Last Updated on April 4, 2019
Facing healthcare expenses at an early age is such a pain in the neck. This is most especially true if you are the breadwinner of the family.
There are people who pay their medical bills mostly from using their own money. There are also people who have coverage due to the health insurance of their working spouse. Other people qualify to become a Medicare beneficiary due to disability. There are also circumstances which health coverage and Medicare can work together.
If that’s not possible, you can look for other option such as Medicare Supplement insurance plans or Medicare Advantage plans.
Disability and Medicare
Medicare is a federal government program that provides health insurance to people age 65 and above. But there are certain circumstances that people below age 65 can become a Medicare beneficiary. People under 65 can have eligibility for Medicare if they become disabled or have End Stage Renal Disease (ESRD).
According to Medicare.gov, people with disability will be automatically enrolled in Medicare Part A and Part B as long as they meet even one of the following:
- Disability benefits from Social Security for 24 months
- Certain disability benefits from the RRB for 24 months
How your Original Medicare will work will also depend on what other health insurance you currently have. Medicare will depend on the situation and may work differently if you have health benefits due to employer coverage of a working spouse.
The Medicare Disability Benefits for People Under 65 With Employer Coverage
Medicare for disabled under 65 can play as primary or secondary paying health insurance depending on your situation.
If the employer has more than 100 employees, Medicare will pay as secondary to the health coverage that you have. Most people enroll in Medicare Part A only. They delay getting Medicare Part B and D since outpatient and drugs are most likely part of employer coverage.
People who are under employer coverage usually choose to enroll in Medicare Part A to reduce hospital or inpatient expenses. You won’t have to pay Part A premiums if you have worked for about ten years in the US.
On the other hand, Medicare will be the primary payer if the employer has less than 100 employees. It is best to enroll in both Part A and Part B since Medicare will primarily provide your health coverage. So that both Parts will work with your employer coverage in reducing your health care costs.
People Under 65 on Medicare Disability Without Employer Coverage
People who are still under 65 but are already on Medicare may opt to find additional coverage from a Medicare supplement plan (Medigap).
Medicare supplement plans for disabled under 65 people may vary or are different from the plans for people age 65 and older.
Medigap policies for disabled under 65
Federal state laws do not require Medigap insurance companies to sell policies to people under 65. Because of that, insurers can ask you to undergo medical underwriting or reject your application.
But a lot of states require insurance companies to sell at least one type of Medigap plan to under 65 people. These states are:
|New Hampshire||South Dakota|
States selling Medigap to people under 65 only to those with end-stage renal disease
States selling Medigap to people under 65 excluding those with end-stage renal disease:
How much is the cost of Medigap insurance under 65
Because of high claim costs, many insurance companies in the states don’t offer much other Medigap options. Because of that insurers often just sell Medigap plan Ato disabled people.
Despite the few benefits, Medigap Plan A can be expensive in most states if it is for disabled and under age 65 person. Rates for this group of Medicare beneficiary can expect higher Medigap premiums. That is because insurance companies need to obtain funds to make up for the high claim ratios.
When is the best time to get Medicare supplement insurance for disabled people
Disabled people on Medicare can have Medicare supplement insurance plan and freely choose which type of plan they want when they turn 65.
The best time for people on disability Medicare benefits to buy Medicare supplement is during the Medigap Open Enrollment period. During this period, no insurance companies can reject your application because you are disabled or have pre-existing conditions. Also, insurance companies can’t charge you with higher premiums than other enrollees. You’ll have the opportunity to choose any Medicare supplemental plan available in your state.
Medicare Supplement Open Enrollment Period starts from the month of your 65th birthday and will last for only 6 months. You should also have Medicare Part b by this time. This period only comes once in your life and can’t be replaced with another starting date.
If you miss this period, insurance companies can require you to undergo medical underwriting or answer questions about your health. Depending on the result of the underwriting exam, your premium might be much higher, or worst be declined.
Guaranteed Issue Rights
Aside from the Medigap Open Enrollment Period, there are other circumstances that you can get a Medigap policy without the need to undergo Medical underwriting.
You’ll have another Guaranteed Issue Rights and be able to get a Medigap in certain situation such as:
- When you are moving outside the service area of your Medicare Advantage plan or Medicare SELECT plan
- You have a Medicare Advantage plan for the first time and you wish to switch to a Medigap plan. Do it within 12 months from the time you enroll in the Medicare Advantage Plan.
- When you leave your company and its employer health insurance coverage within the last 63 days.
Do you need help?
Let one of our licensed Medigap advisors help you and find the best plan for your needs. Compare Medicare supplements and discuss all your options with our experts. Just send us a Medigap quote request and one of them will reach you.