The ability to enroll in Medicare before age 65 is an amazing benefit for people with ALS, end-stage renal disease, or who are eligible for Social Security Disability Insurance (SSDI). Having this coverage can reduce out-of-pocket medical spending, which can be high for all these conditions.
The only catch is that federal law doesn’t guarantee access to Medigap coverage for people who qualify for Medicare before age 65. Most people this age opt for solely Original Medicare or a Medicare Advantage plan because insurance carriers can require underwriting for Medigap coverage, set higher premium rates, or limit the plans available for people under 65. This means you could be subjected to high premiums – or denied altogether.
When you turn 65, though, you get the chance to hit the Medicare disability reset button. Now that you are age-eligible for Medicare, you’re granted the same enrollment periods as any new Medicare beneficiary. If you’ve been unhappy with your Medicare coverage or just want to explore options now that you’re 65, a Medicare Supplement plan may be right for you.
What happens when I turn 65? Understanding guaranteed issue rights
If you’re already enrolled in Medicare Part B, when you turn 65, you have a six month window (starting on your birthday month) to enroll in a Medigap policy. This period is called the Medicare Supplement (Medigap) Open Enrollment Period. This is the federal requirement that prohibits insurers from denying you a Medigap policy based on things like age, gender, pre-existing conditions, and health status. This is a vital time to consider a Medigap plan, particularly if you have one or more chronic conditions. During open enrollment at 65, carriers can’t ask questions about your health and your plan will cost the same as any other enrollee.
Strategic moves to make to get the best Medigap rate
If you’re under 65 and enrolled in a Medicare Advantage plan, you can switch to Medigap during the Medigap Open Enrollment Period – six months that begins on your 65th birthday month. It’s important to change during this time so you avoid underwriting. If you choose a Medicare Advantage plan when you turn 65, you also have a year to try out the plan. If you don’t like it, you can switch to a Medigap plan without underwriting during that time.
Some states mandate that carriers offer at least one Medigap plan to people under age 65 with a disability. The plans offered often have more cost sharing and less coverage, like a Plan A, Plan N, or a high-deductible Plan G. For example, Plan A doesn’t pay your Part B deductible like other Medicare Supplement plans, and doesn’t cover care when you’re outside the country. If you are already signed up for one of these plans and want to switch to a plan with more robust coverage, like Plan G, you can change at age 65 during your reset period.
Avoiding pitfalls and missing Medigap timelines
If you miss the six-month window to enroll in a Medigap plan, you’ll have to undergo medical underwriting if you apply for a plan. ALS and end-stage renal disease are two conditions that may allow carriers to deny coverage if you aren’t in your Medigap Open Enrollment Period. What medical conditions and medications carriers approve and don’t approve through underwriting varies by plan.
There are a handful of states — including Maine, New York, Connecticut, and Massachusetts — that require plans to offer guaranteed issue year-round after the age of 65. If you don’t live in one of these states, it’s best to apply for a Medigap plan during its Open Enrollment Period within six months of your 65th birthday month.
If you’re already enrolled in Medicare early because of a disability or qualifying health condition, you get to hit the reset button on your coverage at age 65. With this clean slate, a Medigap policy may be a viable option for you, but purchasing this coverage can be confusing. To ensure you don’t miss your Open Enrollment window, talk with a licensed United Medicare Advisors agent. They can help you avoid gaps in coverage and find plans that fit your needs.
