American Kidney Fund Commends Texas for Expanding Medigap Access to People Under 65 with ESRD

ROCKVILLE, Md. (June 23, 2025) - The American Kidney Fund (AKF) applauds Texas for passing legislation (HB 2516) that mandates Medicare supplement policies — known as Medigap — be accessible to people under age 65 with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) who are eligible for Medicare.  

Medigap is private supplement insurance that Medicare beneficiaries living with ESRD rely on to cover costs that Medicare does not. Importantly, the new law also helps make Medigap more affordable by including premium protection, preventing ESRD patients under 65 from having to pay a higher premium than Medigap Plans A, B, and D subscribers over 65 for most plans, and not more than twice the standard rate for other plans.  

Although federal law requires Medigap insurers to offer plans to all Medicare beneficiaries who are 65 and over, state laws determine Medigap policy for Medicare beneficiaries under 65.  

In passing HB 2516, Texas has become the 35th state to require Medigap insurers to offer plans to people under 65 with ESRD who use Medicare as their health insurance.  

AKF helped lead efforts to advance HB 2516, including meeting with one of the bill's sponsors and authors, state Rep. Ryan Guillen. AKF also secured co-sponsors, co-authors and supporters of HB 2516 and testified in favor of the bill in Austin.  

"Kidney failure does not discriminate based on age, and the costs associated with this condition can be a significant burden to people living with kidney failure and their families," said LaVarne A. Burton, AKF President and CEO. "This is a big win for Texans, and we thank Rep. Guillen and all of the authors, sponsors and supporters of this legislation for their work on passing this bill." 

Medicare is a federal health insurance program for people 65 and older and younger people with disabilities, including ESRD or ALS. However, Medicare covers only 80% of the cost of most services, which means that beneficiaries have a 20% out-of-pocket responsibility with no annual limit. Having secondary insurance such as Medigap is critical to ESRD patients because it protects them from the 20% cost burden. Health care for kidney failure, including dialysis, can cost $16,000 per year or more in out-of-pocket costs for those who do not have secondary insurance like Medigap. 

Medigap coverage also plays an important role in helping people with ESRD get on the transplant waiting list. A kidney transplant is considered the best treatment for kidney failure. There are currently over 105,000 Americans on the organ transplant waiting list and more than 93,000 of them, or about 89%, are waiting for a kidney. In Texas, of the 10,862 people waiting for an organ transplant, 9,204 are waiting for a kidney. 

AKF's Health Insurance Premium Program helps ESRD patients with the premiums for all types of insurance, including Medigap. This long-term financial assistance from AKF makes transplants and post-transplant care possible for low-income dialysis patients. In 2024, AKF grants helped 1,601 people nationwide receive kidney transplants. AKF's program helps post-transplant patients for their full insurance plan year, ensuring continuity of care.