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FAQ: Disabled Medicare Beneficiaries

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An agent from Arlington, TX asks…

Q: Are disabled people who are under 65 and receiving Medicare benefits eligible for Medicare Advantage plans or Medigap?

A: After receiving Social Security disability benefits for 24 months, individuals who are under age 65 are eligible to receive Medicare benefits. However, disabled people on Medicare have limited access to supplement insurance. Laws vary by state, and some states do not require insurance companies to offer Medigap coverage to people under age 65 with disabilities. The following states do require carriers 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, and Wisconsin. Once the beneficiary turns 65, they are guaranteed acceptance into a Medigap plan, regardless of their disability.

Medicare Advantage plans, however, have to accept all Medicare beneficiaries unless they have End Stage Renal Disease (ESRD). If a beneficiary develops ESRD while enrolled in the plan, plans are required to continue providing service. In the event that an MA plan terminates its contract with Medicare, members of the MA plan who have ESRD may enroll in another MA plan, if there is one available. If one is not available but becomes available later, a person with ESRD who previously lost their MA coverage can join that MA plan.

If you would like to be considered for our Medicare FAQ expert panel to answer frequently asked questions, email associate editor Heather Trese.

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