Medicare Supplement Insurance, also known as Medigap, is optional insurance for people enrolled in Original Medicare. Its primary function is to help beneficiaries reduce the potentially high out-of-pocket costs associated with Original Medicare, such as the deductibles and coinsurance for covered services.
However, Medicare beneficiaries under 65 years old may face obstacles in buying a Medigap policy. In some states, insurers do not have to offer as many or any Medigap policies to those under 65. In fact, under-65s made up 15% of Medicare members, but only 3% of Medigap policyholders in 2018. However, in areas where these policies are available, they can be a valuable source of supplemental coverage for beneficiaries under 65.
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Can You Get Medicare Supplement if You Are Under 65?
Federal law does not require insurers to sell Medigap plans for disabled people under 65. However, individual states can provide their own regulations, so the availability of Medigap plans for Medicare beneficiaries under 65 varies widely across the country. In some states, there are no requirements for Medigap availability, while in others, insurers must offer one or more Medigap plans.
Medigap Plans for Under 65 Availability By State
State | Medigap Options for Those Under 65 |
|---|---|
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must make plans available upon request, but those under 65 can be charged more or denied coverage | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 who are eligible for Medicare due to disability | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
Medigap insurers must offer at least one Medigap option for those under 65 | |
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
No requirements for Medigap availability for those under 65 | |
Medigap insurers must offer all Medigap options for those under 65 | |
No requirements for Medigap availability for those under 65 |
Medigap Enrollment Criteria For Those Under 65
People under 65 may be eligible to buy a Medigap policy if enrolled in Original Medicare, not a Medicare Advantage plan. Those younger than 65 are eligible for Medicare if one or more of the following applies:
- End-stage renal disease (ESRD): For those who did not enroll when they were first eligible, this coverage can be retroactive up to one year.
- Amyotrophic lateral sclerosis (ALS): People with ALS are eligible for Medicare if they receive disability benefits from Social Security or the Railroad Retirement Board. Medicare enrollment is automatic and begins the same month as the disability benefits.
- Social Security Disability Insurance (SSDI) eligibility: SSDI provides financial support to eligible people with specific physical or mental impairments. SSDI recipients are automatically enrolled in Medicare after a 24-month waiting period; this waiting period is waived for ALS patients.
- Railroad Retirement Board (RRB) disability benefit eligibility: The RRB provides disability benefits to eligible railroad workers and their families. RRB recipients are automatically enrolled in Medicare 25 months after they are entitled to benefits or the 30 months after disability began. There is no waiting period for people with ALS.
Children with ESRD could be eligible for Medicare if at least one of their parents has worked and paid taxes for enough time. They may also be eligible if at least one parent receives or is eligible to receive Social Security or RRB benefits.
What Benefits and Costs Does Medigap Cover?
In most states, insurers can sell Plans A, B, C, D, F, G, K, L, M, and N, but available Medigap plans for those under 65 can vary. Each lettered plan covers a different set of standardized benefits, such as:
- Coinsurance: This is the share of cost for covered services. For example, doctor services have a 20% coinsurance, which means you are responsible for paying 20% of the final bill. Medicare would pay the remaining 80%. Medigap plans may partially or fully cover coinsurance so that you do not have to pay it out of pocket.
- Deductibles: This is the amount beneficiaries pay out of pocket before Medicare kicks in. For 2023, the deductible for Part A is $1,600 per inpatient benefit period and $226 per year for Part B services. Medigap plans may partially or fully cover deductibles.
- Hospitalization: Original Medicare covers up to 90 days of inpatient hospital care per benefit period. Medigap plans may help cover the deductible and coinsurance. Medigap plans also cover 365 lifetime reserve hospital days, in addition to the 60 included in Original Medicare.
- Durable Medical Equipment: Medicare Part B covers DME such as wheelchairs and oxygen equipment, but beneficiaries are responsible for 20% of the Medicare-approved amount. Medigap plans may help cover this out-of-pocket expense.
- Lab Work: Original Medicare covers diagnostic lab work and imaging tests. While beneficiaries generally do not have out-of-pocket costs for lab work, a 20% coinsurance may apply to imaging tests like X-rays. Medigap plans may help cover these costs.
- Specific Benefits: Medigap plans may offer coverage for additional benefits, such as the first three pints of blood for transfusions or emergency care received outside the United States.
Remember that Medigap plans can help people with Original Medicare pay for out-of-pocket healthcare costs, such as deductibles and coinsurance. Medigap does not work with the Medicare Advantage plans.
What Does Medigap Not Cover?
Medigap for those under 65 could help pay for a variety of costs in Original Medicare, but it generally does not cover:
- Prescription drugs: Plans sold after January 1, 2006, do not cover prescription drugs because this coverage is available through Medicare drug plans (Part D). Medicare drug plans are standalone policies that add drug coverage to Original Medicare. Many Medicare Advantage plans also include Part D benefits.
- Dental and vision care: Original Medicare excludes most dental services and routine vision care, so beneficiaries either pay for care entirely out of pocket or through an additional insurance policy. However, Medicare Part A does cover any dental work that is part of another covered hospital procedure, such as jaw surgery. Part A may also cover hospital stays if you need emergency medical aid or complex dental work, though it would not cover the dental work itself. In these cases, Medigap could help cover those Part A costs. Medigap plans do not cover any costs incurred from non-Medicare insurance plans.
- Long-term care: Original Medicare generally does not cover non-medical long-term care, such as nursing home care. As such, Medigap will also not help defray those expenses.
How to Enroll in Medigap When You’re Under 65
To enroll in a Medigap plan, first ensure that policies for younger Medicare beneficiaries are available in your state. If they are, search specifically for Medigap plans for disabled people under 65. Compare your plan options based on premium prices and breadth of coverage.
Insurers sell Medigap policies throughout the year, but applicants may not be approved depending on when they apply and the reason for enrolling. However, your Medigap open enrollment period is the best time to buy a policy. This 6-month period begins when you turn 65 and are enrolled in Medicare Part B. For example, if you already have Medicare Part B and turned 65 years old in August, your Medigap open enrollment period would run from August until the last day of January.
During this period, applicants can buy any Medigap plan sold in their state except for Plans C and F, which are not available to those who became eligible for Medicare on or after January 1, 2020. This applies even if they have health issues or previously had a different Medigap plan. Insurers must also offer all applicants the same premium as someone healthy.