Health Insurance For Disabled Under 65

Health Coverage For 2022

Finding the right plan can be difficult. Each plan has its pros and cons, especially considering how costs can vary – depending on the plan’s monthly premiums, deductibles and co-pays.

The good news is that we can connect you to an agent who summarize all the key info for you, making it easy to compare your options and decide. Whether you prefer to lower your monthly premiums with a Bronze or Silver plan, or need to lower your out-of-pocket cost with a Gold or Platinum plan – they can help. In fact, depending on your eligibility and qualifications, some plans can be as low as $49 per month.

Who Is Eligible For Medicare Before They Turn 65

Those who have been diagnosed with amyotrophic lateral sclerosis, also called ALS or Lou Gehrigâs disease, are automatically enrolled in Medicare regardless of age.

Also, those who have been diagnosed with End-Stage Renal Disease can get Medicare no matter how old they are if all of these apply:

• Their kidneys no longer work
• They need regular dialysis or have had a kidney transplant
• One of these applies:

You can read more about ESRD on Medicareâs website.

The final â and most common â way to qualify for Medicare coverage under 65 is if you have received Social Security Disability checks or Railroad Retirement Benefits because of a disability for 24 months .

The latest data from 2014 breaks down the conditions of those who received SSDI:

• 34% qualified for Medicare due to mental disorders
• 28% due to diseases of the musculoskeletal system and connective tissue
• 4% due to injuries
• 3% due to cancer
• 30% due to other diseases and conditions

Employer Insurance Through Your Spouse

If you have a spouse with an employer-provided insurance plan, hop on their policy. This is one of the easiest and most affordable ways to get health insurance for disabled persons under 65.

More good news: if you qualify for Medicare, you can use this government insurance to help pay for your health care in tandem with your spouses group health plan coverage. Medicare will pay first and the group health plan will pay second if your spouses employer has less than 20 employees. If the employer has 20 or more employees, the group plan pays first and Medicare pays second.

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Enrolling In Medicare With A Disability

Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.

Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.

You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.

NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.

Do I Have To Take Part B

You are not required to take Part B, and some people choose to delay. Deciding to opt out of Part B at this time is a personal choice and depends on your unique situation. about whether or not you should take Part B when you qualify for Medicare with a disability. Some people who qualify for Medicare under age 65 due to disability but are covered under an employers plan or a spouses employer plan, may opt to delay.2

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Veterans Health Insurance For Disabled Adults

Individuals who have served in the military can apply at Veterans Affairs for VA health benefits. Your VA health insurance will cover you whether your disability is a result of service or not, but those with service-related disabilities receive the most thorough benefits and coverage.

Learn more: VA Health Insurance for Veterans: Check Your Eligibility.

How To Get Help With Medicare If Youre Disabled And Under 65

We understand Medicare is confusing. Thats why we take our time to answer all your questions. Our agents consider the coverage you need and make the best recommendation based on your situation. Dont waste your time calling each company individually. To get started with a quote, complete this form to see what options are available in your area.

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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 cant charge you with higher premiums than other enrollees. Youll 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 cant 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 .

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How Do Sources Of Supplemental Coverage And Prescription Drug Coverage Differ For Medicare Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Supplemental coverage

Most Medicare beneficiaries, including those under age 65 with disabilities, have public or private supplemental insurance to help cover Medicares cost-sharing requirements.9 A much larger share of beneficiaries under age 65 with disabilities than older beneficiaries rely on Medicaid to supplement Medicare because of their relatively low incomes .10 Medicaid helps with Medicare premiums and cost-sharing requirements, and covers services needed by many people with disabilities that are not covered by Medicare, particularly long-term services and supports.

Figure 3: Supplemental Coverage Among Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older in 2012

Just over 1 in 5 beneficiaries under age 65 has no supplemental coverage, compared with 12% of those age 65 or older. Lack of supplemental coverage among Medicare beneficiaries is associated with higher rates of access problems, but rates of access problems are higher among younger beneficiaries with disabilities who lack supplemental coverage than among older beneficiaries, including not seeing a doctor for a health problem when they think they should and having trouble getting needed health care .12 Regardless of whether or not they have supplemental coverage, however, a larger share of younger beneficiaries with disabilities than older beneficiaries experience access and cost-related burdens .

