. But if something did happen, or if a person had a chronic health need, lots of the costs shifted to the individual.

“It left people with huge financial exposure,” he says.

That’s, in part, why the ACA included a rule that insurance plans now have to offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.

Cantor says these experiences point to an ongoing dilemma in health care: A small portion of people consume a big chunk of health care costs. It’s hard to predict who among us will cost a lot — or when. So, the question becomes, what kind of care should insurance plans cover and who should shoulder that cost?

This story is part of a reporting partnership with NPR, WHYY’s health show The Pulse and Kaiser Health News.

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Repeal and replace is on-again, off-again, but that doesn’t mean the rules affecting your insurance will stay the same in the meantime.

The Trump administration late Thursday issued a final rule aimed at stabilizing the existinghealth law’s insurance marketplace that could have rapid, dramatic effects — perhaps as soon as early summer — on people who do not get insurance through work, and buy it on the Affordable Care Act’s exchanges instead.

The final rule upholds much of what was proposed by the administration in February, including a shorter enrollment window, tighter vetting of people who sign up outside of those open periods and efforts to require some consumers to show proof of prior insurance coverage.

The controversial proposal by the Department of Health and Human Services drew letters from nearly 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. In their comments, consumer advocacy groups decried the proposal, saying it would wreak havoc by making it harder to get coverage. Insurers were generally supportive.

But some specialists in the health law, including Christopher Condeluci of CC Law & Policy in Washington, D.C., saw the initial proposal released in February by HHS as helpful for insurers, though he also thought more adjustments were necessary.

“Does it meet all the carriers’ asks when it comes to what changes are needed? No, I don’t think it goes far enough,” said Condeluci, a former staffer to the Senate Finance Committee who specialized in insurance issues.

Sabrina Corlette, an attorney who studies the individual marketplace for the Center on Health Insurance Reforms at Georgetown University, said the directive could result in fewer healthy enrollees — which insurers also would not like — and doesn’t address some of the biggest concerns for the insurance industry, such as the fate of federal subsidies that help low-income consumers pay deductibles and other out-of-pocket costs.

The Trump administration’s proposal, Corlette said, is “nibbling away at the margins.”

She could not be reached late Thursday for comment on the final version.

Here are four ways the stabilization rule might change the individual health insurance market:

If you owe, you pay first

The final rule, to be published in the Federal Register next week, saysconsumers who want to sign up for an ACA plan with their same insurer for 2018 would have to repay past-due premiums from the previous 12 months before being granted new coverage. Because Obamacare has allowed a three-month grace period before people who haven’t paid premiums are kicked out of coverage, a consumer’s overdue premiums could tally hundreds of dollars — even more than $1,000.

The proposed change aims to discourage people from gaming the system. Insurers say a person with a bad knee, for example, might enroll and pay just long enough to get an expensive knee replacement, then stop paying premiums.

But wait, consumer groups and the National Association of Insurance Commissioners warned in their comment letters: There might be legitimate reasons people stop paying premiums — billing errors that are not the fault of the consumer, for example, or the loss of a job. By making such a change, the groups argue, the Trump administration violates a key part of the health law that requires insurers to offer coverage to just about everyone who applies.

“Only those who can rapidly come up with a possibly significant sum of money by a given deadline can be guaranteed access to coverage,” wrote Families USA.

Better act quickly

Open enrollment this fall (for 2018 health insurance coverage) would shorten to six weeks, down from three months. While opening day would remain the same — Nov. 1 — the final rule closes the marketplace on Dec. 15 instead of at the end of January. That period “provides sufficient time for consumers to enroll,” the administration has said, and would mean all who sign up would have a full year of coverage starting Jan. 1.

The shorter time period, the administration said, could also reduce the number of people who wait to enroll until after they find out they have a health problem. These late joiners are likely to use more health care than a healthy person their age, insurers and the Trump administration say, and can drive up the cost of insurance to everyone.

Consumer groups argue the Trump plan could backfire, because those who tend to wait until the last minute to sign up are actually often the youngest and healthiest — and they may miss the enrollment window if it is shorter. Additionally, the deadline falls around the holidays, when money and time are often tight, which could have a chilling effect on insurance sign-ups.

Prove you have a reason — and maybe prior coverage

The ACA allows people to sign up outside the open enrollment period for a variety of special reasons, such as moving, losing coverage, getting married or having a child. This provision has always been a sticking point with insurers, who have maintained that too many customers who made a change during the special enrollment period were sicker and costlier than average. In response, the Obama administration tightened some of these requirements last year and announced it would run a pilot program starting this summer to randomly select half of all special enrollment applicants for verification review, holding up the applicant’s insurance coverage until they provide the proper documentation.

Under the new rule, 100 percent of those applications would be required to undergo preapproval verification — beginning in June 2017. Consumers will have to provide documentation proving they qualify for special enrollment before getting coverage. The rule also says that for marriage, at least one member of the couple would have to prove they had health coverage for at least one day in the two months before their nuptials.

Consumer groups are unhappy with the pre-verification idea — and the extra requirement of prior coverage for people who have gotten married. Particularly hard-hit would be couples who were uninsured previously because they could not afford health insurance as singles or could not get it under their state’s Medicaid rules. Additionally, consumer advocates and some regulators say requiring newlyweds to prove prior coverage violates the health law.

Flexibility — or higher deductibles?

