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Can I get Medigap insurance if I’m under 65?

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.

What are state rules for Medigap under age 65?

Medigap coverage rules for those younger than 65 vary considerably by state.

  • Fifteen states and the District of Columbia don’t require insurers to offer Medigap policies to people enrolled in Medicare who are younger than 65. In 2022, they are Alabama, Alaska, Arizona, Iowa, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Utah, Washington, West Virginia and Wyoming.
  • Thirty-five states do require companies to make at least one type of Medigap policy available to Medicare beneficiaries younger than 65. They are Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia and Wisconsin.

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.


States with Medigap protections if you’re younger than 65

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.

US Map showing which states have Medigap protections for people under 65

Source: Centers for Medicare & Medicaid Services, AARP research


What happens to Medigap protections when I turn 65?

You can try again. You’ll get another chance at Medigap when you turn 65 and become eligible for Medicare because of your age instead of a disability. At that point, you have six months to buy any Medigap policy available in your area at the best rates for your age and gender.

You can switch. If you already have a Medigap policy but are paying high rates, this is when you can switch to another policy that has lower rates. But you need to do so within the six-month time frame.

And you get more protections. You also could qualify for federal “guaranteed issue rights” (also called “Medigap protections”), which require insurers to offer you a Medigap policy in certain situations without subjecting you to health questions or charging more based on past or present health problems. You may qualify for additional state protections too.

Keep in mind

Even if you can’t buy a Medigap policy before age 65, you might consider enrolling in a Medicare Advantage plan, an alternative to original Medicare. Medicare officials must approve each plan, and they must cover everything that Medicare Part A and Part B cover, albeit with different deductibles and copayments. Most Medicare Advantage plans cover prescription drugs too.

These plans usually have provider networks, which means that if your doctor or preferred hospital is out of network, you may not be covered or could be charged more. So make sure your care team is part of the plan’s network and that the plan covers any medications you take. You can use the Medicare Plan Finder to compare all costs and coverage for the plans available in your area.

Anyone enrolled in Medicare Parts A and B can sign up for a Medicare Advantage plan regardless of their health status, even if they’re not yet 65. In the past, people with end-stage renal disease couldn’t sign up for Medicare Advantage plans, but those rules were reversed in 2021, making kidney failure patients eligible.

Some Medicare Advantage plans specialize in certain chronic conditions, such as diabetes, heart failure and other cardiovascular disorders, and kidney failure.

You can enroll in a Medicare Advantage plan when you first become eligible for Medicare, and you can switch plans each year during open enrollment, which runs from Oct. 15 through Dec. 7 for new coverage starting Jan. 1.

Updated November 21, 2022

     

        


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