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Delaware Laws on Medicare Supplements for ESRD

Those with end-stage renal disease (ESRD) often rely on Medicare to provide health insurance. Unfortunately, Medicare does not provide much coverage to ESRD enrollees patients. They do not qualify for any Medicare Advantage plans, so they can obtain traditional Medicare. Medigap policies work as a supplement to traditional Medicare and can help offset some of the costs. Some states, including Delaware, grant those with ESRD the opportunity to purchase a Medigap, giving them more Medicare options.

  1. Medigap Enrollment

    • The federal law currently states that only those over the age of 65 have the guaranteed right to purchase a Medigap. The federal law allows states to expand upon this law. As of January 19, 2009, those with end-stage renal disease were granted a Medigap open enrollment period in the state of Delaware. This means that they will have a three-month period following the month they enroll into Part B. During this period, Medigap plans cannot deny ESRD patients Medigap coverage. This is called a guaranteed issue right.

    Extended Open Enrollment

    • The January 19, 2009 law also extended to those with end-stage renal disease an open enrollment period when they lose qualified health coverage. For example, if an ESRD patient loses employer insurance after they are Medicare-eligible, he will get a second open enrollment period. The ESRD patient must sign up for Part B and sign up for a Medigap plan within 63 days. Within these 63 days, Medigap plans may not deny the ESRD patient coverage. Qualified health coverage is typically a group health plan with 100 or more employees.

    Pre-Existing Conditions

    • Enrollment into a Medigap plan during an open enrollment period cannot delay coverage of pre-existing conditions. If an ESRD patient were to join a Medigap without these guaranteed issue rights, the Medigap may impose a six-month waiting period on pre-existing condition coverage.

    Open Enrollment Period Exceptions

    • Those with ESRD who did not purchase a Medigap plan during their open enrollment period can still purchase a Medigap plan if they can find a company that is willing to sell it to them. However, the company may sell it to them at a higher price and may impose pre-existing condition waiting periods.

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