Springfield, MO

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New rule opens up Medigap enrollment

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As of June 30, tens of thousands of disabled Missourians can now purchase Medicare supplemental insurance also known as "Medigap" policies for the first time, enabled by a new Missouri Department of Insurance rule.

More than 86,000 disabled Missourians participate in the Medicare program that covers most health care needs for more than 700,000 residents who qualify because they are 65 or older, according to a news release from the Department of Insurance.

But younger disabled persons, unlike seniors, have been unable to buy private insurance to supplement basic Medicare coverage, the department stated. Benefits available under the standard Medigap policy can include, most importantly, prescription drugs, but also cover short-term skilled nursing care, in-home care and the patient's out-of-pocket share of doctors' costs.

From June 30 to Dec. 30, current, disabled Medicare participants can buy Medigap policies from any of about 790 insurers marketing the coverage in the state, according to the Department of Insurance.

In the future, the department added, all disabled persons entering the Medicare program before age 65 will have six months to buy a policy without the risk of rejection.

After this initial open enrollment period expires, insurers may deny coverage for such reasons as health status, although a few companies still guarantee all seniors the right to buy coverage, the department stated.

Under the new Department of Insurance rule, insurers can charge no more than their average rate for the policy. A department actuary said the proposed rule could result in a general premium increase of 1 percent.

"The opportunity to buy full health insurance protection is long overdue for these Missourians," said Jay Angoff, director of the Department of Insurance, in the release.

Before 1995, no disabled person enrolled in Medicare before age 65 ever became eligible for the normal six-month open enrollment period that seniors have had.

Congress required open enrollment periods for senior disabled Americans, effective in 1995.

But until recently, state law prohibited the department from addressing the insurance difficulties of disabled Missourians enrolled in Medicare but under age 65, the release stated.

For those persons, the only commercial Medigap insurance option has been the 17 insurers who do permit disabled Missourians to buy such policies. Those insurers, however, can underwrite or refuse to insure persons based on health conditions, the Department of Insurance said.

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