House Bill 2516 creates new Medicare supplement enrollment and rating protections for Texans who qualify for Medicare before age 65 due to end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
- Starting September 1, 2025, an individual with ESRD or ALS who becomes eligible for Medicare before age 65 must be offered the same coverage offered to those 65 and older, at the same rates for Plans A, B, and D, and at no more than 200% higher rates for all other plans. No medical underwriting, waiting period, or preexisting condition limitation may be imposed.
- To ensure carriers are in compliance on September 1, 2025, TDI urges carriers to make necessary filings no later than August 1, 2025.
- Rate filings must demonstrate that the rates for individuals under age 65 with ESRD or ALS comply with Insurance Code § 1652.069.
- Forms must be updated as necessary to ensure that:
- applications collect the information necessary to identify when an individual qualifies for the protections of HB 2516; and
- preexisting condition exclusions are not applied to individuals with ESRD or ALS who are under age 65.
- Rates and forms, including applications, must be filed and approved by TDI before they may be used. See 28 TAC § 3.3322 and Insurance Code § 1701.051.
- Carriers must ensure that approved forms are continuously available, unless the carrier discontinues a form's availability consistent with 28 TAC § 3.3322. TDI urges carriers to notify the department of any application availability issues.
- Between December 1, 2025, and June 1, 2026, an individual who is younger than 65 and is already enrolled, as of June 20, 2025, in Medicare Part B because of ESRD or ALS will have an opportunity to enroll in a Medicare Supplement plan with the enrollment and rating protections of HB 2516.
- Some individuals who will qualify under HB 2516 are already enrolled in Medicare Supplement plans, and TDI has received questions about whether the bill requires carriers to change these individuals' rates. Carriers are not required to change rates for current Medicare Supplement insureds who do not submit a new application for coverage. However, to ensure that all eligible individuals receive the protections under HB 2516, TDI encourages carriers to notify current enrollees of the enrollment opportunity that begins December 1, 2025.