Press Release

Sen. Blakespear Introduces Bill to Protect Seniors from High Health Care Costs

SB 1236 ensures that seniors with Medigap get coverage for pre-existing health conditions and don’t have to pay huge out-of-pocket expenses 

SACRAMENTO – Sen. Catherine Blakespear, D-Encinitas, introduced legislation on Thursday to protect seniors on Medicare Supplemental Insurance plans from incurring high out-of-pocket expenses for pre-existing medical conditions.

SB 1236 ensures that people on Medicare Supplemental Insurance, known as Medigap, are protected from being penalized for having pre-existing medical conditions the same way all Americans are protected in the regular private health insurance markets. Medigap, which requires a monthly payment, is insurance seniors often use in addition to traditional Medicare to cover high-maintenance medical conditions.

Current federal law prohibits private insurers that offer Medigap insurance policies from penalizing seniors for their pre-existing health conditions under a narrow set of circumstances, but outside of these circumstances, the provision does not apply and seniors are faced with high out-of-pocket expenses for coverage or even denial of coverage.

“Seniors on Medigap shouldn’t have to choose between getting health care and eating,” said Sen. Blakespear. “The lack of coverage for pre-existing conditions puts seniors in a bind they shouldn’t be in. SB 1236 corrects that oversight.”

Last fall, Scripps Health, one of the three major health systems in San Diego County, announced that it would not renew its contract with Medicare Advantage plans due to the plans’ administrative issues and low reimbursement rates. This has halted patients’ access to their established health providers and forced them to either change providers or change insurance plans. The current pre-existing conditions protections do not apply to this circumstance, so when many patients switched to Medigap, they saw a big jump in their health expenses.

While Medicare is a federal health care program, the California Department of Insurance and the Department of Managed Health Care regulate all Medigap and Medicare Advantage plans offered in California.

The bill is supported by the Leukemia & Lymphoma Society, California Health Advocates (CHA) and California Alliance for Retired Americans (CARA).

“One of the best-kept secrets in healthcare is that some health plans still discriminate against people with pre-existing conditions,” said Adam Zarrin, director of state government affairs at the Leukemia & Lymphoma Society. “We agree with Senator Blakespear and her co-author: Californians should never be penalized for having a history of cancer. This important bill protects patients with Medicare coverage from having a pre-existing condition used against them. We’re thrilled to work with the authors and co-sponsors to pass this critical protection and improve the health and quality-of-life of aging Californians.”

“Many Medicare beneficiaries are locked into a Medicare Advantage plan that no longer meets their needs when they can't get a Medigap policy,” said Catherina "Trina" Isidro, executive director of CHA. “This bill will allow them the same freedom to choose a Medigap each year as they have to change a MA plan.” 

“CARA is proud to co-sponsor SB 1236,” said Cindy Young, vice president for CARA. “As a statewide senior and disability advocacy nonprofit, expanding access to affordable and equitable health care coverage for California’s rapidly aging population is our top priority. We applaud Senator Blakespear for authoring this long overdue legislation that will expand access and affordability in Medicare supplement plans while protecting our most vulnerable communities.”

Elected in 2022, Sen. Blakespear represents Senate District 38, which covers northern San Diego County and part of Orange County. To learn more about the district and Sen. Blakespear, visit her Senate website.