Medigap Plans for Home or In-center Dialyzors

This blog post was made by Beth Witten, MSW, ACSW, LSCSW on May 12th, 2016.
Medigap Plans for Home or In-center Dialyzors

A dialyzor is enrolling in or recently enrolled in Medicare and doesn’t have other health insurance. S/he asks you if there’s any way to get help to pay Medicare Part A and Part B deductibles, hospital copays and Part B coinsurance. Although the Affordable Care Act prevents companies from refusing to sell a plan to someone with a pre-existing condition, the ACA did not extend to Medigap plans. So, the answer is, it depends:

  • If s/he is 65 or older, has it been less than 6 months since Medicare Part B enrollment?
    • If so, a federal law protects his/her right to buy a Medigap plan without worry about having kidney failure (a pre-existing condition) or being charged more.
    • If not, there is no federal law but there may be state regulations that require insurance companies to still sell a Medigap plan to a person with kidney failure.
  • If s/he is under 65;
    • There is no federal law that requires a company to sell a Medigap plan to anyone who has kidney failure, or for that matter, to anyone who is eligible for Medicare due to disability
    • Some states have insurance regulations that do require companies that sell Medigap plans to those eligible for Medicare due to age to also sell them to people under age 65, including those with kidney failure.

Where to Buy a Medigap Plan

On this page on the Medicare site is a list of states that require plans to sell to people with Medicare who are younger than 65. Check back, as the list may change over time. Note any asterisk footnotes below the chart and what they mean. Some other states may sell Medigap plans to people with ESRD at a higher premium. At age 65, a dialyzor will have a new 6 month open enrollment period to check plan options, and there may be more options at lower cost.

States Currently Requiring Insurance Companies to Offer at Least One Kind of Medigap Policy to People with Medicare Under 65

To find out the latest information on health insurance regulations in your state, contact your state insurance department or the State Health Insurance Assistance Program (may be called different things in different states).

Other Resources:

Tags:

Comments

  • Wendy Schrag

    Nov 11, 3:50 PM

    In addition to the states above, Idaho has just approved a rule through the state's department of insurance that will require insurers to offer Medigap policies to those under age 65. It has to be approved by the state legislature and then will go into effect.

    Reply to this Comment

    * All fields are required.

    1. Your email will not be displayed publicly
    • Beth Witten

      Nov 11, 5:47 PM

      Thanks for this information, Wendy. Please update us if/when the state legislature approves this rule.

      Reply to this Comment

      * All fields are required.

      1. Your email will not be displayed publicly
Leave a New Comment

* All fields are required.

  1. Your email will not be displayed publicly