Sen. Blakespear’s Bill to Protect Access to Health Care for Seniors Passes Committee

SACRAMENTO – Legislation by Sen. Catherine Blakespear, D-Encinitas, to protect access to health care for seniors passed the Senate Health Committee on Wednesday. 

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 extremely high premiums for them.

“Seniors should not be shut out of Medigap for pre-existing medical conditions, something that is not allowed in the rest of health insurance marketplace,” Sen. Blakespear said. “It’s imperative that seniors have access to affordable health care, and SB 242 ensures they get it.”

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.

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, as do people with Parkinson’s disease, ALS and other long-term maladies. 

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.

Sen. Blakespear represents Senate District 38. Her constituents live in northern San Diego County and southern Orange County. To learn more about the district and Sen. Blakespear, visit her Senate website.