DISABLED MEDICARE PARTICIPANTS GAIN PERMISSION TO BUY MEDIGAP INSURANCE

More than 86,000 disabled Missourians under 65 years of age will be able to buy supplemental health insurance later this year as a result of a new rule issued by the Missouri Department of Insurance.

The new rule, a result of changes in federal and state laws, takes effect June 30.

The Department of Insurance can't issue regulations without enabling legislation, said spokesman Randy McConnell.

For example, the insurance department can't require insurers to offer health coverage to individuals such as farmers and small-business employees.

The Missouri House last week approved a bill that would allow those Missourians to buy health coverage through an insurance plan for government workers.

McConnell said the Legislature legally could pass a law requiring insurers to offer health care coverage to farmers and others.

Some 13 states have laws requiring insurers to offer health care coverage for individuals.

But he said such a scenario is politically unrealistic in Missouri and no such bill has been introduced. Lawmakers and insurance companies would oppose the idea, he said.

Regarding Medicare coverage, Congress had to first change the law and then the state Legislature.

Medicare currently covers most health care needs for more than 700,000 elderly Missourians.

But younger disabled persons haven't had the right to buy private Medigap policies to supplement basic Medicare coverage, said McConnell.

Benefits available under the standard Medigap policies can include prescription drugs, short-term nursing home care, in-home care and the patients' out-of-pocket share of doctors' costs.

Those benefits now will be made available to disabled Medicare recipients under 65 years of age, McConnell said.

From June 30 until Dec. 30, current, disabled Medicare participants will be able to buy Medigap policies from any of about 70 insurers that offer health coverage in the state.

In the future, all disabled persons entering the Medicare program before age 65 will have six months to buy a policy without being denied coverage.

After the open-enrollment period, insurers may deny coverage for health or other reasons.

Under the new Department of Insurance rule, insurance companies can't charge more than their average rate for the policy.

"The companies have to get the rates approved by us," McConnell said.

Current Medicare recipients should experience no more than a 1 percent increase in premiums, he said.

Open enrollment is essential for disabled Medicare recipients, McConnell said. Otherwise, he said, insurers would refuse to insure many disabled persons for health reasons.

The department rule also keeps insurers from charging high premiums that many disabled persons couldn't afford, McConnell said.

Seventeen companies currently offer Medigap insurance to some disabled Missourians. But those insurers also have the right to deny coverage to such applicants for health reasons, McConnell said.

Before 1995, no disabled person enrolled in Medicare could qualify for the normal six-month open enrollment for Medigap policies that was available to senior citizens.

In 1995, Congress passed a law that requires open enrollment periods for elderly, disabled Americans, McConnell said.

The law left it open for states to decide if they wanted to expand open enrollment to disabled persons under the age of 65.

In 1996, the Missouri Legislature passed such a law, setting the stage for the Insurance Department to issue its new rule.