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Important News for Younger People with Disabilities on Medicare
January 7, 2004For Immediate Press Release
(Sacramento, California) Effective January 1, 2004, people under 65 years old with Medicare in California have a one time opportunity for 90 days to purchase one of five Medigap policies regardless of their health condition. This new right applies to all younger people with Medicare except those with end stage renal disease (ESRD). The legislation or SB 1531, responsible for this new right to coverage was authored by Senator Jackie Speier (D-Hillsborough).
Unfortunately, very few people are aware of this new right stated Bonnie Burns, Training & Policy Specialist with California Health Advocates, the California HICAP Association. This new law makes it possible for people with disabilities to purchase a Medigap plan, including a plan that offers some prescription drug coverage.
The monthly premiums of Medigap for people under 65 year old can be much higher when compared to premiums charged for people over 65 years old. Companies charge for these policies based on age, gender, residence and marital status. There are no restrictions on how much a company may charge younger Medicare beneficiaries. For comparison shopping or to get an idea on the potential cost of a policy, people can visit the California Department of Insurance website which offers a list of Medigap companies and sample rates at ; search for Medigap Guide to find the Medicare supplemental information.
A Medigap plan is a Medicare supplemental insurance policy. Ten standardized policies labeled as plans A through J are federally approved policies which pay some or all of the Medicare co-payments, deductibles and costs not covered by the Medicare program. Plans H, I and J offer some coverage for prescription drugs, but also have a higher monthly premium. In addition, these plans have a $250 deductible and a 50% co-payment. Plans H and I have an annual cap of $1,250 and Plan J has an annual cap of $3,000. If a person has other health benefits, they may not want to trade them for one of these plans.
Under this new law, if people with Medicare under 65 years of age apply for coverage through plans A, B, C, F or one of the three prescription drug plans (H, I or J), the insurance company must sell a plan to them, regardless of poor health or pre-existing conditions. The insurance company decides which of the three prescription drug Medigap plans they will make available. Unlike Health Maintenance Organizations (HMOs), or Medicare+Choice Plans or Preferred Provider Organizations (PPOs), Medigaps do not limit coverage to a closed network of doctors or require pre-authorization for treatment.
If a person is under 65 years old and just became eligible for Medicare, the same legislation allows the right to purchase one of these five plans for six months after first signing up for Medicare Part B, unless diagnosed with permanent kidney failure or end stage renal disease (ESRD).
People who are interested in looking into purchasing a plan or those who have been denied coverage by a Medigap insurance company should contact their nearest Health Insurance Counseling and Advocacy Program (HICAP) office at the statewide toll free number 1 (800) 434-0222 for free guidance. For easy access to information via the Internet, visit CA Medicare website for a complete listing of resources, phone numbers and addresses for the closest counseling program.
Contact Information
Bonnie Burns, Training & Policy Specialist
(831) 438-6677
FAX (831) 438-2441
mail to: E-mail Bonnie Burns
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