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:

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Comments

  • Cindy Datangel

    Aug 6, 2019 9:47 AM

    Thank you for the quick responses. I forgot to mention that we live in California and I understand that this is one of the states that allows denial due to dialysis even at age 65. I would like to know if there is a medi-gap plan that will accept her even with higher premiums. I tried calling around but so far no luck.

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    • Beth Witten

      Aug 6, 2019 10:18 AM

      Section 1882 of the Social Security Act states this:
      "(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

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      • Cindy Datangel

        Aug 6, 2019 10:36 AM

        Thank you so much. I will definitely try again after she turns 65. You have given me some hope.

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  • Cindy Datangel

    Aug 5, 2019 7:35 PM

    I am in search of a medi-gap plan that will cover my mother who is on dialysis and will be turning 65 in a week. She has the original medicare part A and B and a prescription plan from AARP for many years.

    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.

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    • Beth Witten

      Aug 6, 2019 9:39 AM

      When your mother turns 65, federal law protects her from being denied a Medigap plan for 6 months. She should be able at that time to buy any Medigap plan that she wants. Unless she's in MA, MN, or WI where plans are a little different, there are standardized plans where the coverage in Plan A is the same when sold by any company, but the cost may be different. The most popular Medigap plan in the U.S. is Plan F (not high deductible). This plan covers anything that Medicare covers and pays Part A and B deductibles and coinsurance/copays. It also pays the 15% extra that doctors can charge if they're not Medicare participating providers. Another plan that is similar to Plan F but doesn't pay the extra 15% is Plan C. This is the last year anyone will be able to buy a Medigap plan that covers the Part B deductible so she should buy before December. You can read about how to compare plans here and see a chart that shows what plans cover. Near the bottom of the page there are links to plans in MA, MN, and WI.

      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/.

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  • Wendy Schrag

    Nov 11, 2016 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.

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    • Beth Witten

      Nov 11, 2016 5:47 PM

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

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