Sen. Blakespear Introduces Legislation to Protect Access to Health Care for Seniors

SACRAMENTO – Sen. Catherine Blakespear, D-Encinitas, introduced legislation on Thursday to protect access to health care for seniors. 

SB 242 expands protections for seniors with pre-existing medical conditions, requiring that they be offered access to Medicare Supplement Insurance, known as Medigap, and without discrimination regarding their age or health condition. The legislation would stop the practice of Medigap plans denying coverage to seniors with pre-existing medical conditions or charging them extremely high premiums for them.

“Being able to access affordable health care is crucial for seniors who are often forced to live on fixed incomes or limited means,” Sen. Blakespear said. “It’s not fair that some seniors are shut out of Medigap for pre-existing medical conditions, forcing them to choose between food and needed health care. SB 242 eliminates this injustice.”

The bill requires health insurance companies to set up an annual open enrollment period for Medigap. During open enrollment, all Medicare beneficiaries would have the right to buy Medigap without discrimination based on their health condition or age.

Under current California law, Medicare beneficiaries only have a right to purchase a Medigap plan when they initially enroll in Medicare, which is usually at age 65. Medicare and Medigap are also available for a select class of disabled persons under age 65.

Although the Affordable Care Act prohibited private insurers from denying coverage to people with existing medical conditions or charging them high prices for it, the provision does not apply to Medigap. Medicare is a federal health care program for seniors, but states are given the authority to regulate the rules regarding coverage for Medigap plans.

Supplemental insurance is crucial for many on Medicare. That’s because Medicare is a traditional fee-for-service program that only covers 80 percent of the cost for inpatient and outpatient services. Therefore, people with expensive health issues or costly diseases, such as cancer, need additional insurance to cover out-of-pocket expenses. 

They can choose between Medicare Advantage or traditional Medicare with Medigap. Medicare Advantage is essentially a bundled alternative to Medicare, with different coverages and benefits. Medigap only supplements Medicare Parts A and B, and instead of a fee for service, charges a monthly premium that covers nearly all costs, making it attractive to people with ongoing health issues or expensive-to-treat conditions.

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

"Medicare beneficiaries deserve the same right to access Medigap as they have to annually switch to Medicare Advantage plans,” said Bonnie Burns, Consultant for California Health Advocates and Consumer Representative to the National Association of Insurance Commissioners. “No one should be denied coverage simply because of their current health condition — especially when the option to purchase Medigap could provide relief from high, unpredictable healthcare costs."

Laurie Adami is a cancer survivor and peer mentor who resides in Los Angeles, Calif. She has lived with follicular lymphoma and an incurable form of non-Hodgkin lymphoma for 19 years.

“Medigap helps me cover my life-saving infusions which cost $10,850 each month,” Adami said. “Without Medigap, I can’t imagine the sacrifices we would have to make and the medical debt we would have taken on. Other patients in my position have talked about skipping treatment, cutting pills in half, or changing the food they ate to pay their medical bills.”

Adami’s story illustrates the challenges seniors can face without access to Medigap, according to Adam Zarrin, Director of State Government Affairs for the Leukemia & Lymphoma Society, which is sponsoring the legislation.  

"Laurie's story reinforces why having comprehensive health insurance is important, not just for blood cancer patients, but for every patient,” Zarrin said. “Without Medigap, high out-of-pocket costs force patients to make decisions that place their health or finances at risk. We thank Senator Blakespear for carrying this important legislation to make sure every Californian on Medicare can have access to the health plan that best meets their needs."

Said Hene Kelly, Chair of the California Alliance for Retired Americans (CARA) Legislative Committee: "Without guaranteed issue and community rated Medigap offerings, health insurance companies can deny patients access to Medigap plans entirely or charge much higher premium rates based on health and age. By working together to pass SB 242, we can eliminate using pre-existing conditions against patients in need of supplemental Medigap coverage and make coverage more affordable for California's seniors."

SB 242 will also end the long-standing discrimination against patients under age 65 with end-stage renal disease (ESRD) and their inability to purchase a Medigap plan. ESRD is a condition covered by Medicare for people under the age of 65, but those afflicted don’t have access to Medigap to manage the costs.

Once Rosheen McLaughlin of Sacramento stopped working due to needing kidney dialysis, the 32-year-old was transitioned to Medicare. He had no way to cover the 20 percent out-of-pocket costs required under Medicare, making him ineligible to get a transplant due to the high cost of his health care.

“After spending down my assets for eight years, I became eligible for Medi-Cal to cover my out-of-pocket expenses, and I finally received both a heart and kidney transplant,” McLaughlin said. “But if I had access to affordable Medigap coverage when I first was on dialysis, I could have been immediately added to the active transplant waitlist.”

"For far too long,” said Dialysis Patient Citizens (DPC) Board President Andrew Conkling, “dialysis patients in California have faced discrimination from insurers, making it harder for them to secure life-saving treatment and necessary health coverage. With Senator Blakespear’s legislation, dialysis patients in California will finally have access to affordable Medigap coverage that they’ve been denied for more than 20 years, saving them thousands of dollars and giving them access to the transplant list. DPC is grateful for Senator Blakespear’s leadership on this bill, and we look forward to partnering with her in our fight to restore protections for dialysis patients.”

Said Kelly Goss, Managing Director of Advocacy for the ALS Association: “California needs to increase access to Medigap without subjecting patients to medical underwriting and to protect premium pricing for Medicare beneficiaries of all ages because too many have inadequate coverage. People living with ALS or other serious medical conditions need access to specialty care and don’t have the luxury of time to continually fight delays and denials imposed by their Medicare Advantage plan, nor can they afford to choose traditional Medicare without having supplemental coverage.” 

"Senator Blakespear’s leadership on this important issue will make a tremendous impact on seniors across our state,” said Chris D. Van Gorder, FACHE, Scripps Health President and CEO. “We are one of the few states that has not closed the pre-existing condition loophole for seniors with Medicare Advantage and it's time we did." 

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

###