Gómez Urges Action on Medigap Bill During Joint Committee on Health Care Financing Hearing

The Massachusetts Joint Committee on Health Care Financing heard testimony today on legislation filed by State Senator Adam Gómez (D–Springfield) to eliminate a long-standing gap in state law that prevents Medicare-eligible residents under age 65 with End Stage Renal Disease (ESRD) from accessing affordable Medigap supplemental insurance. 

Senator Gómez, who personally survived his experience with kidney failure and underwent a kidney transplant, filed the bill to ensure that younger patients facing kidney failure are no longer denied the financial protection and transplant access that older Medicare beneficiaries receive. 

“As someone who survived End Stage Renal Disease and knows firsthand the fear, the cost, and the uncertainty that come with kidney failure, I filed this bill because no one should be denied the coverage they need simply because they got sick before turning 65,” said Senator Gómez. ”Massachusetts is one of only four states that still blocks younger ESRD patients from accessing affordable Medigap plans, and that barrier keeps too many people from financial stability and lifesaving transplants. This legislation is a simple, long-overdue fix that will finally give hundreds of patients the protection and dignity they deserve.”  

The legislation, S.2737, An Act Relative to Medicare Coverage of End-Stage Renal Disease, would correct a technical exclusion in state law that currently prevents Medicare-eligible residents under 65 with ESRD from purchasing Medigap plans. Key provisions include: 

• Ensuring equal access to Medigap coverage for under-65 ESRD patients who are on Medicare but do not qualify for MassHealth. 

• Aligning protections so that younger ESRD patients receive the same guaranteed Medigap enrollment rights that all Medicare beneficiaries receive at age 65. 

• Ending Massachusetts’ status as one of only four states — alongside California, Nebraska, and Vermont — that still deny this coverage. 

• Providing financial stability by shielding patients from uncapped 20% Medicare cost-sharing, which can reach up to $16,000 annually. 

• Expanding access to kidney transplantation, since most transplant centers require secondary insurance before listing a patient. 

Who This Bill Helps 

Approximately 846 Massachusetts residents under age 65 with ESRD would gain access to affordable Medigap coverage under this proposal. These individuals are Medicare-eligible due to kidney failure but do not qualify for Medicaid, leaving them responsible for high out-of-pocket costs that often force families into financial crisis. 

Why It Matters 

• Financial protection: Medicare covers only 80% of costs, leaving ESRD patients exposed to unlimited cost-sharing. 

• Transplant eligibility: Secondary insurance is required by most transplant centers before a patient can be placed on the active waitlist. 

• Preventing medical impoverishment: The bill could save MassHealth an estimated $1.6 million over five years by reducing the number of residents forced to spend down assets to qualify for Medicaid. 

• Minimal cost impact: Adding this population to the Medigap pool of 343,000 policyholders would result in a de minimis premium increase of about $1 per month, if insurers choose to adjust rates.