If you qualify for Medicare before age 65, your ability to get a Medigap policy depends on the state where you live.
Medicare supplement policies, also known as Medigap, help pay Medicare’s deductibles, copayments and other out-of-pocket costs. People 65 and older can get any Medigap policy available in their area at the best rates if they buy at certain times — such as within six months after signing up for Medicare Part B.
Roadblocks if you’re younger. Those federal protections don’t apply to people who are younger than 65 and qualify for Medicare because of kidney failure, also known as end-stage renal disease (ESRD), or another disability. This is where state protections can kick in.
Thirty-four states now require Medigap insurers to offer at least one policy to Medicare recipients younger than 65. Some insurers may limit coverage to one or two plans, and only to people with certain conditions.
Without a Medigap policy or other supplemental coverage, such as employer or retiree health insurance, you may have to pay Medicare’s deductibles and copayments yourself, which can add up quickly, depending on your medical condition.
An example. Even though Medicare Part B covers outpatient dialysis for people with kidney failure, without other supplemental coverage you’ll have to pay 20 percent of the cost — called Part B coinsurance. The American Kidney Fund estimates that Part B coinsurance can cost dialysis patients $10,000 or more out of pocket each year. To make matters worse, not having supplemental coverage could jeopardize your chance to get on a kidney transplant list.
Medigap coverage rules for those younger than 65 vary considerably by state.
Yet the states with laws requiring Medigap availability don’t have blanket protections for all disabilities that can qualify a patient for early Medicare. Some require offering Medigap policies only to those without end-stage renal disease. Others mandate the inverse, saying only people with kidney failure must be offered Medigap.
If you don’t qualify for state protections where you live, you may be unable to get a Medigap policy before age 65. Some insurers will issue a policy but take your health status and existing medical conditions into account when determining your premium, which can significantly increase the price you’ll pay.
To find out more about your state’s rules, contact your State Health Insurance Assistance Program (SHIP) or your state insurance department.
While the federal government doesn’t require private companies to make Medicare supplement insurance available to disabled beneficiaries under 65, 35 states have regulations directing insurers to make at least one type of policy available to select groups of younger Medicare recipients.
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