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Medigap Policies For People Under Age 65 With A Disability or End-Stage Renal Disease (ESRD)

You may have Medicare before age 65 due to the following:

  • A disability, or
  • ESRD (permanent kidney failure requiring dialysis or a kidney transplant).

If you are under age 65 and disabled or have ESRD, you may not be able to buy the Medigap policy you want until you turn 65. Federal law doesn't require insurance companies to sell Medigap policies to people under age 65. However, some states require insurance companies to sell you a policy, at certain times, even if you are under age 65.

During the first six months after you turn age 65 and are enrolled in Medicare Part B, you will get a Medigap open enrollment period. It doesn't matter that you have had Medicare Part B before you turned age 65. During this time:

  • You can buy any Medigap policy (including those policies that help pay the cost of prescription drugs), and
  • Insurance companies cannot refuse to sell you a Medigap policy due to a disability or other health problem, or charge you a higher premium than they charge other people who are 65 years old.

When you buy a policy during your Medigap open enrollment period, the insurance company must shorten the waiting period for pre-existing conditions by the amount of creditable coverage you have. If you had Medicare for more than six months before you turned 65 years old, you won't have a pre-existing condition waiting period because Medicare counts as creditable coverage.

Several states require Medigap insurance companies to offer a limited Medigap open enrollment period for people with Medicare Part B who are under age 65. The following states require insurance companies to offer at least one kind of Medigap policy during a special open enrollment period to people with Medicare under age 65:

California Connecticut Kansas
Louisiana Maine Maryland
Massachusetts Michigan Minnesota
Missouri Mississippi New Hampshire
New Jersey New York North Carolina
Oklahoma Oregon Pennsylvania
South Dakota Texas Washington

Also, some insurance companies will sell Medigap policies to people with Medicare under age 65. However, these policies may cost you more. Remember, if you live in a state that has a Medigap open enrollment period for people under age 65, you will still get another Medigap open enrollment period when you turn age 65.

Also, if you join a Medicare Advantage Plan (formerly Medicare + Choice) and your coverage ends, you may have the right to buy a Medigap policy. If you have questions, you should call your State Health Insurance Assistance Program.

Right to suspend a Medigap policy for disabled people with Medicare

If you are under 65, have Medicare, and have a Medigap policy, you have a right to suspend your Medigap policy. You can suspend your Medigap policy benefits and premiums, without penalty, while you are enrolled in your or your spouse's employer group health plan.

If, for any reason, you lose your employer group health plan coverage, you can get your Medigap policy back. You must notify your Medigap insurance company that you want your Medigap policy back within 90 days of losing your employer group health plan coverage.

Your Medigap benefits and premiums will start again on the day your employer group health plan coverage stops. The Medigap policy must have the same benefits and premiums it would have had if you had never suspended your coverage. Your Medigap insurance company can't refuse to cover care for any pre-existing conditions you have. So, if you are disabled and working, you can enjoy the benefits of your employer's insurance without giving up your Medigap policy.

Page Last Updated: April 10, 2007


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