Prescription drug coverage

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How Mepd Services Are Provided

If you’re an adult with a disability and qualify for MEPD, these services are typically provided by STAR+PLUS. You will choose a STAR+PLUS health plan from the ones available in your service area.

If you have a child with a disability who qualifies for MEPD, these services are typically provided by STAR Kids. You will choose a STAR Kids health plan from the ones available in your service area.

You might also be enrolled into traditional Medicaid. Traditional Medicaid just means the state pays your doctors, nurses and other caregivers directly.

What Are The Characteristics Of Medicare Beneficiaries Under Age 65 With Disabilities Compared To Beneficiaries Age 65 Or Older

Medicare beneficiaries under age 65 with disabilities differ from beneficiaries age 65 or older in several ways, including their demographic, socioeconomic, and health status profiles.

Income: In 2012, a much larger share of beneficiaries under age 65 with disabilities than older beneficiaries had low annual incomes . Nearly one quarter of younger beneficiaries with disabilities had incomes less than $10,000 per year and two-thirds had incomes less than $20,000 per year, compared to 13% and 39%, respectively, of older beneficiaries.7

Figure 1: Selected Characteristics of Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older

Race/ethnicity and gender: A larger share of beneficiaries under age 65 than older beneficiaries are black and Hispanic , and a larger share are male .

Health status: Nearly two-thirds of all younger Medicare beneficiaries had a cognitive or mental impairment in 2012, compared to 29% of older beneficiaries . This includes memory loss that interferes with daily activity, difficulty making decisions, trouble concentrating, and loss of interest within the past year.8 Nearly 6 in 10 reported their health status as fair or poor and almost the same share reported having one or more limitations in their activities of daily living, compared to 20% and 34% of beneficiaries age 65 or older, respectively. But roughly the same share of both younger beneficiaries with disabilities and older beneficiaries report having five or more chronic conditions .

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How To Qualify For Medicare

There are three different ways you can qualify for Medicare benefits. The most common way people qualify for Medicare is by turning 65. As long as youve paid into the Medicare tax system for at least 40 quarters , you automatically qualify for Medicare at 65.

The second way people qualify for Medicare is by being diagnosed with a certain health issue. For example, if youve been diagnosed with Lou Gehrigs disease or with permanent kidney failure, youre eligible to enroll in Medicare at any age because of your health issues.

The third and final way people qualify for Medicare is that theyve received Social Security disability benefits for 24 months. If youve been receiving SS disability checks for 24 months, you are automatically enrolled in Medicare on the 25th month, no matter your age.

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Medicare Disability Coverage For Those Under 65

A disability and a long wait are required for early Medicare enrollment

Lisa Sullivan, MS, is a nutritionist and health and wellness educator with nearly 20 years of experience in the healthcare industry.

Ariel Skelley / Blend Images / Getty Images

Medicare isn’t available to most people until age 65, but if you have a long-term disability or have been diagnosed with certain diseases, Medicare is available at any age.

According to Kaiser Family Foundation data, 14% of all Medicare beneficiaries are under age 65. As of April 2021, 63.3 million Americans were enrolled in Medicare. So roughly 9 million of those beneficiaries are under age 65 and eligible for Medicare because of a disability, as opposed to age.

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Medicare Advantage Hmos And Ppos

In central Illinois, our Medicare Advantage HMO and PPO options arenât that compelling right now. We frequently run into network issues where our clients are not able to see their preferred doctor, and in most cases, a Medicare Supplement makes more sense.

If you live in a larger city, like Chicago, there are more Medicare Advantage options available, but in smaller cities and rural areas, we find it challenging to find a great plan.

Medicare Advantage Insurance Coverage

In states where Medicare supplement insurance is not available to those under age 65 you may want to consider Medicare Advantage insurance coverage. These are private insurance plans offered by companies like Aetna, Anthem Blue Cross and Blue Shield, Humana, United Healthcare and others.

Typically Medicare Advantage plans have the potential for higher out of pocket expenses than a traditional supplement, but they are less expensive and can be a better alternative to Medicare alone. And most MA plans also include prescription drug coverage as part of the overall policy. Our agency can help you better understand MA policies.

