Advocates press committee to allow Medicare supplement parity for under-65 ALS and ESRD patients; insurers warn of premium shifts

Representative Karen Matheak introduced House Bill 323 to the Senate Insurance and Labor Committee, asking the panel to consider parity in Medicare supplemental (Medigap) premiums for people under age 65 who qualify for Medicare because they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Supporters said the change would expand affordable access to Medigap policies for a small group of patients now facing sharply higher premiums and consequent financial strain. Elizabeth Lively, Eastern Region Advocacy Director for Dialysis Patient Citizens, cited an independent actuarial report from Health Management Associates that analyzed 2019 Medicare claims and estimated roughly 3,800 ESRD patients could gain access to Medigap at parity; the report estimated the change would raise average premiums in the broader Medigap pool by about $2 per month and save the state roughly $6.3 million over five years by preventing some patients from “spending down” onto Medicaid.

Patients described high out-of-pocket costs. Richard McDaniel, who said he lives with kidney failure, told the committee that dialysis patients face large medical and financial burdens and that lack of affordable supplemental coverage can keep patients off transplant lists. A patient who testified by video described paying $2,610 per month for a Medigap plan at age 36, compared with $288 per month for a 65-year-old on the same plan; advocates urged the committee to consider the human and state fiscal implications.

Insurer perspective: Jesse Wellington, president of the Georgia Association of Health Plans, testified in opposition. He said carrier estimates place premium impacts in the range of roughly 5–15% for the 65-and-older Medigap population, and he framed the policy choice as cost‑shifting between a very large pool of older Medicare beneficiaries and a small group of high‑cost, under‑65 beneficiaries. Wellington emphasized federal disability and anti‑discrimination statutes and noted dialysis reimbursement differentials that affect provider behavior.

Key clarifications: testimony said the proposal is an offering (not a mandate to sell) and that the pool of potential enrollees is small relative to the entire Medigap market. Witnesses noted AARP’s neutral position and included letters from providers and patient groups; proponents said a modest premium increase for the broader pool could avert larger state Medicaid costs.

Procedure and next steps: the committee held a hearing only and did not vote. Committee members asked for additional claims data from the all‑payer claims database and for follow-up actuarial analysis; sponsors said they would pursue further data.

Ending: The committee’s discussion highlighted a policy trade-off between expanding affordable access for a small, high-need group and possible premium increases for the broader Medicare supplement market; no action was taken at the hearing.