The health law uses a complex formula to divide plans into metallic tiers — bronze, silver, gold and platinum — based on an average percentage of a typical year’s health care bills that each level of plan covers. Bronze plans, for example, currently must cover an average of 60 percent of costs, while a silver one is 70 percent. Insurers are allowed wiggle room of plus or minus 2 percent around those averages.

The Trump rule tweaks the formula, allowing insurers to create plans with larger variations around the average. (It exempts certain silver plans for low-income consumers from the change.) So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent. Insurers say this would allow them to create plans that appeal to more customers, particularly those looking for lower premiums. But critics say the move would increase the size of deductibles.

One big problem in boosting enrollment has been that many potential consumers — particularly younger, healthier ones — say premiums are too high. But adjusting the law in this way could raise deductibles and other cost-sharing requirements, which consumers may dislike even more. While the health law sets a maximum cap per year on such payments, for many people those deductibles are already thousands of dollars annually. Under the proposal, deductibles could increase by more than $1,000 a year, according to an analysis by the consumer advocacy group Families USA.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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As members of Congress debate the future of the health law and its implications for consumers, how are they personally affected by the outcome? And how will the law that phases out the popular Medigap Plan F – popular supplemental Medicare insurance — affect beneficiaries? We’ve got answers to these and other recent questions from readers.

What type of insurance do our elected representatives in Washington, D.C., have? Is it true that they’re insured on the ACA exchanges now and that any repeal and replacement will affect them too?

Under the Affordable Care Act, members of the U.S. House of Representatives, the Senate and their office staffs who want employer coverage generally have to buy it on the health insurance exchange. Before the ACA passed in 2010, they were eligible to be covered under the Federal Employees Health Benefits Program. (People working for congressional committees who are not on a member’s office staff may still be covered under FEHBP.)

The members of Congress and their staffs choose from among 57 gold plans from four insurers sold on the DC Health Link’s small business marketplace this year.

Approximately 11,000 are enrolled, according to Adam Hudson, a spokesperson for the exchange. The government pays about three-quarters of the cost of the premium, and workers pay the rest. They aren’t eligible for federal tax credits that reduce the size of insurance premiums.

For some other members of Congress, declining exchange coverage was a political statement.

“There are several who, because of animus to Obamacare, rejected the offer of coverage, and either buy on their own or get it through a spouse,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

Proposed bills to replace the ACA don’t affect this provision of the law, said Timothy Jost, a professor emeritus of law at Washington and Lee University School of Law in Lexington, Va., who has written widely on the regulation of health care and its reform.

I am told by our insurance broker that in 2020 Medicare is eliminating Medigap Plan F. Having to switch to a new plan may be difficult for many seniors whose health has deteriorated. Should seniors act early, if needed, to switch Medigap plans while they still have good health?

You needn’t worry. As long as you continue to pay your Medigap Plan F premium you won’t lose that coverage.

“This guy can hang onto his F plan forever,” said Bonnie Burns, a training and policy specialist at California Health Advocates, a Medicare advocacy and education group.”All Medigaps are guaranteed renewable as long as the premiums are paid,” she said.

There are 10 standard Medigap plans, sold by a variety of private insurers, that pay for expenses that Medicare doesn’t include. These supplemental plans are identified by letter from A through N. They cover – to varying degrees — beneficiaries’ out-of-pocket Medicare costs, including deductibles and coinsurance. All the plans with the same letter offer the same basic benefit.

When seniors first enroll in Medicare, insurers must sell them a Medigap plan without taking their health into account. But if those who are eligible wait, or want to switch plans later, they can be turned down.

Medigap plans F and C cover all the Medicare costs that the program doesn’t pay for, including the deductible for Medicare Part B (which covers outpatient care, such as doctor visits). Generally, that Part B deductible in 2017 is $183. Plans F and C are the only two Medigap plans that cover it.

As part of the 2015 Medicare Access and CHIP Reauthorization Act, Congress decided that, starting in 2020, newly eligible Medicare beneficiaries will no longer be allowed to buy plans that pay the deductibles for Medicare Part B.

“Congress decided that people should have more ‘skin in the game,'” said Burns, referring to the idea that patients will make more prudent health care decisions if they’re on the hook for at least part of the cost.

But the change doesn’t affect anyone who is enrolled in those plans before 2020 or who will be eligible for Medicare by then even if they aren’t yet using it.

And even though Plans C and F will no longer be available to new beneficiaries, Medigap plans D and G will be good substitutes. They provide similarly comprehensive coverage — except for the Part B deductible.

Can my spouse continue to cover me under her health insurance after we are divorced?

Once you’re divorced, it’s unlikely you’ll be able to remain covered as a dependent on your ex-wife’s plan, said J.D. Piro, who leads the health and law group at benefits consultant Aon Hewitt. A few states may allow it, and that could work in your favor if the plan is subject to state law. But many large employers pay their employees’ claims directly rather than buy insurance, and they’re generally not subject to state insurance rules.

However, you may be able to keep your ex-wife’s coverage for up to three years under the federal law known as COBRA. That law applies to companies with 20 or more workers, and several states have similar laws that apply to smaller companies. The catch: You’ll have to pay the insurance policy’s full premium.

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. Email questions for future columns: KHNHelp@KFF.org. Michelle Andrews is on Twitter: @mandrews110

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