Insuring the Disabled with Guaranteed Issue Pre-65 Medicare Supplements



Of all the people I help find health insurance, some of the most grateful are people under 65 who are permanently disabled and have parts A and B of Medicare. Many disabled people believe that there is no way they’ll qualify for a health plan. A very important point I want to get across here is that there are guarantee issue health insurance plans for people who are under 65 and have parts A and B of Medicare. Both HMO and PPO, and some of the plans even include a prescription drug benefit.

When it comes to Medicare, it’s important that you know both sides of the story, and understand the advantages and disadvantages of relying solely on Medicare to provide for your health care needs. Though Medicare by itself covers many health care costs, there are many medical services that Medicare does not cover. This point is clearly made in the “Guide to Health Insurance for People with Medicare,” which is published yearly by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services. As the guidebook suggests, there are health care costs that Medicare either does not pay in full or does not pay at all. If you need or want services not covered by Medicare, you must pay the bill. To help fill the gaps in your Medicare coverage, you have the option of buying supplemental insurance policies known as “Medigap” plans. Supplement plans help pay the bills Medicare does not, and provide you with protection from the ever-increasing gaps in Medicare.
For the pre-65 Medicare beneficiary there are certain guidelines and timeframes you need to follow in order the get a health insurance policy issued. For a Medicare Supplement plan acceptance of your application is guaranteed if you are under age 65 and apply within six (6) months of your initial enrollment in Part B of Medicare. You must already be enrolled in both Parts A and B of Medicare to apply for these plans. If you have missed the enrollment period you will have to wait until November 15th and apply for a Medicare Advantage Plan.

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
So, if you are under 65 and have both parts A and B of Medicare, you can get good affordable California health insurance. We just need to follow a few rules and timelines.

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14 Comments

  • Michael A says:

    If there is any way that you can provide me with an answer to this question, I will appreciate your help greatly.
    I am “uninsurable.” Because I had health insurance before a diagnosis, I have been able to remain insured through the many years since. I now have an Anthem Blue Cross Pre-65 plan in California.
    If my parents’ health requires me to care for them in Pennsylvania, will I be able to buy a Pre-65 plan as a resident of Pennsylvania or will I find myself tossed into the “uninsurable” category?

  • admin says:

    I talked to an internal Anthem Blue Cross rep today and asked about your situation. If you move to Pennsylvania you can keep your pre-65 Anthem Blue Cross F plan. I would double check that answer by calling Senior Support at 800-928-6201. You also can coincide your move to Pennsylvania with your birth-day month and qualify under the Medicare Supplement Guaranteed Issue Guideline #8 which states:

    “Birthday Rule: You are entitled to acceptance into equal or lesser value plans for 30 days beginning on your birthday. You must have a Medicare Supplement Plan and you must provide proof of prior coverage with your application.”

    Whatever you do, do not cancel any coverage you have in force now until you have a new policy accepted and issued.
    You do have a fairly unique situation and I hope I was able to help.

  • Paul says:

    Matt –

    Thank you for your well written, understandable, article.

    I live in Palm Desert, CA.

    I need your assistance in finding good, affordable, California health insurance for my 47 year old disabled wife who will soon be eligible for Medicare.

    Thanks!

    Paul

  • Dawn says:

    I live in southern/eastern Florida. I am 47 years old and have been insured by Medicare since April of 2008. Waiting for Medicare to begin was the longest 2 1/2 years of my life. I don’t get why there has to be a wait. I was approved for Medicare within 20 days of my application submission. It was obvious that I was totally disabled and that would not change, so why the wait? Social Security is my only form of income which makes it hard to keep up with the 20% balances, yearly deductible and non-covered services. I earn too much with Social Security to qualify for Medicaid. Could you give me some ideas of where to begin looking for a companion policy to Medicare part A and part B? There are NO HMOs within a 60 mile radius of my home. I live in a very wealthy retirement community. Since a HMO hospital, labs and physicians are not needed by the majority of the community, the physicians are not feeling the financial pressure to take the HMO patients and start an IPA, etc. What is a person to do in this situation. Thanks for any help you can provide to me. Dawn

  • admin says:

    I do not do business in Florida. Try my friend at http://www.nusurance.com .

  • Christie says:

    Does guaranteed issue under 65 apply to ESRD patients? It is my understanding that in CA ESRD patients under 65 are excluded from purchasing Medicare Supplements. Is this accurate or not?

  • admin says:

    You are correct. California is one of the states that does not have a Pre-65 Medicare supplement plan for people with ESRD. You may be able to join a Medicare Special Needs Plan (SNP) for people with ESRD if one is available in your area. Try this link for more information: http://www.cms.hhs.gov/specialneedsplans/

  • Christie says:

    Are there any exceptions for ESRD patients under 65? For instance, if they had an EGHP secondary to Medicare that termed due to loss of employment, are they able to get an open enrollment period to replace the loss coverage within 63 days?

  • admin says:

    I think SecureHorizones is going to have the plan your looking for. https://www.securehorizons.com/

  • Dan says:

    Completely unrelated, but could you write something about delays in the processing of claims? I’ve been recently diagnosed with cancer and have had some large ticket items – a surgery for one. Blue Shield has been very slow to process the specific claims and I am worried they are trying to find reasons to cancel my policy or get out of their legal duties… are there red flags I can watch for? Are there questions to ask about these claims that would shed light on what the company is up to? I know about the recent class action suit Blue Shield lost about rescission policies but am going crazy with worry.

  • Jack Cyrus says:

    Hi just thought i would tell you something.. This is twice now i’ve landed on your blog in the last 2 weeks searching for totally unrelated things. Spooky or what?

  • Bob Smithey says:

    I have been declared disabled by Social Security. The disability date went back to August, 2008. I am now covered under a policy I had with my previous employer, but I understand that I will automatically go on Medicare this coming August, and I am 62 years old and will need a supplemental policy for fear of not having enough insurance.

    I have rheumatoid arthritis and I had a mild TIA stroke 2.5 years ago.

    Will I be able to obtain a supplemental policy since I am not 65 years old and have had these previous health issues?

    I would like to have the best of carriers, and be able to extend it through the post-65 age years.

    Am I insurable?

  • dan says:

    I’m an injured worker with a workers comp. claim coming close to settling, after almost 7 years. I was approved for Soc. Security in Feb. 2010, but I still get my meds through the Workers Comp. Insurance company. When my case settles I’m looking at having a MSA account. I am looking for a plan that covers Meds. because it is my biggest expense monthly. I entered numbers into the web site at Medicare.gov and got back estimates of medication costs from 7k to 10k a year. Is there any plan that could reduce this amount?

    Also note I am supposed to be approved for Medical coverage through my Union, but they say they are secondary to Medicare, does that mean meds too. Wondered if you might know? Thanks for any help!

    I’m in LA

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