Representatives Callender and Sweeney Provide Sponsor Testimony on Bill to Expand Medigap Coverage
COLUMBUS—This week, the House Insurance Committee held sponsor testimony on House Bill (HB) 24, announced bill sponsors, State Representatives Jamie Callender (R-Concord) and Bride Rose Sweeney (D-Westlake). HB 24, a reintroduction of HB 400 (135th General Assembly, Callender/Sweeney), aims to extend Medigap coverage to Ohio patients under the age of 65 who are diagnosed with End Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS). While ESRD and ALS patients are federally eligible to receive Medicare Part B Coverage, Ohio does not allow them to purchase Medigap coverage.
Currently in Ohio, there are approximately 1,772 ESRD patients and 410 ALS patients under 65 who would be eligible to purchase Medigap coverage. These patients are covered by Medicare, but not Medicaid. With treatment, ESRD patients have a life expectancy of approximately 5 – 10 years while ALS patients have a life expectancy of 2-5 years. According to the ALS Association, it costs approximately $90,000 in out-of-pocket expenses to cover the cost of caring for a person with ALS. For ESRD patients it can cost as much as $500 per dialysis session, with many patients needing multiple sessions per week, on top of the other medical costs associated with treating ESRD.
"No one diagnosed with ALS before age 65 should face extra financial burdens simply because of their age," said Lindsay Jack, Managing Director of Advocacy at the ALS Association. "Passing HB 24 would eliminate this unjust gap in coverage and ensure that younger Ohioans living with ALS have the same access to affordable Medigap plans as those 65 and older. This is not only the fair thing to do—it also makes economic sense by helping families avoid financial ruin and reducing reliance on Medicaid."
By extending Medigap coverage to these ESRD and ALS patients, it would eliminate the often-crippling financial burden these diseases place on families. Medigap coverage, also known as a Medicare supplement insurance plan, is an additional insurance plan – called secondary coverage – that can be purchased to assist with covering expenses not paid by Medicare. This can include things like co-payments, co-insurance costs, and deductibles.
“This bill will help prevent 1 in 4 of the 1,772 Ohioans with ESRD from spending down their hard-earned assets or declaring bankruptcy to qualify for Medicaid as their secondary coverage,” explained Elizabeth Lively, Eastern Region Advocacy Director for Dialysis Patient Citizens. “It is estimated that passing this legislation will save the Ohio Medicaid program $3.2 million over 5 years.”
Nationally, 12% of all Medicare enrollees are eligible due to a long-term disability rather than age. 17 other states have already adopted similar legislation to extend Medigap Coverage to ESRD and ALS patients. Actuarial analysis from the Health Management Associates commissioned by Dialysis Patient Citizens, indicates that expanding Medigap coverage to 1,772 Ohioans under 65 with ESRD who are non-duals would only lead to a 0.2% increase in premiums, or 40 cents taking the monthly payment from $204.00 to $240.40.
“Every year, hundreds of families here in Ohio receive the crushing news that their loved one has been diagnosed with a terminal disease,” said Callender. “By removing the additional burden of potentially crippling medical debt, friend and family will be able to focus on the things that matter, spending time with their loved one and ensuring quality of care.”
“No one should have to bankrupt their family to pay for basic medical care after receiving a terminal diagnosis,” said Sweeney. “This legislation takes a balanced, targeted approach that fills in the gaps that would otherwise leave outpatients facing a devastating diagnosis like ALS or end-stage renal disease and will help ensure that patients and their families can access affordable health insurance while maintaining continuity of care.”
HB 24 now awaits proponent testimony in the House Insurance Committee.