Callender, Sweeney Introduce Legislation to Expand Medigap Coverage to Terminal Patients

COLUMBUS—State Representatives Jamie Callender (R-Concord) and Bride Rose Sweeney (D-Westlake) recently introduced legislation to address a critical shortcoming in Ohio’s Medigap insurance market for patients suffering from Amyotrophic Lateral Sclerosis (ALS) or end stage renal disease (ESRD). HB 400 aims to expand access to Medigap plans to all patients, regardless of age, who have been diagnosed with either ALS or ESRD and are eligible for Medicare Part B coverage. 

Medigap Coverage, also known as Medicare Supplemental Insurance, is an extra insurance package offered to individuals to help cover out-of-pocket costs that aren’t covered by Medicare Part A or B. Expanding access to these plans will prevent the families of those diagnosed with ALS or ESRD from having to endure crippling medical bills or spending down assets to attain Medicaid eligibility. 

“No family impacted by ALS should be denied the ability to purchase an affordable Medigap plan,” said Kara Nett Hinkley, Vice President of State Policy at The ALS Association. “Ohioans living with ALS deserve the opportunity to purchase coverage that guarantees them the care they need and provides the financial security they so desperately seek for the wellbeing of their families. The ALS Association is committed to ensuring everyone with ALS has access to an affordable Medigap plan, no matter where they live, while aggressively pursuing a cure for this devastating disease.”

“Dialysis Patient Citizens is pleased that the Ohio Legislature will have the opportunity to improve the quality of life for dialysis patients by helping prevent bankruptcies and access to lifesaving kidney transplants while saving Ohio Medicaid dollars,” said Hrant Jamgochian, JD, LLM, CEO of Dialysis Patient Citizens. “We urge swift passage of this critically important legislation.”

“Affordable access to Medigap insurance for ESRD patients is a critical need in Ohio,” said LaVarne A. Burton, CEO of the American Kidney Fund. “We are thankful to Rep. Callender and Rep. Sweeney for their leadership on this bill. ESRD patients on Medicare face high out-of-pocket cost obligations, and most transplant centers will not accept Medicare beneficiaries onto their transplant list without secondary insurance such as Medigap.  Since a kidney transplant is the best treatment for those with ESRD, it is not an overstatement to say that this legislation will be a lifesaver.”

HB 400 would require insurance companies who offer Medigap policies to individuals over 65 years old to extend this coverage to qualifying individuals under 65. These insurance companies would not be able to charge a rate greater than the rate charged to individuals who are 65 years old. Sixteen other states have already adopted expanded Medigap access including Pennsylvania, Missouri, and Kentucky. 

“Every year, hundreds of families face the physical, emotional, and mental challenges of an ALS or ESRD diagnosis,” said Callender. “Removing the additional stress of potentially crippling medical bills will allow families to focus on their loved one’s care and quality of life.”

“No one should have to bankrupt their family in order to pay for basic medical care following an ALS or ESRD diagnosis,” said Sweeney. “This legislation takes a balanced, targeted approach that helps to fill in the gaps that would otherwise leave out patients and families facing these devastating diseases, ensuring that our insurance system takes into account the unique circumstances in which these families find themselves.”

This legislation awaits consideration by the House Insurance Committee.