New law helps the elderly get 'Medigap' insurance No rejections allowed for health reasons

November 05, 1991|By New York Times News Service

WASHINGTON -- State insurance commissioners announced yesterday that people reaching the age of 65 now will be able to buy private health insurance to fill the gaps in Medicare without having to worry about being rejected because of illness, injury or existing medical problems.

The guarantee, which could lead to higher private insurance premiums, is one of several new consumer protections for elderly people buying health insurance to supplement Medicare. The relaxed eligibility standards generally do not apply to people who turned 65 before May 1991, although there are exceptions.

Beginning today, for the first time, Americans 65 or older will be able to buy private insurance to supplement Medicare, regardless of the condition of their health, if they act within six months after enrolling in Medicare.

The protections apply to new beneficiaries, which means about 2 million people a year.

About 30 percent of people covered by Medicare do not have such "Medigap" insurance, many because of medical problems that made them ineligible.

Private policies supplementing Medicare are called Medigap insurance because they fill gaps in Medicare, the federal program that provides health insurance for 34 million people. Medigap policies cost $300 to $1,200 a year.

The new protections, which result from a law Congress passed last fall, will be enforced by state insurance commissioners. Some take effect this week, others next summer.

Earl R. Pomeroy, the insurance commissioner of North Dakota, said, "What this means is that from now on, new recipients of Medicare 65 or older have an opportunity to buy Medicare-supplement insurance without having to worry about being rejected because of past health problems. They now have an ironclad assurance that they will be able to supplement their Medicare coverage."

Since Medicare was created, thousands of consumers have complained about shortcomings in the program, and Congress established federal standards last year for Medigap insurance.

Gail E. Shearer, manager of policy analysis at Consumers Union, said the new standards mean that elderly people with such ailments as heart problems, high blood pressure and cancer "will have the opportunity to purchase high-quality supplemental health insurance coverage on the same footing as other consumers" who have no such medical problems.

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