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Home > Insurance Division > Medicare Supplement Under 50 Program > Introduction
Medicare Supplement Coverage for Individuals Eligible for Medicare due to Disability
 

In 1995, New Jersey enacted legislation to address the insurance needs of individuals under age 65 who become eligible for Medicare for reasons other than age.

 
Medicare Supplement Program for Individuals Under Age 50
 

One part of the law (N.J.S.A. 17B:26A-14 through 17) requires that the Department of Banking and Insurance establish a program assuring that people under 50 years old who become entitled to Medicare benefits due to disability have access to Medicare Supplement coverage.  By law:

  • At least one carrier must offer the Medicare Supplement coverage (the Contracted Carrier).

  • The Contracted Carrier must issue coverage to any applicant under age 50, so long as the individual applies for the Medicare Supplement coverage within 6 months following enrollment in Medicare Part B.

  • The Contracted Carrier must charge individuals under age 50 the same premium for Medicare Supplement Plan C as the carrier charges to those age 65 (rating on the basis of health status, age, or claims is not permitted).

  • There must be a mechanism to equitably spread losses that the Contracting Carrier incurs among all carriers offering health benefits plans in New Jersey.

  • The program is overseen by a governing board that includes representatives of various interested parties.

Carrier contact information, and more information about the plan option is available at the State Health Insurance Assistance Program website, at http://www.nj.gov/humanservices/doas/documents/SHIP_Under_50.pdf.   The current Contracting Carrier is Horizon Blue Cross Blue Shield of New Jersey (Horizon).  Horizon has information available online at https://medicare.horizonblue.com/plan-types/medicare-supplement.

More information about the Governing Board, its activities, and the program is available here.  

Regulations have been promulgated at N.J.A.C. 11:4-23A.

 
Medicare Supplement Program for Individuals Age 50 through 64
 

Another part of the law (N.J.S.A. 17B:26A-13) requires that all carriers offering Medicare Supplement plans in New Jersey to individuals aged 65 and older must also offer Medicare Supplement Plan C to individuals who become eligible for Medicare on or after their 50th birthday, but before age 65.  The following standards apply:

  • Carriers must issue the coverage to any applicant residing in the carrier’s service area, so long as the individual applies for the Medicare Supplement coverage within 6 months following enrollment in Medicare Part B.

  • Carriers must rate the plans on the same basis as all other Medicare Supplement plans, and a carrier may not charge rates that are more than what the carrier charges for the same policy issued to an individual aged 65 who becomes eligible for the coverage by reason of age.

  • Each calendar year, the carrier must meet a 65% loss ratio for individual policies, or a 75% loss ratio for group policies.

Companies offering Medicare Supplement coverage to people age 50 through 64 are listed on the State Health Insurance Assistance Program (SHIP) website, at http://www.nj.gov/humanservices/doas/documents/SHIP_50_Under_65.pdf.

Regulations have been promulgated at N.J.A.C. 11:4-23B.

 
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