Medigap’s Gap for People with Disabilities

The Kaiser Family Foundation ran a story, The Gap in Medigap focuses on the “gap” for those individuals with disabilities on Medicare who don’t have Medigap policies.  The gap is significant: “even with Medicare, beneficiaries under 65 with disabilities report greater difficulty accessing the care they need, sometimes because they cannot afford the cost. For some, this may be related to not having supplemental coverage, such as Medigap, to help with their out-of-pocket costs. In fact, a much smaller share of beneficiaries under 65 with disabilities than seniors have a Medigap policy (2% versus 17%, respectively), and a much higher share have no supplemental coverage whatsoever (21% versus 12%).”

Why the gap?  Cost may be a factor, but the article offers another, compelling reason. 

The substantially lower rate of Medigap coverage among under age 65 adults with disabilities may be due in large part to the provision in the federal law mentioned above that gives Medicare beneficiaries age 65 and older the right to purchase a Medigap policy during the first six months after they enroll in Medicare Part B and under other limited circumstances, but does not provide the same guarantee to younger people who are entitled to Medicare due to having a disability. According to the Centers for Medicare & Medicaid Services, 31 states have gone beyond the federal minimum standard to require insurers in their states to provide at least one kind of Medigap policy to beneficiaries younger than age 65, but the other 19 states and DC have not ….

The article also notes how things have changed since the law went into place over 25 years ago, including changes to the Medigap provisions of the Medicare statute. One of the big changes is that with Part D, Medigap policies no longer cover prescription drugs. So factoring out the Part D spending, the Kaiser story notes “Medicare per capita costs are similar for younger beneficiaries with disabilities and seniors….”

So why maintain the difference between those 65 and older and those under 65 with disabilities?  Is it time for a change? The article suggests yes, that “it’s not clear what the justification is for treating younger adults with disabilities differently from older adults when it comes to buying a Medigap policy.” The article proposes several benefits to changing the law which “could help to reduce the gap in Medigap coverage between younger and older beneficiaries, help alleviate cost-related access problems among the relatively small but vulnerable group of people under 65 who qualify for Medicare, and provide more equitable treatment to Medicare beneficiaries across the states.”

Good food for thought! (and maybe a good topic for a student paper)