GUARANTEED ISSUE FOR MEDIGAP PLANS LEFT OUT OF FINAL HOUSE HEALTH BILL

from MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center A provision that would have guaranteed access to supplemental “Medigap” coverage plans for people with Medicare under 65 was dropped from health reform legislation introduced in the House of Representatives. The provision had been part of an earlier discussion draft of the legislation. Medigap plans help many people with Medicare pay Medicare’s cost-sharing. Older adults with Medicare have a guaranteed issue right to Medigap when they turn 65 and sign up for Part B, which means they cannot be denied coverage or charged a higher premium because of their medical condition. This helps older adults avoid catastrophic medical expenses. Federal law does not require insurance companies to sell Medigap plans to people under the age of 65. In absence of a federal requirement, only 29 states grant people with disabilities who have Medicare guaranteed issue rights to Medigap plans. When the three House committees released the draft of their health care reform legislation, it had included a provision that would extend Medigap guaranteed issue rights to people eligible for Medicare because of a disability. The bill did not extend guaranteed issue rights to people who qualify for Medicare because they have end-stage renal disease. This guaranteed issue provision was removed from the final version of the bill, H.R. 3200, America’s Health Choices Act, reportedly to bring the cost of the bill down. The Congressional Budget Office (CBO) estimated that extending Medigap guaranteed issue rights to people with disabilities would increase Medicare spending by $4.1 billion over ten years, as the enhanced coverage would allow people with disabilities greater access to health care. Separately, Senator John Kerry, Democrat of Massachusetts, in a letter to Senator Max Baucus, Democrat of Montana, and Senator Chuck Grassley, Republican of Iowa, urges the leaders of the Senate Finance Committee to include provisions in their health care legislation that will extend guaranteed issue rights for Medigap to people with disabilities. He stated “Medigap plans provide vital assistance to Medicare beneficiaries in paying Medicare cost-sharing. Without supplemental coverage, the absence of an out-of-pocket limit in Medicare leaves beneficiaries vulnerable to catastrophic medical expenses.”