Committee hears House Bill 24 to let under‑65 Medicare-eligible Ohioans buy Medigap supplemental coverage

House Bill 24 received proponent testimony in its second hearing before the Ohio House Insurance Committee on proposals to allow certain Medicare‑eligible Ohioans under age 65 to purchase Medigap (Medicare supplement) coverage currently available to beneficiaries age 65 and older.

Witnesses from patient groups told the committee the change would remove a coverage gap for small groups of Ohioans who become Medicare‑eligible because of medical disability, including people living with amyotrophic lateral sclerosis (ALS) and end‑stage renal disease (ESRD). Proponents said access to Medigap coverage would improve patients’ access to transplant and other high‑cost services and could reduce state Medicaid spend‑down by some individuals.

Alex Meixner of the ALS Association described the experience of Angelina Fanus of Strongsville, Ohio, who enrolled immediately in Medicare after an ALS diagnosis but could not purchase Medigap because she was under 65 and therefore had to rely on Medicare Advantage and other stopgap arrangements. “The difference of this bill would be transformational,” Meixner said, adding that Medicare enrollment for ALS patients is immediate but that supplemental Medigap protections are limited by age rules today.

Elizabeth Lively of Dialysis Patient Citizens urged support for House Bill 24 on behalf of under‑65 dialysis and transplant candidates, noting that Medigap can cover the roughly 20% cost‑sharing Medicare leaves to patients and that transplant centers commonly require secondary coverage to place patients on active transplant wait lists. Lively cited an independent actuarial analysis (Health Management Associates) commissioned by proponents that estimated a de minimis premium impact of 0.2% across the broader Medigap market (approximately $0.40 per month per policy on average) and projected up to $3.2 million in five‑year Medicaid savings from reduced spend‑down among the affected population.

The bill would do three principal things, according to proponents: 1) Allow Medicare‑eligible Ohioans under 65 who qualify on the basis of ALS or ESRD to purchase Medigap coverage (aligning their right to buy supplemental coverage with that of beneficiaries age 65 and older). 2) Create a one‑time, six‑month look‑back/open‑enrollment window for currently Medicare‑enrolled qualifying individuals who missed their initial guaranteed‑issue window. 3) Permit portability between carriers for the same lettered Medigap plan (for example, moving from one carrier’s Plan G to another carrier’s Plan G) without creating a new guaranteed‑issue open enrollment period beyond existing rules.

Proponents emphasized that the measure would not create a recurring open enrollment or allow someone who previously declined Medigap to buy it later without underwriting; the portability provision preserves existing consumer protections while allowing shopping within the same plan letter. Meixner and Lively cited state precedents in other states (their materials cited 17 states with similar rules for ALS and related provisions) and patient stories to illustrate the proposal’s benefits.

Committee members asked whether portability would permit medical underwriting on carrier‑to‑carrier transfers; proponents said the bill preserves the special initial guarantees and that portability would not reintroduce medical underwriting at the time of a permitted transfer. Lawmakers also asked about actuarial assumptions; supporters cited the HMA report and provided specific premium‑increase examples from carriers to put the 0.2% aggregate impact in context (examples included contemporaneous premium adjustments the brokers supplied).

No formal vote on the bill occurred at the hearing; the committee concluded the second hearing after receiving proponent testimony and written submissions from patient and medical organizations.