American Kidney Fund Applauds Virginia for Expanding Medigap Access to People Under 65

ROCKVILLE, Md. (March 24, 2023)  — The American Kidney Fund (AKF) applauds the state of Virginia for enacting SB 1409/HB 1640. This new law requires that Medicare supplemental policies, or Medigap, be made available to people with disabilities that qualify for Medicare, including people with end-stage renal disease (ESRD), who are under age 65.  

Medigap is private insurance available to Medicare beneficiaries to cover costs that Medicare does not cover. Federal law stipulates that Medigap insurers must offer plans to all beneficiaries age 65 and over, but state law dictates Medigap policy for Medicare beneficiaries under the age of 65. With the passage of SB 1409/HB 1640, Virginia is the 32nd state to require Medigap insurers to offer plans to people with ESRD who have Medicare as their insurance. Just as importantly, this bill includes premium protection, making sure that ESRD patients under 65 will not pay a higher premium than other plan subscribers over 65.

"Where you live shouldn't determine whether your Medicare coverage is affordable, so this legislation is an important victory for people with ESRD in Virginia," said LaVarne A. Burton, AKF President and CEO. "AKF is grateful to Sen. George Barker and Majority Leader Del. Terry G. Kilgore for introducing the bill in the Virginia Senate and House, respectively."

Medicare covers dialysis treatments as an outpatient procedure, which means that it covers only 80 percent of the cost of treatment. The patient must pay the other 20 percent with no annual out-of-pocket limit. Dialysis, which usually occurs three times a week, can cost approximately $10,000 per year or more for a patient without secondary insurance. Access to a Medigap plan can ease the burden of these high costs, making it easier for patients to cope with the serious financial challenges that patients often experience after being diagnosed with a chronic disease.

Medigap coverage also allows patients with ESRD to get on the transplant waiting list.

"Most transplant centers will not accept Medicare beneficiaries onto their transplant list without secondary insurance such as Medigap," said Burton. "Since a kidney transplant is the best treatment for those with ESRD, it is not an understatement to say that this legislation will be a lifesaver."

There are nearly 104,000 Americans on the organ transplant waiting list and more than 90,000 of them, or 87%, are waiting for a kidney. In Virginia, of the 2,792 people currently on the transplant waiting list, 2,453 are waiting for a kidney.

AKF provides long-term financial assistance that makes transplants and post-transplant care possible for low-income dialysis patients. In 2022, AKF grants helped 1,767 people nationwide receive kidney transplants — roughly 7% of all kidney transplants performed in the United States last year. AKF's program helps post-transplant patients for their full insurance plan year, ensuring continuity of care.