How have the OBRA 90 Medigap policy reforms changed the health insurance market for both the elderly and non-elderly populations? Using interviews and document and data analyses, this evaluation examined the implementation of the OBRA 90 changes and their impact with respect to changes in the supplementary insurance products, the workings of the insurance market, the structure and operations of insurance carriers, access and affordability for beneficiaries, and other types of coverage (e.g., long-term care coverage). The research was intended primarily to determine whether the policy changes reduced the marketing abuses and confusion faced by elderly Americans with regard to the Medigap market, and to explore the implications of the changes for efforts to improve the availability of insurance for the non-elderly (e.g., individuals and small employers).