Legislation to Protect Seniors from High Health Care Costs Passes Senate Health Committee

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 – Legislation by Sen. Catherine Blakespear, D-Encinitas, to protect seniors on Medicare Supplemental Insurance plans from incurring high out-of-pocket expenses for pre-existing medical conditions passed the Senate Health Committee on Wednesday.

SB 1236 protects people who want to enroll in Medicare Supplemental Insurance, known as Medigap, 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.

“It’s shocking that Medigap can deny coverage to seniors with pre-existing health conditions or charge them extremely high premiums, when that is forbidden in the rest of the private marketplace,” said Sen. Blakespear. “SB 1236 fixes this so seniors with pre-existing conditions can enroll in Medigap without being charged so much they have to choose between food and health care.”

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.

For those with pre-existing medical conditions attempting to change insurance to Medigap, they faced the prospect of either being denied coverage or being charged thousands of dollars more each month to receive the same health care they were receiving under Medicare Advantage plans.

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 co-sponsored by the Leukemia & Lymphoma Society, California Health Advocates (CHA) and California Alliance for Retired Americans (CARA) and supported by 39 other organizations, including the American Association of Retired Persons, Health Access Now and the Western Center on Law and Poverty. 

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. 

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