Officials introduce legislation to expand Medigap coverage to terminal patients

Chad Felton, The News-Herald, Willoughby, OhioNews-Herald

State Rep. Jamie Callender, R-Concord Township, and state Rep. Bride Rose Sweeney, D-Westlake, recently announced the reintroduction of legislation aimed at addressing “a critical shortcoming” in Ohio’s Medigap insurance market for patients suffering from Amyotrophic Lateral Sclerosis or end-stage renal disease.

Introduced in the 135th General Assembly as House Bill 400, the new House Bill 24 seeks to expand access to Medigap plans for all patients eligible for Medicare Part B coverage, regardless of age, who have been diagnosed with either ALS or ESRD.

Medigap coverage — referred to as Medicare Supplemental Insurance — is an additional private health insurance policy that helps cover out-of-pocket costs not included in Medicare Part A or B.

Officials noted that expanding access to these plans will prevent families of those diagnosed from having to endure overwhelming medical bills or depleting their assets to qualify for Medicaid eligibility.

“Ohioans diagnosed with ALS under the age of 65 shouldn’t be penalized for being too young,” stated Alex Meixner, vice president of state policy for The ALS Association, in a news release. “Passing HB 24 would close this unfair age-related loophole and give those living with ALS the same access to affordable Medigap coverage that Ohioans over 65 already enjoy.

“It’s the right thing to do and could save the state money by helping ALS families avoid sliding into bankruptcy and eventual Medicaid enrollment.”

For Ohioans struck down with a diagnosis of ESRD in the prime of their lives, HB 24 will open the door to qualify for life-saving kidney transplantation, stated Elizabeth Lively, eastern region advocacy director for Dialysis Patient Citizens.

“And, because Medicare only pays 20 percent of the cost of (their) dialysis treatments, a diagnosis of ESRD can cripple a family’s finances, often forcing them to spend down hard-earned assets to qualify for Medicaid.”

To date, Lively added, 56 percent of under-age 65 dialysis patients are covered by the Ohio Medicaid program (dual-eligible, covered by both Medicare and Medicaid), and Ohio is paying their out-of-pocket costs.

Callender and Sweeney noted that the legislation would require insurance companies that offer Medigap policies to individuals over 65 years old to extend this coverage to qualifying individuals under 65, adding that the companies would not be able to charge a rate greater than the rate charged to individuals who are 65 years old.

The reps said 17 other states have already adopted the expanded Medigap access, including Pennsylvania, Missouri, Kentucky and Indiana.

Callender emphasized that during the 135th General Assembly, HB 400 received three hearings in the House Insurance Committee.

“Rep. Sweeney and I introduced this legislation last year with the goal of supporting the hundreds of families who face the physical, emotional, and mental challenges of an ALS or ESRD diagnosis,” Callender said.

“With the reintroduction of this legislation, we are continuing our commitment to reduce the specter of potentially crippling medical debts on those diagnosed and their families.”

This legislation is awaiting referral to a committee and sponsor testimony.