by Russell Noga | Updated January 18th, 2024
Disabled people under 65 make up just over 8% of the US population and account for nearly 16% of Medicare beneficiaries. These individuals usually live on social benefits and have lower incomes, making it challenging to deal with the rising healthcare costs in the United States.
Medicare Parts A & B assist these individuals with the healthcare they need, reducing their annual hospitalization and medical services costs. Medigap policies further mitigate these expenses. Medicare supplement for disabled under 65 covers the remaining out-of-pocket costs not covered by Original Medicare Parts A & B.
There are ten Medigap plans, each offering a different level of coverage. Depending on the plan, it could reduce out-of-pocket costs on Parts A & B services to zero.
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What are the State Rules for Medicare Supplement for Disabled Under 65?
The rules for Medigap policies covering individuals under 65 vary from state to state. Fifteen states and the District of Columbia don’t require healthcare insurers to offer Medicare supplement plans to individuals younger than 65.
35 states require healthcare insurers to have at least one plan available to beneficiaries under 65. These states don’t offer blanket protections covering all disabilities qualifying beneficiaries for Medicare or Medigap.
Some states require insurers to offer Medigap plans only to people under 65 who don’t have end-stage renal disease. Other states have mandates saying people with the condition must have Medigap policies available to them.
If your state doesn’t offer these protections, you’re unable to qualify for Medigap if you’re under 65. Some healthcare insurers will issue the individual a Medigap policy at inflated costs, increasing the individual’s monthly premiums above the average rate.
How Does Medicare Supplement for Disabled Under 65 Work?
People under 65 with disabilities have the same Medicare eligibility as those 65 or older. Those individuals eligible for Medicare receive the full range of Part A & B benefits. This coverage extends to care at hospitals, nursing homes, the doctor’s office, home-based care, and community services.
Healthcare services offered to disabled individuals under 65 don’t have to be related to their disability. For instance, these individuals have coverage for mental illness, dementia, and chronic conditions. There are no underlying conditions disqualifying disabled individuals from Medicare coverage.
Beneficiaries are also entitled to individualized assessments of their ability to meet the Medicare coverage criteria. Medicare policies are not resultant of the individuals underlying health conditions, diagnosis, or the following.
- Beneficiaries cannot be denied Medicare coverage because they need long-term healthcare coverage.
- Beneficiaries cannot be denied Medicare coverage because underlying conditions are terminal and won’t improve.
- Beneficiaries cannot be denied Medicare coverage because they require maintenance services, or the beneficiary has a specific condition or illness.
The beneficiary may receive preventative treatments, such as physiotherapy, even if their condition is expected to deteriorate. People with chronic and long-term health conditions if a doctor deems it necessary for the following conditions.
- Mental illness.
- Alzheimer’s disease
- Parkinson’s disease.
- Multiple sclerosis
If a disabled individual receives a denial of coverage, they can ask their doctor to assist with motivating their application for Medicare or Medigap. To qualify for Medicare or Medigap, the disabled individual under 65 must have received Social Security Disability benefits for a minimum of 24 months or have one of the following conditions.
- Amyotrophic Lateral Sclerosis (ALS, aka “Lou Gehrig’s disease”).
- End Stage Renal Disease (ESRD).
The beneficiary must undergo a five-month waiting period after diagnosis of their disability before receiving Social Security Disability benefits. People with ALS and ERD don’t have to collect Social Security benefits for 24 months to be eligible for Medicare. The eligibility requirements for these individuals are the following.
- ESRD – Three months after regular dialysis starts or after a kidney transplant.
- ALS – Immediately upon collecting their Social Security Disability benefits.
Disabled individuals meeting these criteria for Social Security Disability can enroll in Medicare Parts A & B. Those who meet the requirements but aren’t eligible for Social Security benefits can purchase a Part A & B policy.
What are the Benefits & Coverage Available with Medigap Plans?
If you qualify for Medicare, you can apply for a Medigap policy to bolster your coverage. Medigap policies provide coverage for the 20% of out-of-pocket costs left unpaid by Original Medicare Parts A & B. As a result, you have minimal financial responsibility for our healthcare costs and, in some cases, nothing to pay.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
- Unlimited coverage for all out-of-pocket costs.
*Plan F is unavailable for people enrolling in Medicare who are under 65. Your next best option is Plan G. With Plan G, you must pay the Part B deductible. However, your savings on Monthly premiums for Plan G vs. Plan F usually account for the cost of the Part B deductible or more.
What Happens to Medicare Supplement Protections When I Turn 65?
Disabled applicants denied coverage before they turn 65 can reapply for Medicare and Medigap when they turn 65. During this “Open Enrollment” period, they can purchase any Medigap plan from any provider without being charged higher-than-average premiums due to their disability.
The Medigap provider may not refuse the applicant’s request to join their Medigap plan. However, they can institute a three to six-month waiting period where the applicant must pay premiums monthly but won’t receive any benefits.
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Frequently Asked Questions
Who is eligible for Medicare Supplement plans if they are disabled and under 65?
In some states, individuals who are under 65 and have been receiving disability benefits from Social Security or the Railroad Retirement Board for at least 24 months may be eligible for Medicare Supplement plans. Eligibility criteria can vary by state, so it’s important to check with your local Medicare office.
Call Us for Advice on Understanding Medicare Supplement Eligibility
If you need assistance understanding how to enroll in Medigap plans, call our team at 1-888-891-0229. We offer you a free consultation to discuss your Medigap options and how to register. We’ll answer our questions on special issue rights and show you the path for enrolling in the Medigap plan of your choosing.
Our team provides free quotes on Medigap plans, and we’ll secure you the best rate on premiums in your state. If you want our fully-licensed Medigap agents to call you back, leave your details on our contact form, and we’ll connect with you.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.