Medigap for the Disabled Under 65

By Joan Opiyo
eMedicareSupplements Contributor

Woman in a Wheelchair Reading a Newspaper

Even with all the news about health care reform and the attempt to create affordable health insurance for all Americans, disabled individuals under age 65 remain an overlooked segment of the population. While qualified disabled Americans enjoy Medicare coverage, Medicare does have certain out-of-pocket costs but no annual out-of-pocket limit. Because of this, serious conditions can prove to be rather expensive. In addition, because various states have different terms and regulations for Medicaid coverage, beneficiaries under age 65 may find themselves ineligible for state assistance.

Many of these individuals are also unable to afford a Medicare supplement plan, also known as a Medigap plan. The rules that govern Medicare supplements provide that if an applicant is within six months of their Part B effective date, an insurance carrier is not allowed to turn down their application, regardless of any pre-existing conditions. But this provision does not apply to a disabled Medicare beneficiary under age 65.

Certain states require insurance companies that are offering Medicare supplements to offer at least one Medigap plan to the under-65 market, although their premiums are typically on the higher side. If you find yourself stuck in this position, the good news is that once you reach the age of 65 you will get to take advantage of the Medigap rates offered to seniors.

Insurance carriers state that they need to charge the disabled population more due to the conditions that led to their disabilities. This leads to higher premiums because the policy usage of disabled beneficiaries tends to be higher than that of seniors. A good alternative for some disabled individuals on Medicare may be a Medicare Advantage plan, which does not discriminate by age. While some individuals have capitalized on this option, others may reside in areas where the available Medicare Advantage plans will not let them use their current doctors or facilities of choice.

If you are a disabled Medicare beneficiary under age 65, contact one of our trained specialists to determine the best private insurance plan among the options available to you in your state. You may also benefit from contacting state assistance programs that seek to help offset the cost of healthcare.

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