Medicare Supplement Plans for Disabled Under 65: What You Need to Know

by David Bynon, last updated

Medicare Supplement Plans for Disabled Under 65

If you’re under 65 and you qualify for Medicare benefits due to a disability or End-Stage Renal Disease (ESRD), you may or may not be able to purchase Medicare supplement insurance plans. It all depends on where you live. However, you absolutely will once you do turn age 65.

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Medicare Supplement Plans for the Disabled

Each state has its own set of rules regulating the sale of supplemental Medicare insurance. Even though Federal law includes a nationwide Medicare supplement guaranteed-issue right protection for Medicare beneficiaries, it does not mandate that insurance companies must sell Medigap plans to people under 65.

There are 29 states that do require insurers to sell Medicare supplements to people who are eligible for Medicare, regardless of their age:

  • California **
  • Colorado
  • Connecticut
  • Delaware *
  • Florida
  • Georgia
  • Hawaii
  • Illinois
  • Kansas
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts **
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • Oklahoma
  • Oregon
  • Pennsylvania
  • South Dakota
  • Tennessee
  • Texas
  • Vermont **
  • Wisconsin

* Only available to people with ESRD.
** Not available to people with ESRD.

Although the insurance board in your state may not require insurers to sell Medicare supplements to people under 65, some insurance companies do. In most cases, due to less competition and higher risk, the cost will be higher and you can be denied coverage for preexisting conditions. Be sure to visit your state’s board of insurance web page to review your rights.

Best Medicare Supplement Plans for Disabled Under 65

Everyone’s situation is different, so there’s no single best plan. In general, you should try to get the most coverage you can afford, especially if your condition requires you to frequently see your doctor or a specialist. These visits can add up fast if you’re paying out-of-pocket.

Medicare Advantage Plans for the Disabled Under 65

If you live in a state that does not require insurers to sell Medicare supplements to people who are eligible for Medicare, regardless of their age, your next best option is a Medicare Advantage plan. Although these plans do cover deductibles, copays, and coinsurance in the same way as a Medicare supplement, they will protect you from the risk of high out-of-pocket costs. All Medicare Advantage plans have a maximum out-of-pocket limit of $8,550 per year, and some are much lower.

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Medicare Supplement Open Enrollment Period at Age 65

The fact that your state does not force insurance companies to sell you a Medicare supplement under the age of 65 does not negate your privilege when you do turn age 65. So, no matter the age when you first become a Medicare beneficiary, at age 65 you have a one-time personal open enrollment period that grants you a guaranteed-issue right to get the Medigap plan of your choice. As a result, insurance companies can’t ask you about your pre-existing health condition and must issue you a policy.

Be aware, however, that your guaranteed-issue right only lasts for six months, starting on your 65th birthday. Once that six-month window has passed, your guaranteed-issue right expires and you can be turned down.

Need help? Call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency.

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