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Medigap Eligibility for People Under 65

There are no federal laws which require insurance companies to sell Medigap coverage to people under the age of 65. Despite this, many states have enacted their own laws ensuring that consumers have access to at least one form of coverage. It is important to contact your individual state’s insurance department or the State Health Insurance Assistance Program because the rules vary state-by-state.

Conditions for Under 65 Medigap Eligibility

In order to be eligible for a Medigap plan under the age of 65, some states require that have a particular condition that qualifies as a permanent disability or you have End Stage Renal Disease (ESRD). You must be classified as permanently disabled by the Social Security Administration (SSA) in order to qualify. Those who are partially disabled or on short-term disability do not qualify for Medigap coverage because they are usually covered by workers’ compensation or other monetary resources.

There are several additional ways to access Medicare supplement insurance. First, if you have received either Social Security Disability Income or Supplemental Security Income for the past two years, you will first be eligible for Medicare Part B and then a Medigap plan. Secondly, you qualify if you collect disability income from the Railroad Retirement Board. Finally, if you have worked for a specific amount of time in the local, state, or federal government and you meet the prerequisites of the SSD program, you will be eligible for Medigap.

If any of these situations apply to you and you enroll for Medicare Part B, you will have 6 months to purchase a Medigap plan.

States With Mandatory Under 65 Medigap Options

According to Medicare.gov, the following states require insurers to offer Medigap coverage for people under the age of 65:

States That Offer Medigap for Those Under 65:
California* Maine North Carolina
Colorado Maryland Oklahoma
Connecticut Massachusetts* Oregon
Delaware** Michigan Pennsylvania
Florida Minnesota South Dakota
Georgia Mississippi Tennessee
Hawaii Missouri Texas
Illinois New Hampshire Vermont*
Kansas New Jersey Wisconsin
Louisiana New York

*In California, Massachusetts, and Vermont, a Medigap policy is not available to those under the age of 65 with ESRD.

**In Delaware, Medigap coverage is only available to those under the age of 65 with ESRD.

Every other state mentioned above legally must offer at least one Medigap plan to those under 65. Some states not mentioned above may have an insurance provider who voluntarily provides Medigap coverage for those under the age of 65.

Since there is no federal law guaranteeing coverage for those under 65, insurers do not have to provide the protections for those who enroll in the standard Medigap open enrollment period. Those under the age of 65 with Medigap coverage could have limited options and could face higher premiums.

Medigap Protections for Those Under 65

There are several statewide laws which protect Medigap users under the age of 65 with certain disabilities.

In Florida for example, citizens under 65 who qualify for a Medigap plan will be entitled to guaranteed issue protection once they turn 65 during their open enrollment period.

An additional protection is available in 14 states which require the same premium for both seniors and non-seniors. Each participating state has its own specific age guidelines. For example, in Pennsylvania, Medigap plans must be charged the same premium as a 65-year-old senior but in South Dakota this age bracket is stretched to 75.

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