Medigap eligibility rules for Americans under age 65 vary by state | (2024)

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Key takeaways

  • Currently, no federal legislation guarantees enrollment in Medigap for under-65 beneficiaries.
  • However, states have the authority to enact legislation that makes Medigap coverage guaranteed issue.
  • Two states have no provisions – and no plans – geared to the under-65 population.
  • 12 states and DC have no coverage requirement for insurers, but coverage is available.
  • 12 states require insurers to offer at least one Medigap plan to those under age 65.
  • 10 states make all plans guaranteed-issue, but under-65 premiums can be much higher.
  • 14 states make all plans guaranteed-issue, and include restrictions on premiums.

For Americans who become eligible for Medicare upon turning 65, enrollment in Medigap plans is guaranteed during a six-month federally mandated enrollment period. During this time, all available Medigap plans are guaranteed-issue, regardless of medical history.

But for almost 12% of the people enrolled in Medicare, eligibility is triggered by long-term disability or by a diagnosis of ALS or end-stage renal disease (ESRD, aka kidney failure), rather than age – and there are no federal rules guaranteeing access to Medigap plans for these enrollees. Members of Congress have introduced federal bills to mandate guaranteed access – among them, HR1394in 2019 and HR1676 in 2021 (specific to beneficiaries with ESRD) – but these bills have thus far stalled.

Efforts to guarantee access to Medigap vary by state

States, meanwhile can create their own rules to ensure that disabled Medicare beneficiaries under age 65 can enroll in supplemental coverage, and the majority of the states have done so. But the solutions vary considerably from one state to another – ranging from access to a state-run high-risk pool all the way to a requirement that all Medigap plans be guaranteed issue with premiums that don’t exceed the rates charged to a 65-year-old.

This is an issue that at least a few state legislatures (or regulatory bodies) consider each year; Idaho, Indiana, Virginia, Oklahoma, Rhode Island, and Kentucky are recent examples of states where at least some Medigap plans have been made available to beneficiaries under age 65 due to legislation or regulatory changes.

But there have also been several states where legislative efforts to expand access to Medigap plans for people under 65 were not successful in recent years, including Arizona in 2021 and Texas in 2023.

You can click on a state on this map to see details about under-65 Medigap regulations. But here’s an at-a-glance overview:

Two states have no provisions – and no plans – geared to the under-65 population

These states have not enacted any provisions to ensure access to supplemental coverage for Medicare beneficiaries who are under age 65, and there do not appear to be any guaranteed-issue plans available for this population:

  • Nevada
  • Ohio (Legislation under consideration in 2024 would require Medigap insurers to make their plans available to under-65 beneficiaries, with premiums no higher than age-65 premiums.1)

12 states and DC have no coverage requirement for insurers, but some coverage is available

These states do not have regulations requiring Medigap insurers to offer plans to Medicare beneficiaries under the age of 65. But in each state, there is either a functioning high-risk pool that continues to offer coverage to Medicare beneficiaries under age 65, or there are at least some Medigap insurers that voluntarily offer coverage to beneficiaries under 65 (albeit typically with premiums that are much higher than the premiums for a person who is 65):

  • Alabama
  • Arizona
  • Washington, DC
  • Utah
  • West Virginia
  • Nebraska (Legislation introduced in 2023 and carried over into the 2024 session would require insurers to offer all Medigap plans to beneficiaries under age 65, with premiums no higher than the weighted average premiums for enrollees 65 and older.2)
  • Alaska (high-risk pool coverage is also anoption)
  • Iowa (high-risk pool coverage is also an option; legislation under consideration in 2024 would create an annual 30-day window that begins on an applicant’s birthday, allowing guaranteed-issue access to all available Medigap plans, and the legislation applies equally to applicants under the age of 653 But previous efforts to implement an annual Medigap enrollment window in Iowa were unsuccessful.4)
  • New Mexico (high-risk pool coverage is also anoption)
  • North Dakota (high-risk pool coverage is also an option)
  • South Carolina (high-risk pool coverage is also an option; legislation introduced in 2024 would make Medigap Plan A available5)
  • Washington (high-risk pool coverage is also an option)
  • Wyoming (high-risk pool coverage is also an option)

A note about high-risk pools: Before the Affordable Care Act did away with medical underwriting in the individual major medical insurance market, the majority of the states had high-risk pools that served as coverage of last resort for people with pre-existing conditions who didn’t have access to employer-sponsored health coverage. Many of them also offered Medicare supplement coverage for people under age 65 who weren’t able to enroll in private Medigap plans.

