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.
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:
Comments
Cindy Datangel
Aug 06, 2019 2:47 PM
Beth Witten
Aug 06, 2019 3:18 PM
"(2)(A) The issuer of a medicare supplemental policy may not deny or condition the issuance or effectiveness of a medicare supplemental policy, or discriminate in the pricing of the policy, because of health status, claims experience, receipt of health care, or medical condition in the case of an individual for whom an application is submitted prior to or during the 6 month period beginning with the first month as of the first day on which the individual is 65 years of age or older and is enrolled for benefits under part B." Basically what this means is that someone who turns 65 and who has Part B can't be denied coverage or charged more if they have a preexisting condition for 6 months after turning 65." This is a federal law and applies to all states.
My advice is to wait until her birthday to contact companies that sell Medigap plans or contact HICAP to ask for their help. https://www.shiptacenter.org/about-medicare/regional-ship-location/california
Cindy Datangel
Aug 06, 2019 3:36 PM
Cindy Datangel
Aug 06, 2019 12:35 AM
Is there a medi-gap plan that will accept individuals on dialysis? So far I have been turned down. The cost is getting to be a problem and she can not afford to pay her bills. Thank you for your help.
Beth Witten
Aug 06, 2019 2:39 PM
Every state has a government funded state health insurance assistance program. They're called different things in different states. Here's a link to find a counselor in her state - https://www.shiptacenter.org/.
Wendy Schrag
Nov 11, 2016 9:50 PM
Beth Witten
Nov 11, 2016 11:47 PM