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Committee hears HB24 to let Medicare-eligible under‑65 patients buy Medigap; advocates cite small population, negligible premium impact and Medicaid savings
Summary
Proponents told the House Insurance Committee that House Bill 24 would allow Ohioans under 65 with ALS or end-stage renal disease who become Medicare-eligible to purchase Medigap (Medicare supplement) coverage; advocates said the change affects a small group and would have a de minimis effect on premiums while reducing Medicaid spend-down.
Proponents of House Bill 24 told the Ohio House Insurance Committee on Wednesday the bill would allow Medicare-eligible Ohioans younger than 65 who qualify for Medicare because of ALS or end-stage renal disease (ESRD) to purchase Medicare supplemental (Medigap) coverage, and they argued the change would help patients, preserve access to transplants and produce modest Medicaid savings.
Alex Meister of the ALS Association and Elizabeth Lively of Dialysis Patient Citizens described how the current system leaves some younger patients without practical access to Medigap. "I learned that I couldn't enroll in traditional Medicare because I was under 65 and ineligible for a Medigap plan," Alex Meister said in written and oral testimony describing an Ohio resident's experience; proponents also noted federal law already grants immediate Medicare eligibility to people with ALS (there is no 24-month waiting period for Medicare entitlement in that circumstance). Elizabeth Lively said the proposal would help a narrow population of "about 1,700" Ohioans under 65 who are Medicare-eligible but not covered by Medicaid, and that Medigap coverage can be crucial for dialysis patients seeking active placement on transplant wait lists.
Key provisions and evidence presented: Supporters said HB24 would (1) allow under-65 Medicare-eligible Ohioans with ALS or ESRD to buy Medigap, (2) include a one-time six-month window allowing already-Medicare-enrolled under-65 individuals to obtain Medigap, and (3) adopt a birthday-rule style protection permitting moves between carriers for the same lettered Medigap plan without creating a recurring open-enrollment period. Proponents provided a third-party actuarial analysis (Health Management Associates) estimating a de minimis premium impact of about 0.2% across the broader Medigap pool (about $0.40 per month on average), and an estimated Medicaid savings of roughly $3.2 million over five years by reducing spend-down into Medicaid for this small group.
Patient testimony and examples: Alex Meister read a written statement from an Ohio resident (Angelina) who described delays and denials under Medicare Advantage and the difficulty obtaining durable medical equipment, ongoing medications and timely treatments. Elizabeth Lively said dialysis patients frequently face annual out-of-pocket spending that can exceed $16,000 and that many transplant programs require secondary coverage for a patient to be placed on an active waiting list.
Committee questions and clarifications: Committee members asked about underwriting and whether switching between carriers would require medical underwriting. Witnesses said the bill's switch provision is designed to allow moves between carriers for the same lettered Medigap plan without fresh medical underwriting during that permitted switch window, mirroring protections already available to the over-65 Medigap population in some states. Proponents also compared modeled premium effects with normal yearly Medigap increases, noting insurers sometimes raise premiums by double-digit percentages in a single year and that the bill's projected 0.2% effect would be small by comparison.
Where the bill stands: HB24 received proponent testimony; no committee vote was taken during this session. Supporters included the ALS Association and Dialysis Patient Citizens; written support from the American Kidney Fund, ALS United Ohio and others was entered into the record.
Less-critical details and next steps: Proponents urged the committee to consider the bill as a targeted fix for a narrowly defined, high-need population that could reduce Medicaid costs and offer immediate consumer protections for younger Medicare-eligible patients with ALS or ESRD.
