Panel hears SB 292 to require Medigap access for Medicare beneficiaries under 65

Sen. Roberta Lang presented Senate Bill 292 to the Assembly Commerce and Labor Committee proposing that insurers who sell Medicare supplemental (Medigap) policies be required to offer those policies to eligible Medicare beneficiaries under age 65 — including people who qualify for Medicare because of end-stage renal disease (ESRD) or disability — with the same premium rates and protections offered to people 65 and older.

Lang said millions enroll in Medicare before age 65 due to disability or ESRD and that younger Medicare beneficiaries often face worse access and higher out-of-pocket costs. “Federal law does not require insurers to offer Medigap policies to Medicare beneficiaries under the age of 65, leaving a substantial portion of the Medicare population vulnerable to high out-of-pocket medical costs,” she said.

Pamela Zielske, Western regional advocacy director for Dialysis Patient Citizens, and other patient advocates testified in strong support. Zielske cited an actuarial report from Health Management Associates (HMA) included in the record that estimated adding the small number of under-65 ESRD beneficiaries into the Medigap pool at age-65-equivalent premium rates would raise overall premiums by roughly 0.9 percent (about $2 per month on average), while also potentially saving state Medicaid dollars by reducing asset “spend-down” among patients who otherwise qualify for Medicaid.

A Nevada dialysis patient, Charles Leizer, spoke about his need for a transplant and the upfront costs patients can face, saying the bill would “take a lot of the burden” off families and improve quality of life. Other supporters included the Nevada Donor Network, American Kidney Fund, transplant surgeons and dialysis providers who testified that Medigap access is often a requirement in transplant evaluations and can be life–saving.

Opponents including America’s Health Insurance Plans (AHIP) and the Nevada Association of Health Plans said they were concerned about cost shifting within the Medigap risk pool and that beneficiaries on Medigap are often lower-income seniors who could face higher premiums if expensive ESRD cases are added to the pool without offsetting funding. AHIP noted ESRD beneficiaries incur spending several times higher than beneficiaries without ESRD and urged more flexible approaches such as limiting plan options or other premium methodologies used in some other states.

Other stakeholders — independent insurance brokers and the Division of Insurance — provided neutral testimony and offered to work with sponsors on premium methodology and implementation details. Broker testimony urged restricting access to a limited set of plans to reduce premium impacts; patient advocates urged allowing all lettered Medigap plans so patients could choose the best fit.

Key provisions summarized by Sen. Lang included a required open enrollment period (six months beginning the first month an eligible person enrolls in Medicare Part B), a prohibition on imposing preexisting-condition exclusions during that open enrollment, and a required effective open-enrollment window beginning Oct. 1, 2025, and remaining open through April 1, 2026, if the bill passes.

Committee members asked about which groups are covered; Lang and witnesses confirmed the bill covers beneficiaries qualifying because of ESRD and for disability. No committee vote was recorded during this hearing; stakeholders said they would continue discussions about premium methodology and implementation.