If you’re under 65 and disabled, you automatically get Medicare Part A and Part B (known as Original Medicare) after you’ve received disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months.
You should get a Medicare card in the mail during the 25th month you are receiving disability benefits. Even if you return to work, you can continue to get Part A benefits premium-free for up to 8.5 years.
If you have Amyotrophic Lateral Sclerosis (ALS), you automatically get Part A and Part B in the month that your disability benefits begin.
What Does Medicare Supplement Insurance Cover?
As with seniors, Medicare requires those under 65 to meet deductibles before their Medicare coverage actually begins. Even after the Part A or Part B deductible has been met, co-insurance may require both Medicare and the patient to pay a portion of a medical bill. Likewise, co-payments or out-of-pocket costs are still due on some services that are partially covered by Medicare.
Part A coverage has a deductible of $1,132. Your coverage doesn’t start until you have met this deductible for a period of time known as a benefit period. That begins on the day you enter the hospital or a skilled nursing facility and continues until you have not received hospital or nursing facility care for 60 consecutive days.
If you need hospital or nursing care after one benefit period has ended, you’ll have to meet the deductible again. There is no limit on the number of times you may be required to meet this deductible.
Part B helps with doctor care, home health care, lab tests, outpatient care and other services from non-hospital providers. It has an annual $162 deductible, after which it pays for 80 percent of a pre-approved rate for services from health care providers other than hospitals. You are responsible for the remaining 20 percent. If your doctor charges more than Medicare’s rate, you’re also responsible for the excess.
Depending on which Medigap plans are available in your state, you could be reimbursed for the Part A and Part B deductibles. Certain Medigap plans also cover the 20 percent Medicare routines leaves you to pay for doctor services as well as fees your doctor charges that exceed Medicare’s predetermined rate.
When Can People Under 65 Get Medicare Supplement Insurance?
If you have Medicare Part B for doctor services, you can participate in an open enrollment period for Medicare supplemental insurance in many states. Open enrollment lasts for six months after your Part B coverage becomes effective.
During this period, many states guarantee your right to buy a Medicare supplement or Medigap plan no matter what health problems you may have. No underwriting is involved so there’s no possibility of your application being declined based on a pre-existing condition.
Of course, when you do turn 65, you’ll have a second opportunity for open enrollment. It will extend for six months after you become 65. If you already have Medigap insurance at that time, you can change to a different plan without the scrutiny of medical underwriting.
Which States Offer Medigap Insurance To People Under 65?
In at least 25 states, one or more Medigap plans are available for those under the age of 65. That includes California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Washington and Wisconsin.
Some states (such as Colorado, Florida, Kansas, Illinois, Louisiana, Missouri, Oregon, Pennsylvania and South Dakota) make all 10 existing Medigap plans available to people under 65.
Even if your state is not listed above, it’s possible that an insurance company will sell you one the Medigap policies. You can also contact your state health insurance assistance program (SHIP) for free assistance.
Monthly premiums on Medigap insurance can be more expensive if you’re under 65. Rates vary from state to state and even though Medigap plan benefits are standardized, prices are not.
In addition to Medicare Supplement plans, Medicare Advantage plans are available in some areas.
