Buying Medigap If You’re Under 65

By Patricia Barry

Copyright © 2015 AARP. All rights reserved.

One of the most glaring examples of discrimination in Medicare is the fact that if you’re under 65 and have Medicare because of disability, you don’t get the same guarantees and protections when buying Medigap that federal law gives to people who are 65 and over.

Over the years, many consumer organizations, health policy experts, and some politicians have worked hard to end the discrimination. Some held hopes that the Affordable Care Act would do so. But so far Congress hasn’t acted to change things on the federal level. This situation means that under federal law, insurance companies are free to refuse to sell you a policy or charge high premiums based on your pre-existing medical conditions — which, by definition, everybody with disabilities has.

However, 31 states have passed laws that give their residents under 65 some protections when buying Medigap: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin.

Some of these states offer protections almost identical to those given to people 65 and older under federal law. Hawaii, Louisiana, Maine, New Hampshire, and New York allow all Part B enrollees to buy Medigap, regardless of age. Others give far fewer rights. For example, in California, Massachusetts, and Vermont, you can’t buy a Medigap policy if you have end-stage renal disease (ESRD). Otherwise, all these states give you the right to buy at least one type of Medigap policy. For up-to-date info on which states give rights and protections for people under 65 buying Medigap, see this chart.

Even outside these states, some insurance companies may still sell Medigap policies to people under 65, so it’s worth checking out. The quickest way to find out what choices you have in your state for buying a policy is to go to the Medicare website and follow these steps:

  1. Enter your zip code and click on “Continue.”

    You can ignore the two questions in the box. The page you now see lists all Medigap policies.

  2. Click on the “Medigap Policies Available to People under Age 65” link at the top of the page.

    The list of the policies you can buy in your state now appears on-screen. If all ten policies are there, you have similar rights to people 65 and older in your state. If none appear, no Medigap policies are available to you in your state.

    Clicking on the “View companies” link to the right of any policy shown takes you to contact information for the insurance companies that sell this policy in your state, together with the pricing method they use. In some areas, the choice of insurers for any particular policy is very limited — maybe no more than one.

You can also find this information by calling Medicare at the number listed earlier and asking a customer service representative to mail you a list. Or you can call your state department of insurance. (For contact information, see the website of the National Association of Insurance Commissioners.) If you need personal help choosing a Medigap policy, call your State Health Insurance Assistance Program (SHIP).

If this search turns out to be dismal news — meaning that you can’t buy the Medigap policy you prefer, or maybe no policies are available to you in your state — keep in mind the light at the end of this particular tunnel. When you turn 65 and become eligible for Medicare on the basis of age rather than disability, you can buy any Medigap policy of your choice with full federal guarantees and protections. If you already have a policy by then, you’ll still have the right to buy another policy, from the same or a different insurer, and your premium will most likely be reduced.