Medicare

Medicare Supplement Policies for Individuals Under 65

In Georgia and 26 other states, insurers that sell Medicare supplement insurance must also sell those policies to individuals under 65 who receive Medicare as a result of disability. Specifically, O.C.G.A. § 33-43-3(g) provides:

Insurers offering medicare supplement policies in this state to persons 65 years of age or older shall also offer medicare supplement policies to persons in this state who are eligible for and enrolled in medicare by reason of disability or end-stage renal disease. Except as otherwise provided in this Code section, all benefits, protections, policies, and procedures that apply to persons 65 years of age or older shall also apply to persons who are eligible for and enrolled in medicare by reason of disability or end-stage renal disease.

Further, a Medicare supplement policy may not exclude or or limit benefits for losses relating to a preexisting condition that were incurred more than six months from the effective date of coverage. O.C.G.A. § 33-43-3(b). Insurers cannot prohibit a third party from paying premiums as long as the third party is a family member exercising a power of attorney or a legal guardian, or is a qualified nonprofit.

One reason it is important to be aware that supplement coverage is available is to protect younger, disabled individuals from medical debt. In Many Seniors on Medicare Falling Into Medical Debt, Dennis Thompson wrote:

The Medicare crunch particularly affects people under 65 who are on the program due to disability, results show. One-quarter of the younger enrollees have delayed care they couldn’t afford, and nearly 30% have trouble paying medical bills.

Part of the problem is the Medicare Part B co-pay of 20% if the patient does not have a supplement. For more complicated procedures, 20% quickly becomes a large number. Thompson suggests an annual cap on out of pockets costs might solve this problem, but so would Medicare supplement insurance.

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