If you are under 65 and living with a disability, you might be eligible for Medicare due to a qualifying disability. While Medicare covers a portion of your healthcare expenses, it may not cover everything.
That’s where Medigap insurance comes into play. Medigap, also known as Medicare Supplement Insurance, is designed to fill the gaps in Original Medicare coverage, providing you with additional financial security and peace of mind. In this article, we’ll delve into the intricacies of obtaining Medigap insurance if you’re under 65 and disabled, ensuring you have all the necessary information to make informed decisions about your healthcare coverage.
Can I get Medicare Supplement insurance if I’m under 65 and disabled?
Yes, you can get Medigap insurance if you’re under 65 and disabled, but it largely depends on the state you reside in. Not all states offer Medigap plans to individuals under 65, even if they qualify for Medicare due to a disability. However, some states do provide this option, so it’s essential to understand the regulations in your specific state.
Understanding Medicare Supplement Insurance
Medigap insurance is supplementary coverage offered by private insurance companies to help pay for the “gaps” in Original Medicare, such as co-payments, deductibles, and coinsurance. There are ten standardized Medigap plans available, labeled A, B, C, D, F, G, K, L, M, and N. Each plan offers different benefits, allowing you to choose the one that best fits your healthcare needs and budget.
How to Qualify for Medicare Supplement Insurance Under 65
To qualify for Medigap insurance if you’re under 65 and disabled, you must meet certain criteria. Here are the general requirements:
Medicare Eligibility: You must be enrolled in both Medicare Part A and Part B due to a qualifying disability. Typically, there is a waiting period of 24 months after receiving disability benefits before your Medicare coverage begins.
State Regulations: As mentioned earlier, not all states offer Medigap plans to individuals under 65. Confirm with your state’s insurance department to determine if you are eligible.
Open Enrollment Period: If you are eligible for Medigap insurance, your best opportunity to secure a plan is during the six-month open enrollment period that starts the first day of the month you turn 65 and are enrolled in Medicare Part B. During this period, you have guaranteed issue rights, meaning insurance companies cannot deny you coverage or charge higher premiums based on pre-existing conditions.
Learn more about Medicare Enrollment Periods here.
Guaranteed Issue Rights: Apart from the initial open enrollment period, there are specific situations where you may have guaranteed issue rights. For instance, if you lose other health coverage, such as employer-sponsored insurance, you might have a limited window to purchase a Medigap policy without fear of medical underwriting.
Medical Underwriting: If you apply for Medigap insurance outside of your open enrollment or guaranteed issue rights, insurance companies may subject you to medical underwriting. This means they can consider your medical history and may charge higher premiums or deny coverage based on pre-existing conditions.
Medigap Plans for Disabled Individuals Under 65
If you are under 65 and disabled, you should explore the Medigap plans available in your state. Each plan offers different coverage levels, so it’s essential to find one that caters to your specific medical needs and budget. Here are some popular Medigap plans:
1. Medigap Plan F
Medigap Plan F, one of the most comprehensive plans, covers almost all Medicare-related out-of-pocket costs. This includes deductibles, coinsurance, copayments, and excess charges. However, Plan F is no longer available to newly eligible Medicare beneficiaries as of 2020.
2. Medigap Plan G
Medigap Plan G is similar to Plan F but does not cover the Medicare Part B deductible. It provides excellent coverage for those willing to pay the Part B deductible themselves. Plan G has gained popularity among beneficiaries who want robust coverage without paying for benefits they may not utilize fully.
3. Medigap Plan N
Medigap Plan N is a cost-sharing plan, meaning you’ll be responsible for certain copayments and coinsurance. This plan usually has lower premiums compared to Plan F and Plan G, making it an attractive option for those looking to save on monthly costs while still having significant coverage.
Medigap Coverage for Disabled Beneficiaries
Medicaid and Medigap
If you’re eligible for Medicaid, a joint federal and state program that assists with healthcare costs for individuals with limited income and resources, your Medigap options may vary. Some states provide additional Medigap benefits for beneficiaries with both Medicare and Medicaid, such as coverage for deductibles or copayments. It’s crucial to understand your state’s policies regarding dual eligibility to maximize your benefits.
FAQS
Can I switch Medigap plans in the future if my healthcare needs change?
Yes, you can switch Medigap plans in the future, but you may be subject to medical underwriting if you’re outside your open enrollment or guaranteed issue rights period. It’s essential to consider your current and future healthcare needs when selecting a plan.
Will Medigap cover all my medical expenses?
While Medigap plans provide additional coverage, they may not cover everything. For instance, prescription drug coverage is not included in Medigap plans. You may need to enroll in a separate Medicare Part D plan for prescription drug coverage.
Conclusion
If you’re under 65 and disabled, Medigap insurance can be a valuable addition to your healthcare coverage. While not all states offer Medigap plans to individuals in this category, those that do provide an opportunity for greater financial security and access to a broader network of healthcare providers. Remember to explore the available Medigap plans in your state and take advantage of your open enrollment or guaranteed issue rights for the best coverage options. By understanding the eligibility criteria and available plans, you can make informed decisions about your healthcare and ensure you receive the best possible care.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
