Members of the Joint Select Committee on Deficit Reduction – the 12-member "Super Committee" that is supposed to find $1.2 trillion in deficit reductions by Thanksgiving – have been talking about eliminating or restricting the ability of Medigap plans to provide "first-dollar" coverage for Medicare enrollees.

Critics of first-dollar coverage say it encourages enrollees to spend on care that may not really be necessary; advocates of keeping current Medigap plans as is say first-dollar coverage can help seniors on a budget prevent minor problems from becoming big problems.

One of the most vocal opponents of efforts to change Medigap program rules, Florida Deputy Insurance Commissioner Mary Beth Senkewicz, told other regulators on the call that she is extremely concerned about the effects of any changes on policies that are already in force.

Senkewicz, whose boss, Florida Insurance Commissioner Kevin McCarty, chairs the Senior Issues Task Force at the Health Committee, said changes affecting in-force policies could shift costs to seniors who have not prepared for such expenditures, cause "major market disruptions," and lead to legal issues such as impairment of contracts and due process problems.

Even on a prospective basis, eliminating Medigap first-dollar coverage would shift more costs to seniors, call participants said.

Defending Medigap first-dollar coverage is one of those issues where everyone – consumer groups, the insurance industry and regulators – all on the same table, Senkewicz said.

Senkewicz, who worked on health policy issues for the NAIC in Washington for more than a decade, said she thinks the threat of budget cuts affecting the Medigap program is serious.

The Congressional Budget Office has estimated that prohibiting Medigap from paying any first-dollar coverage for any enrollee starting in 2013 and limiting coverage to 50% of the next $5,000 in Medicare cost sharing would save $3.7 billion in 2013 and about $53 billion over the 9-year period starting in 2013 and ending in 2021.

"When you have a number like that, it is not chump change," Senkewicz said in an interview.

Seniors know what is going on, and read, and make phone calls, and any changes affecting Medicare beneficiaries become very serious, Senkewicz said.

During the NAIC call, interested parties from insurers, managed care companies and organizations like AARP took no issue with the NAIC's position, reflecting the letter prepared for Congress.

Blue Cross Blue Shield Association plans are among those strongly voicing opposition, as well.

Currently, the vast majority of  Medigap consumers purchase first dollar coverage and studies show they value the financial security first dollar coverage affords.     These policies enable Medicare beneficiaries to budget without unexpected medical expenses," stated BCBSA  in a position paper on why Congress should preserve policies with first dollar coverage.

"While substantial changes were made to Medicare in the Affordable Care Act, beneficiaries were assured that their benefits would not be cut," it stated.

The Kaiser Family Foundation commissioned a paper on the subject in July that  warned of jeopardizing of quality, noted that Medigap enrollment is likely to grow in coming years and  cautioned that "policymakers considering changes in Medigap rules will need to consider how Medigap fits into broader efforts to control the growth of Medicare spending."