By David Forbes
Medicare benefits are available for people under 65 due to a disability or ESRD (end stage renal disease). If you or someone you know is eligible for Medicare benefits due to a disability, you will have the same benefits as a Medicare beneficiary who is over 65. That is the good news. The bad news is, you may not have as many options for supplemental coverage as the person over 65.
Generally, when you turn 65 and enroll in Medicare, you have three options.
Enroll in Medicare and pay out-of-pocket for the portion of charges that Medicare does not cover.
Purchase a Medicare supplement (Medigap policy) during your open enrollment period.
Enroll in a Medicare Advantage plan that may even include the Part D Medicare drug coverage.
If you are receiving Medicare disability benefits, you can choose the first option and pay the out-of-pocket charges that Medicare does not cover. This will include a hospital deductible, hospital co-pays for extended stays and 20% of the charges for outpatient services. This can be a slippery slope. You are more than likely on a fixed income of SSI and the gaps in Medicare can be unpredictable and potentially financially devastating. Due to the nature of your Medicare eligibility, a qualifying disability, your health care costs may be higher than someone becoming eligible due to turning 65.
The second option, purchasing a Medicare supplement, may not even be available to you. Federal law does not currently require insurance companies to sell you a Medicare supplement if you are younger than 65. Although, some States require companies to do so, it generally means that you will pay a much higher premium than someone who is 65.
A Medicare Advantage plan is available to all beneficiaries, including those receiving Medicare disability benefits. If you have both parts A and B of Medicare, live in the plans service area and do not have ESRD, you are allowed to enroll in a Medicare Advantage plan.
These are the benefits of an Advantage plan for those receiving Medicare disability benefits.
An Advantage plan offers the certainty of fixed costs, including; co-pays, co-insurance and deductibles. The uncertainty of outpatient costs (20%) are eliminated with co-pays and co-insurance.
The premium (if required) is usually a fraction of the premium for a Medicare supplement.
The Part D Medicare drug plan is often included.
Advantage plans often include benefits beyond what Medicare includes. Extras can include dental, vision, hearing, gym memberships, discounts on alternative health services and transportation to and from medical appointments.
A Special Needs Plan may be available for qualifying chronic conditions. These plans include a comprehensive level of managed care related to your health condition.
An Advantage plan can give you a more comprehensive health plan than Medicare alone while costing considerably less than a Medicare supplement. When you compare the choices available to you, it is easy to see that a Medicare Advantage plan has a great deal to offer you if you are receiving Medicare disability benefits.
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