Representatives Reintroduce Legislation to Expand Medigap Coverage to Terminal Patients

Columbus, Ohio – State Representatives Jamie Callender (R-Concord) and Bride Rose Sweeney (D-Westlake) reintroduced 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). Introduced in the 135th General Assembly as HB 400, HB 24 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 private health 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 spend down assets to attain Medicaid eligibility. 

“Ohioans diagnosed with ALS under the age of 65 shouldn’t be penalized for being too young,” said Alex Meixner, VP of State Policy for The ALS Association. “Passing HB 24 would close this unfair age-related loophole and give those living with ALS under 65 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 End Stage Renal Disease (ESRD) in the prime of their lives, this legislation will open the door to qualify for life-saving kidney transplantation,” said Elizabeth Lively, Eastern Region Advocacy Director for Dialysis Patient Citizens.  “And, because Medicare only pays 20% 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.”  

Currently, 56% 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.

HB 24 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. Seventeen other states have already adopted expanded Medigap access including Pennsylvania, Missouri, Kentucky, and Indiana. During the 135th General Assembly, HB 400 received three hearings in the House Insurance Committee. 

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

“No one should have to bankrupt their family to pay for basic medical care after receiving a terminal diagnosis,” said Rep. Sweeney. “This legislation takes a balanced, targeted approach that fills in the gaps that would otherwise leave out patients 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 testimony in the House Insurance Committee.