Medigap, or Medicare Supplement insurance, is private insurance available to Medicare beneficiaries to cover costs that Medicare does not cover. Federal law stipulates that Medigap insurers must offer plans to all beneficiaries age 65 and over, but state law dictates Medigap policy for Medicare beneficiaries under the age of 65. Because of this, individuals with end-stage renal disease (ESRD) under the age of 65 who are enrolled in Medicare can find themselves without access to a Medigap plan.
Medigap is vital for people with ESRD because Medicare covers dialysis as an outpatient procedure, which means that it pays for 80 percent of costs. The patient must pay the other 20 percent with no annual out-of-pocket limit. Dialysis usually occurs three times a week, and hence, is very expensive — approximately $10,000/year or more — for a patient without secondary insurance. These high costs can drive patients to bankruptcy. Even more dire, however, is the fact that most transplant centers will not accept Medicare beneficiaries onto their transplant list without secondary insurance such as Medigap. This means that without a Medigap plan, ESRD patients can be denied the life-saving procedure of a kidney transplant.
Currently, twenty states do not require Medigap insurers to offer plans to people with ESRD who have Medicare as their insurance.
On March 9, 2021, Iowa Representative Cindy Axne was joined by Washington Representative Jaime Herrera Beutler in introducing H.R. 1676, the Jack Reynolds Memorial Medigap Expansion Act of 2021. This bill would require insurers nationwide to offer Medigap plans to ESRD patients on Medicare regardless of age or state. This would provide a much-needed insurance option for ESRD patients and offer a lifeline to Medicare recipients who wish to be added to the kidney transplant list.
Please ask your Representative to cosponsor the legislation below.