1. Executive Summary:
Ohio House Bill 24 aims to amend existing sections of the Ohio Revised Code and enact a new section (3923.3310) to provide access to Medigap (Medicare Supplement) policies for Medicare-eligible individuals under the age of 65. Currently, these policies are primarily available to those 65 and older. The bill intends to extend similar coverage, benefits, and protections to younger individuals eligible for Medicare due to disability or end-stage renal disease. A key provision of the bill prohibits higher premiums for those under 65 compared to those 65 and older. The bill also mandates an open enrollment period for eligible younger individuals.
2. Key Themes and Provisions:
- Expansion of Medigap Coverage: The central theme of the bill is to broaden access to Medigap policies. Section 3923.3310 (A) explicitly states that issuers offering Medigap coverage to those 65 and older “shall offer the same coverage to individuals younger than sixty-five years of age who are eligible for and enrolled in medicare by reason of disability or end stage renal disease.”
- Equal Benefits and Protections: The bill ensures that the benefits, protections, and procedures applicable to older Medicare recipients also apply to younger recipients. Section 3923.3310 (B) states, “Any benefit, protection, policy, or procedure applicable to coverage under a policy for an individual sixty-five years or older shall also apply to coverage offered under this section.”
- Premium Parity: A crucial aspect of the bill is the requirement that premiums for those under 65 cannot exceed those for the 65 and older group. Section 3923.3310 (C) specifies, “The premiums for coverage offered under this section to individuals who are sixty-four years of age or younger shall not be higher than the premiums for a medicare supplement policy offered to individuals sixty-five years of age.”
- Open Enrollment Period: The bill mandates an open enrollment period for younger Medicare-eligible individuals to enroll in Medigap policies. Section 3923.3310 (E) establishes that the open enrollment period “begins on the first day of January that immediately follows the effective date of this section and ends on the immediately following first day of July.”
- Pre-existing Conditions: The bill explicitly prohibits exclusions or limitations on benefits for pre-existing conditions for policies issued to individuals under 65. Section 3923.3310 (D)(2) states “Notwithstanding any provision of the Revised Code to the contrary, a policy issued under this section shall not exclude or limit benefits for losses attributable to a preexisting condition.”
- Policy definitions: The Bill defines key terms like “Applicant,” “Certificate,” “Direct response insurance policy,” “Issuer,” “Medicare,” and “Medicare supplement policy” to clarify the scope and applicability of the regulations.
- Superintendent Authority: The bill reinforces the authority of the Superintendent of Insurance to establish rules, standards, and regulations concerning Medigap policies, ensuring they align with federal law and protect consumers. This includes setting standards for benefits, claims payment, advertising, and marketing practices (Section 3923.332).
- Enforcement and Penalties: The superintendent of insurance has the authority to enforce the provisions of the bill and impose penalties on issuers violating the regulations. This includes the ability to cease marketing non-compliant policies (Section 3923.338).
3. Important Considerations:
- Effective Date: The bill states in Section 3923.3310 (A) that the mandate for offering Medigap policies to the under-65 group begins “not later than the first day of January that immediately follows the effective date of this section.” The open enrollment period also follows the effective date (Section 3923.3310 (E)). Therefore, the timing of the bill’s enactment will dictate when these provisions take effect.
- Potential Impact: The bill could significantly impact the accessibility and affordability of healthcare for younger individuals with disabilities or end-stage renal disease who rely on Medicare. It aims to provide them with more comprehensive coverage by supplementing Medicare benefits through Medigap policies.
- Rulemaking: The Superintendent of Insurance will need to adopt rules to implement the provisions of the bill, particularly concerning benefit standards, claims payment, advertising practices, and premium approval. These rules will be crucial in shaping the practical application of the law.
4. Definitions:
- Medicare Supplement Policy: A policy designed primarily to supplement Medicare reimbursements for hospital, medical, or surgical expenses (Section 3923.33 (G)). Also called a Medigap policy.
- Issuer: Includes insurance companies, fraternal benefit societies, health insuring corporations, and any other entities delivering or issuing for delivery in this state medicare supplement policies or certificates (Section 3923.33 (E)).
5. Conclusion:
Ohio House Bill 24 represents an effort to expand access to Medigap policies for younger Medicare recipients, addressing a gap in coverage for a vulnerable population. The bill’s provisions related to premium parity and open enrollment are particularly noteworthy. Successful implementation will depend on the Superintendent of Insurance’s rulemaking process and the responsiveness of insurance issuers.