Navigating Medicare Supplemental Plans on SSDI and Medicare

When you are on SSDI (Supplemental Security Income) and Medicare, it is essential to consider various factors before purchasing a Medicare supplement. This guide will help you understand the options available, the factors to consider, and the steps to take to ensure you have the best coverage for your needs.

Considerations for Medicare Supplements on SSDI

Several factors come into play when deciding whether to purchase a Medicare supplement while on SSDI and Medicare:

Age and Plan Availability

Medigap Plans for Those Under 65: There is no law requiring the issuance of Medigap plans for those under age 65. This means you may not have much of a choice in plans, and some may be medically underwritten, leading to denial or a higher premium. Age-Related Choices: If you are close to age 65, it may be better to wait until then when you can buy any Medicare supplement plan without underwriting.

State Regulations and Rules

Guaranteed Issue Policies: Some states have rules requiring carriers to offer a "guaranteed issue" policy. However, some areas may only have plans for people with ESRD (End-Stage Renal Disease) while others specifically exclude ESRD. It is important to speak to an agent licensed in your state.

Access to Other Health Coverage

Job-Provided Insurance: If you have coverage from a job or from a spouse who works for a company with 20 or more employees, the plan will pay first. There is no sense in paying for a supplement.

Financial Considerations

Single Income Source: If SSDI is your only income and/or your only household income, you might explore whether you qualify for Medicaid. Having Medicare and Medicaid reduces or eliminates most coinsurance. If your income is very low, you may even qualify for supplemental benefits that help pay your Medicare premium. Medicare Part D: You should also look into Medicare Part D coverage. Call 1–800-MEDICARE and ask if you qualify for "extra help." If you do, you can get low or no-cost Medicare Part D coverage. Premium Costs: If you do not qualify for assistance and the premium is not too prohibitive, you should try to get a supplement to help you in the event of hospitalization. Medicare Part A has a 1364 copayment if you are admitted to the hospital. Most states will have a guaranteed issue plan that should be reasonable.

Choosing the Right Medicare Supplement

Given the high premiums for individuals under 65 on Medicare, it is important to find a type of additional coverage that suits your financial situation. Here are some recommendations:

High Deductible Plans

High Deductible Plan: For individuals on SSDI, a high-deductible plan is typically recommended. The cost varies greatly, but you should be able to find one in the 80/month range. This option provides more flexibility in choosing the best Part D prescription plan.

Conclusion

Understanding your Medicare coverage and the options available is crucial, especially when you are on SSDI and Medicare. By carefully considering your age, state regulations, access to other health coverage, and financial situation, you can make an informed decision about whether to purchase a Medicare supplement and choose the right plan for your needs.