What You Need to Know About Medicare Supplement Insurance Options if You Are Disabled and Under 65

Medicare Supplement Eligibility — General Rules

One major difference in eligibility rules for those who enter Medicare early is that you may not be able to enroll in Medicare Supplement insurance before age 65. The federal Medicare rules require insurance companies to issue Medicare Supplement plans to people during their Medigap Open Enrollment Period.

This Open Enrollment Period begins once you reach age 65. For those who enter Medicare at a younger age due to disability, your Medigap Open Enrollment Period is preserved, but you’ll have to wait until you turn 65 to use it.

During your Medigap Open Enrollment Period, you can’t be declined for coverage, and you can’t pay a higher premium based on preexisting conditions. But these provisions don’t apply to you if you want Medigap before age 65. In this case, you will go through underwriting, and the premiums are often very high.

If you live in a state that allows you to get Medicare Supplement coverage, you must be enrolled in both Parts A and B of Original Medicare. And, you must continue to pay your Part B premium to keep your coverage.

Alternatives to Medicare Supplement Plans for Disabled Under 65

If your state doesn’t allow you to get Medigap under age 65, or if you can’t afford the premiums, you have another option to limit your out-of-pocket costs. Medicare Advantage plans, also known as Medicare Part C, are available to anyone eligible for Medicare, regardless of age. Medicare Advantage plans are generally more affordable than Medigap coverage.

These plans are a private alternative to Original Medicare. Medicare Advantage plans must cover everything Original Medicare covers. In addition to this, all Medicare Advantage plans must have an out-of-pocket maximum (OOPM). This is the maximum you are allowed to spend in any year on Medicare services. If you exceed this amount, your insurance company pays 100 percent of your covered expenses for the rest of the year.

Other Benefits of Medicare Advantage

Original Medicare doesn’t have an out-of-pocket maximum, so this is an important protection. Another key benefit of Medicare Advantage plans is that they often come with prescription drug coverage. This feature can save you money since you’d otherwise have to pay full price for prescriptions, or enroll in a standalone Part D drug plan to get help with the cost of your medications.

Besides these benefits, Part C plans frequently provide for extra benefits beyond what is covered by Original Medicare. These extra benefits can include:

  • Vision and hearing coverage
  • Dental coverage
  • Fitness benefits like free and discounted gym memberships
  • Transportation
  • Safety alert systems

You may want to consider a Medicare Advantage plan for coverage before your 65th birthday. This can protect you from high out-of-pocket expenses and save you money on medications and other services. You can always enroll in a Medicare Supplement insurance plan down the road, when you turn 65, and you can use your Medigap Open Enrollment Period.

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