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Health Insurance For Disabled Persons Under 65 Who Don’t Qualify For Ssdi

If you meet the standards for Medicare, but dont qualify for Social Security Disability Insurance benefits , you can apply for Supplemental Security Insurance and receive Medicaid .

Supplement Security Insurance allows individuals to claim disability if they are medically disabled and/or have never worked. Just keep in mind there is an income and resource limit for the program .

Talk to your Social Security Office if you have questions about your Supplemental Security Insurance eligibility.

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Find The Best Disability Health Insurance For Individuals Start Here

The world is far from perfect for people with disabilities, and ableist conventions can and do prevail, but thanks to The Affordable Care Act , theres never been a better time to get affordable health insurance for disabled adults under 65.

Before, disabled individuals were denied coverage altogether or charged exorbitant ratesrates that made it impossible for many disabled persons to afford the health care they needed. Now, because of ACA regulations, health insurance providers cant cap your benefits, charge you substantially more for your insurance or deny you coverage. In fact, carriers cannot consider pre-existing conditions at all when assigning or offering rates for health insurance.

The result is a country where adults and even children are more readily, easily, and affordably insured.

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Coordination Of Coverage With Esrd

If you have employer-sponsored or union-sponsored insurance and you become eligible for Medicare due to ESRD, Medicare will coordinate with your existing coverage for 30 months.

During that time, your private insurance will be your primary coverage, and Medicare will pick up a portion of the remaining costs. After those 30 months, if you still have coverage under your group health plan, it will become secondary coverage and Medicare will become primary.

Medicare If You Have A Disability And Are Younger Than 65

If you are younger than 65 and have a disability, you may be able to get Medicare. You must:

• Get Social Security Disability Insurance for at least 24 months. This requirement often doesnt apply to those with end stage renal disease or amyotrophic lateral sclerosis .
• Meet the Social Security Administrations standards for disability.
• Have paid Social Security taxes while employed. This applies to you or your spouse.

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Can I Buy Medicare Supplement Insurance If Im Disabled And Under Age 65

Federal law does not require states to sell Medicare Supplement insurance plans for the disabled under 65. Medigap insurers in some states can choose to deny you a policy before you turn 65, even if youâre eligible for Medicare.

But in many states, insurance companies must sell Medigap plans to disabled beneficiaries under 65. Some states might not offer the full range of Medicare Supplement plans that they offer to those over 65.

These are the states* where insurance companies have to sell at least one kind of Medicare Supplement insurance plan to those disabled under 65. Some may have restrictions. Please note that if youâre under age 65 and have end-stage renal disease , you might not be able to get a Medigap insurance plan.

*This list was current at the time of publication. Some insurance companies might offer Medigap insurance to those under 65 even where itâs not required.

Itâs best to check with your State Health Insurance Assistance Program to find out if your state offers Medigap insurance if youâre under 65, and what the details and restrictions are. You can find out how to contact your stateâs SHIP here.

States With Mandated Medigap Coverage Options For Those Under 65

According to a report by the Kaiser Family Foundation, there are 30 states that require insurers to offer at least one Medigap plan to qualifying Medicare beneficiaries under 65.1 Certain states guarantee coverage options for those with ESRD, for those with a disability, or both.

These state requirements can have a big impact on Medigap applicants under 65. For example, if you live in California and have Medicare coverage due to ESRD, a Medigap insurance company is not legally required to offer you a Medigap plan.

The state only protects applicants under 65 with a qualifying disability.

The following chart details the states that legally require Medigap plans to those under 65, along with the health requirements to qualify.

The 30 states in the chart above have a guaranteed issue requirement, which means that insurance companies must offer at least one plan to qualifying applicants under the age of 65.

If applicants are under 65 and have Medicare Part A and Part B coverage, the insurance company must offer at least one Medigap plan to them in the qualifying states. Insurance companies are only required to offer one Medigap plan, but they are permitted to offer more options.

In addition to a guaranteed issue requirement, most of the 30 states above also have an open enrollment period requirement.

1 https://kaiserfamilyfoundation.files.wordpress.com/2013/04/8412-2.pdf#page=24

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