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

If you’re under the age of 65 and you qualify for Medicare benefits due to a disability or End-Stage Renal DiseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD), you may or may not be able to purchase Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plans. It all depends on where you live. However, you absolutely will once you do turn age 65.

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 deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., copaysA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  in the same way as a Medicare supplement, they will protect you from the risk of high out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. All Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). have a maximum out-of-pocket limit of $8,550 per year, and some are much lower.

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 beneficiaryA person who has health care insurance through the Medicare or Medicaid programs., at age 65 you have a one-time personal open enrollment periodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31. that grants you a guaranteed-issue rightGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting. 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.

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