Who gets Medicare before 65
Most people join Medicare at 65, but many Idahoans qualify earlier. If you receive Social Security Disability Insurance (SSDI) or certain Railroad Retirement disability benefits, you're generally enrolled in Medicare automatically after 24 months of disability benefits. People with ALS get Medicare as soon as their disability benefits start, and people with end-stage renal disease (ESRD) can qualify on a separate path tied to dialysis or a kidney transplant.
Once you have Medicare, you face the same coverage question as everyone else: Original Medicare leaves gaps, such as the Part B coinsurance and the Part A hospital deductible, and there's no yearly cap on what you pay. The usual ways to fill those gaps are a Medicare Supplement (Medigap) policy or a Medicare Advantage plan. Under 65, though, the Medigap route has a catch that depends on your state.
The federal gap
Federal law gives everyone a six-month Medigap Open Enrollment Period that starts the first month they have Part B and are 65 or older. During it, a company can't turn you down or charge more because of your health. Under 65, that federal protection doesn't apply. Without a state rule, a Medigap company can decline an under-65 applicant or price the policy however its approved rates allow.
That's why the state you live in matters so much for people on Medicare through disability. Some states require companies to sell Medigap to under-65 beneficiaries; others don't. Idaho is one of the states that does.
What Idaho requires
Idaho's Medigap rule says Medicare Supplement policies offered in the state must be made available to people under 65 during their Medicare Initial Enrollment Period, or during any guaranteed-issue period that applies to them. Idaho has had this requirement since 2018.
There is a price difference. Companies may charge someone on Medicare because of a disability or ESRD up to 150% of the premium they charge a 65-year-old for the same plan. That's a ceiling, not a set amount, and actual prices vary by company. It's still often far better than the alternative, which in many states is not being able to buy a policy at all.
Timing is everything
The protection is tied to windows, so the calendar matters. Your Initial Enrollment Period for disability-based Medicare is built around when your Medicare starts, generally the 25th month of disability benefits. Watch for your Medicare card and the Social Security letter that comes with it, and start comparing Medigap options as soon as you know your Part B start date.
Guaranteed-issue periods can also open later, for example if you lose coverage from an employer, or if you're in a Medicare Advantage plan that leaves your area or stops serving Medicare. If you miss those windows, a company can generally ask health questions and may decline you. If you're unsure whether a window is open for you, SHIBA can check your situation at 1-800-247-4422.
Before your window opens, gather what any comparison needs: your Part A and Part B start dates from your Medicare card, a list of your doctors and specialists and where they practice, and your prescriptions with doses. With those in hand, you can compare Medigap prices across companies quickly and still have time to apply before the window closes.
Medigap or Medicare Advantage under 65?
Medicare Advantage plans are open to people under 65 who have Parts A and B, including, since 2021, people with ESRD. They usually have lower premiums than an under-65 Medigap policy, include a yearly out-of-pocket maximum, and often include drug coverage. The trade-off is a network: you'll generally need to use the plan's doctors and hospitals, and some plans require referrals.
Medigap costs more each month, especially at up to 150% of the age-65 rate, but it works with any provider in the country that accepts Medicare, with no network and no referrals. For people managing a serious condition with specialists in Idaho Falls, Pocatello, Boise, Salt Lake City or beyond, that freedom can matter more than the premium. With Medigap you'd also want a separate Part D drug plan. There's no single right answer; it depends on your doctors, prescriptions and budget. Our Medicare Supplement and Medicare Advantage guides go deeper.
What changes when you turn 65
Turning 65 gives you a fresh start. You get the federal six-month Medigap Open Enrollment Period, even if you already had Medigap or Medicare Advantage before 65. During that window you can buy any Medigap policy sold in Idaho without health questions, at the same price as anyone else who is 65.
Idaho's rule also says that when someone who bought a Medigap policy before 65 reaches 65, the company must charge them the same rate as a 65-year-old who is otherwise rated the same. Either way, the under-65 price premium doesn't follow you past 65. Mark your 65th birthday on the calendar: it's a good moment to review your coverage from scratch.
Help paying for coverage
Many people on disability-based Medicare have limited income, and Idaho has programs that can help. Medicare Savings Programs, run through the Idaho Department of Health and Welfare, can pay Part B premiums and sometimes more for people with limited income and resources. Extra Help from Social Security lowers Part D drug costs. Some people also qualify for Idaho Medicaid alongside Medicare. You can apply at idalink.idaho.gov or 1-877-456-1233.
If you'd like help comparing Medigap and Medicare Advantage options, Eric Jenkins is licensed in Idaho and works with Idaho clients by phone or video, at no cost to you: (702) 249-0514. See our Idaho Medicare page for more.
Frequently Asked Questions
Can I buy a Medigap policy in Idaho if I'm under 65?
Yes, during your Medicare Initial Enrollment Period or a guaranteed-issue period. Idaho requires companies to offer Medigap to under-65 beneficiaries during those windows. Outside them, companies can generally ask health questions.
How much more does Medigap cost under 65 in Idaho?
Companies may charge up to 150% of what they charge a 65-year-old for the same plan. Actual prices vary by company, so compare several.
Does my premium drop when I turn 65?
Idaho's rule requires companies to charge someone who reaches 65 the same rate as a 65-year-old. You also get the federal six-month Medigap Open Enrollment Period at 65, when you can choose any policy without health questions.
Can I join a Medicare Advantage plan under 65?
Yes. If you have Medicare Parts A and B, you can join a Medicare Advantage plan that serves your area, and since 2021 that includes people with end-stage renal disease.
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