Committee hears support for expanding Medigap access to under-65 Medicare beneficiaries with ALS and ESRD

Proponents of House Bill 24 told the Ohio House Insurance Committee that the bill would allow Medicare-eligible Ohioans under age 65 who have amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) to buy Medicare supplemental (Medigap) coverage, align their enrollment rights with those of beneficiaries aged 65 and older, and create a limited one-time enrollment window and a rule allowing beneficiaries to change carriers within the same lettered Medigap plan without new underwriting.

Alex Meixner of the ALS Association described patients’ experiences and urged support for the bill, saying the measure would let people like Angelina Fanal of Strongsville use their own funds to buy supplemental coverage that covers Medicare’s 20% cost-sharing. “When I first enrolled, my plan lived up to that reputation. My medication refills, feeding tube formula, my main source of food were delayed a whole month due to prior authorizations,” the testimony attributed to Angelina said, cited by Meixner to illustrate delays and coverage denials experienced on Medicare Advantage plans. Meixner said ALS patients can enroll in Medicare immediately after diagnosis but often cannot buy Medigap policies until age 65 under current rules; the bill would remove that impediment for specified conditions. Meixner also noted recent promising research on ALS treatments and argued improved access to Medigap can reduce financial hardship while patients await better therapies.

Elizabeth Lively of Dialysis Patient Citizens testified in support and framed the bill as addressing a small but high-need population. Lively said roughly 1,700 Ohioans under age 65 are Medicare-eligible for ESRD but not enrolled in Medicaid (“nonduals”) and that these beneficiaries face out-of-pocket costs that can approach $16,000 a year. Dialysis Patient Citizens and the ALS Association referenced a third-party actuarial analysis by Health Management Associates (HMA) estimating the bill’s effect on the broader Medigap premium pool at about a 0.2% increase (roughly 40¢ per month), and HMA projected Ohio Medicaid savings of about $3.2 million over five years due to reduced spend-down into Medicaid among the affected group.

The bill would also include a one-time six-month window allowing currently Medicare-eligible under-65 beneficiaries with ALS or ESRD to purchase Medigap, and a “birthday rule” provision enabling beneficiaries who already have Medigap to switch carriers offering the same lettered plan tier without new medical underwriting. Committee members asked whether switching would involve underwriting; Meixner said the intent is to preserve the limited initial enrollment protections (no new medical underwriting for the carrier-to-carrier move within the same lettered plan).

Witnesses described the practical benefits for transplant access and continuity of care. Lively said transplant programs commonly require secondary coverage to place patients on active wait lists; Medigap access therefore can affect a kidney transplant candidate’s ability to get listed and receive timely care. Patient examples included a local transplant recipient who needed $15,000 in antiviral medication after receiving a hepatitis C–positive donor kidney and who benefitted from a patchwork of assistance to complete the transplant process.

Supporters emphasized the bill’s modest projected impact on premiums versus the potential reduction in Medicaid costs and the benefit to a small, high-cost patient group. The committee received written testimony from additional patient and clinical groups; no committee vote on the bill was recorded during the second hearing and the committee adjourned after testimony.