Medicare Disability

Original Medicare and Medicare insurance is a concern for disabled individuals under age 65 because the options for  Medicare insurance for individuals under age 65 is not always available or is limited.  However, original Medicare Part A and Part B coverage is available for assisting disabled individuals who meet certain eligibility requirements.  People with End Stage Renal Disease (also known as “ESRD”), or kidney failure, may also be eligible for original Medicare if the individual is entitled to receive benefits from Social Security or the Railroad Retirement Act.  If you are disabled and have been receiving Social Security benefits for over two years and have not “aged-in”, or are not 65 years of age, then you may be eligible for original Medicare and Medicare insurance for individuals under age 65. Some states offer Medicare Supplement plans as a form of Medicare insurance for individuals under age 65.  Medicare Advantage plans may also be available as a form of Medicare insurance for individuals under age 65.

What is the criteria for original Medicare and Medicare insurance for individuals under age 65?

In order to be eligible for original Medicare and Medicare insurance for individuals under age 65 you must either be entitled to worker’s disability benefits, be a disabled widow or widower over the age of 50 or be over 18 and receiving benefits for a disability that you have had since before you turned 22. As an example of the latter category, a disabled 19-year-old man would be eligible for coverage, while a 25-year-old individual who became disabled at age 23 would not be, since his disability occurred after age 22. 

What if I am able to return to work – what happens to my Medicare and Medicare insurance for individuals under age 65?

If you go back to work and no longer get Social Security benefits, you may receive an extension to your original Medicare coverage for 93 months (with Part A being premium-free). This would be the case only if your condition still persisted but the condition did not prevent you from being able to work. Once this extension period has lapsed, you will not get your original Medicare Part A premium-free anymore, but you may still purchase original Medicare Part A coverage by paying premiums if your condition persists.  If you purchased Medicare insurance for individuals under 65, you may be able to suspend the policy as well.

If I am eligible for Medicare, what options are available for Medicare insurance for individuals under age 65?

If you are eligible for original Medicare Part A and Part B then you may have some options for Medicare insurance for individuals under age 65.  Medicare Supplement plans for individuals under age 65 are available in many states, but not all states.  In fact, several states require Medicare Supplement (also known as “Medigap”) insurance companies to offer a limited Medicare Supplement Open Enrollment Period, or guaranteed issue period, for people with original Medicare Part A and Part B who are under age 65.   Nineteen states have implemented laws requiring an Open Enrollment Period of Medicare Supplement plans for individuals under age 65 who are eligible for original Medicare Part A and Part B due to disability.  While nineteen states have implemented laws requirement Open Enrollment of Medicare Supplement plans for individuals under age 65, twenty-five states actually offer Medicare Supplement plans to individuals under age 65.  

The Medicare Supplement plans which must be offered and the duration of the Open Enrollment Period, or guarantee issue period, vary by state. Some insurance companies offer Medicare insurance for individuals under age 65 in the form of Medicare Supplement plans and offer Medicare Supplement plans that provide coverage in excess of the minimum requirements established by each specific state.  In other words, if a state is required to offer Medicare Supplement Plan A as an option to individuals under age 65, then some states offer Plan A, as well as other plans that provide more comprehensive coverage than a Plan A.  The standardization of the plans are the same regardless of whether the individual is under age 65 or over age 65. While some states require that a Supplement Plan be offered to individuals under age 65, if the insurance companies decide to offer other plans other than the required plan, then the insurance companies may  underwrite the application if it is for a plan that includes additional coverage above the plan the state requires the insurance companies to offer, or charge higher premiums for the plan that for an individual that is over age 65. 

Which states are required to offer Medicare Supplement Plans as a form of Medicare insurance for individuals under age 65?

The following states require insurance companies to offer Medicare Supplement Plans for individuals under age 65; however, the states are only required to offer at least one kind of plan during the open enrollment period to individuals with original Medicare under age 65:

  • California
  • Connecticut
  • Kansas
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • Mississippi
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • Oklahoma
  • Oregon
  • Pennsylvania
  • South Dakota
  • Texas
  • Washington
  • Wisconsin

If you have original Medicare and Medicare insurance for individuals under age 65 you will still have an open enrollment period when you turn 65.

A state that offers Medicare Supplement plans as a form of Medicare insurance for individuals under age 65 is also required to adhere to the “aged-in”, or turning 65 years of age Open Enrollment Period.  This is very important because of the limited availability of Medicare insurance for individuals under age 65 because with the open enrollment period for individuals turning 65 opens the market and allows the individual to purchase any of the Medicare Supplement plans offered in his or her state.  The “aged in”, or turning 65 Open Enrollment Period requires the Medicare beneficiary have guarantee issue rights with regard to any plan purchase offered in his or her state.  In other words, the Medicare beneficiary cannot be refused a policy based on his or her disability.  This allows the the Medicare beneficiary to purchase any Medicare Supplement plan available in his or her state and not go through underwriting.  While the choices may be limited for Medicare insurance for individuals under age 65, turning 65 years of age opens the opportunity to purchase any of the Medicare Supplement plans available in the specific state in which the Medicare beneficiary resides.  

Are there other options for Medicare insurance for individuals under age 65?

Another option for Medicare insurance for individuals under age 65 are Medicare Advantage plans.  Enrollment into a Medicare Advantage plan must take place during the Initial Enrollment Period. Changes to the Medicare Advantage plan can be made during Special Enrollment Periods that may occur as a result of certain circumstances; however, every year during the Annual Election Period, which occurs between October 15 and December 7, any Medicare beneficiary has the opportunity to purchase or change Medicare Advantage plans and/or Prescription Drug Plans.

How do I know what plans are available for Medicare insurance for individuals under age 65?

A Medicare Pathways Benefit Advisor can review the Medicare insurance options available to you if you have original Medicare Part A and Part B.  Medicare Pathways specializes in Medicare Supplement Plans, Medicare Advantage Plans and Prescriptions Drug Plans (also known as “Part D”) and can not only make you aware of what plans are available in your area, but can also help you find the most appropriate and most afford Medicare insurance plan for individuals under age 65.  If you are shopping for Medicare insurance such as a Medicare Advantage plan, Medicare Supplement plan, or Prescription Drug Plan please call a Benefit Advisor at Medicare Pathways at 1-866-466-9118.  You can also Request a Quote and a Benefit Advisor will contact you.

 

Stay informed!  Visit our News Blog!

Medicare Pathways:  1-866-466-9118