Some individuals may qualify for Medicare before turning 65 if they have a disability. Once you turn 65, however, you’ll need to understand the topic of disability and Medicare. In this article, we’ll look at how to qualify for Medicare and explore what options are available as you approach 65.
How to Qualify for Medicare
People may qualify for Medicare in several ways. The most common is by turning 65.
The second way people qualify for Medicare is by being diagnosed with a certain health issue. For example, if you’ve been diagnosed with Lou Gehrig’s disease or with permanent kidney failure, you’re eligible to enroll in Medicare Disability at any age because of your health issues.
The third and final way people qualify for Medicare is if they’ve received Social Security disability benefits for 24 months. If this is the case, then you are automatically enrolled in Medicare on the 25th month, no matter your age.
What Coverage Options Are Available With Disability and Medicare?
If you came into Medicare because of a disability, you were issued a Medicare card. That card has a Part A and B effective date, signifying the day you started Medicare.
When you turn 65, you may have new Medicare enrollment rights, including a Medigap Open Enrollment Period if you are age 65 or older and enrolled in Part B.
You may consider changing your Medicare plan from what you previously had when you first applied. Maybe you initially stayed on Original Medicare and purchased a Supplemental plan, or maybe you went with an Advantage plan.
Now that you’re turning 65, the plan you originally chose may not be a good fit anymore. Depending on your enrollment period and coverage, you may have the opportunity to make changes to your plan.
Let’s look at what your options are.
Currently on an Advantage Plan
If you started on Medicare Disability and enrolled in an Advantage plan, you have two different options when you turn 65.
Option 1: Switch Advantage Plans
If you’re approaching age 65, you have an Initial Enrollment Period that begins three months before your birthday month and ends three months after. During this time, you can enroll in Medicare and choose your coverage, including whether to join a Medicare Advantage plan or stay with Original Medicare.
If you’re already enrolled in a Medicare Advantage plan, your ability to switch plans depends on the enrollment period that applies to your situation. Certain enrollment periods may allow you to make changes, while at other times you may need to wait until the next available window.
Option 2: Switch to a Supplemental Plan (Medigap)
Another option to consider is enrolling in a Medicare Supplement (Medigap) plan. If you move from a Medicare Advantage plan back to Original Medicare, you may have a Medigap Open Enrollment Period, depending on your situation.
For individuals who are age 65 or older and enrolled in Medicare Part B, this is generally a one-time six-month period during which insurers typically cannot use medical underwriting. During this time, you may be able to enroll in available Medigap plans without being denied or charged more due to health conditions.
If you apply for a Medigap plan outside of this period, you may be subject to medical underwriting, and acceptance or pricing may vary depending on your health and the insurer.
Currently on a Supplemental Plan
For individuals who enrolled in a Medicare Supplement (Medigap) plan while eligible for Medicare due to disability, there may be opportunities to make changes to coverage depending on the enrollment period that applies.
Option 1: Switch to a Medicare Advantage Plan
If you are approaching age 65, you may have an Initial Enrollment Period that allows you to review your Medicare coverage options. This period generally begins three months before your birthday month and ends three months after.
During this time, you may be able to enroll in a Medicare Advantage plan available in your area.
Option 2: Switch to a New Supplemental Plan (Medigap)
You may also have the opportunity to enroll in a new Medigap plan. In some cases, individuals who enrolled in Medigap before age 65 may have different pricing when they reach age 65, depending on the carrier and rating method.
If you are age 65 or older and enrolled in Medicare Part B, you generally have a one-time six-month Medigap Open Enrollment Period. During this time, insurers typically cannot use medical underwriting, and you may be able to enroll in available Medigap plans.
You may also have an opportunity to enroll in a Part D prescription drug plan during the applicable enrollment period.
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