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Lawmakers hear calls to let dialysis patients under 65 buy Medigap; advocates cite transplant and cost impacts
Summary
Patients, clinicians and kidney advocacy groups urged the committee to support H4425/S2737 to remove a statutory exclusion that prevents many under-65 Medicare beneficiaries with end-stage renal disease from purchasing Medigap, citing long transplant wait times, ~$16,000 annual out-of-pocket costs, and modeling that shows small insurer premium impacts.
Advocates, clinicians and a state senator told the Joint Committee on Health Care Financing that Massachusetts law currently prevents many people under 65 who qualify for Medicare because of end-stage renal disease (ESRD) from purchasing Medigap supplemental coverage, putting them at a disadvantage for transplant eligibility and creating substantial out-of-pocket costs.
"Without that supplemental coverage, many patients are ineligible for a transplant," John Hoffman, senior director of state policy at the American Kidney Fund, said in his virtual testimony. Hoffman and other witnesses said Medicare covers about 80 percent of ESRD-related costs and that remaining uncapped out-of-pocket expenses can total around $16,000 a year.
Elizabeth Lively of Dialysis Patient Citizens described the measure as a "technical fix" to remove a statutory exception and cited an actuarial study by Health Management Associates estimating the affected pool at roughly 846 people in Massachusetts and suggesting insurers might raise premiums by about 0.2 percent (roughly $1 a month) if access changed. Senator Gomez, who testified remotely and recounted his own 18-month experience on dialysis, said the change could also reduce Medicaid enrollment through avoided asset spend-downs and estimated Commonwealth savings of about $1,600,000 over five years.
Survivor testimony underscored the human stakes. Sherry Rodriguez Jones described waiting years to get on the transplant list because she lacked secondary coverage, saying Medigap access had been critical to her survival. Witnesses urged the committee to favorably report H4425 and S2737; the committee did not vote on the bills at the hearing.