High-risk pool coverage is no longer necessary for people who aren’t Medicare-eligible, as individual major medical plans are now guaranteed-issue. But the ACA did not change anything about medical underwriting in the Medigap market. So several states that don’t have specific guaranteed-issue requirements for their Medigap plans have opted to keep their high-risk pools functional in order to serve this population.

Some of these high-risk pools are currently only open to Medicare beneficiaries who need supplemental coverage, although some continue to also offer coverage for people who don’t have other individual market (non-Medicare) coverage. New Mexico’s high-risk pool is an example of one that continues to offer coverage in both markets, with lower premiums for those who only need coverage to supplement Medicare.

12 states require insurers to offer at least one Medigap plan to those under age 65

In these states, insurers are required to offer some – but not all – of their Medigap plans to people under 65. State regulations vary in terms of the specific plans that have to be offered and whether the insurer can charge higher premiums for under-65 enrollees:

  • Arkansas
  • California (plans do not have to be offered to people with ESRD)
  • Connecticut
  • Maryland
  • New Jersey
  • North Carolina
  • Oklahoma
  • Texas (2023 legislation to make all plans guaranteed-issue at the same rates used for 65-year-olds was unsuccessful)
  • Michigan
  • Indiana (Additional legislation passed in 2024 — not yet signed into law as of February 2024 — would, as of 2025, make all plans available and prohibit higher premiums for Plans A, B, and D. For other plans, the under-65 premiums could be no more than 200% of the age-65 premiums.)6
  • Virginia (as of 2024, updated state law prohibits higher premiums for beneficiaries under age 65, and extends eligibility to those with ESRD)7
  • Rhode Island (effective July 2023; additional legislation under consideration in 2024 would require Medigap insurers in Rhode Island to make all policies available to beneficiaries under age 65, with premiums no higher than age-65 premiums8)

10 states make all plans guaranteed-issue, but under-65 premiums can be much higher

These states require Medigap insurers to offer all of their plans to any newly eligible Medicare beneficiary, regardless of age. But insurers are allowed to charge significantly higher premiums when an enrollee is under age 65:

14 states make all plans guaranteed-issue, include restrictions on premiums

In these states, Medigap insurers have to make all of their plans available to all newly eligible Medicare beneficiaries, regardless of age. And there are rating restrictions that either prevent insurers from charging higher premiums for enrollees under age 65, or limit the additional premiums that can apply to this population:

  • Hawaii (rates for those under 65 are the same as age-65 rates)
  • Idaho (rates capped at 150% of age-65 rates; this took effect in 2018)
  • Illinois (rates capped at highest rate the insurer charges over-65 enrollees)
  • Kansas (under-65 rates are the same as age-65 rates)
  • Kentucky (effective in 2024; under-65 rates not more than weighted average for 65+ rates)
  • Maine (rates don’t vary by age, including rates for under-65 enrollees)
  • Massachusetts (rates don’t vary by age, including rates for under-65 enrollees. But Medigap insurers can reject applicants with ESRD)
  • Minnesota (rates don’t vary by age, including rates for under-65 enrollees)
  • Mississippi (rates capped at 150% of age-65 rates)
  • Missouri (rates are capped at the “weighted average aged premium rate” that applies to people age 65+)
  • New York (premiums do not vary based on age)
  • Oregon (under-65 rates are the same as age-65 rates)
  • Pennsylvania (under-65 rates are the same as age-65 rates)
  • South Dakota (rates can’t exceed the rates for a 75-year-old)

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.


  1. Ohio HB400. BillTrack50. Introduced February 2024.
  2. Nebraska Legislative Bill 32. BillTrack50. Carried over from 2023 session to 2024 session.
  3. Iowa SF2081” BillTrack50. Accessed February 27, 2024.
  4. Iowa H.F.228 and Iowa H.F.462. BillTrack50. Accessed January 2024
  5. South Carolina Senate Bill 952. BillTrack50. Introduced January 2024.
  6. Indiana Senate Bill 215 and Indiana House Bill 1346. BillTrack50. Passed February 2024.
  7. Medicare Supplement Policies for Certain Individuals Under Age 65: Scope and Application of § 38.2-3610 (HB 1640/SB 1409) Frequently Asked Questions. Virginia State Corporation Commission. Accessed January 2024.
  8. Rhode Island H7433” and “Rhode Island S2392” BillTrack50. Introduced February 2024.
  9. Georgia HB1098 and Georgia SB409. BillTrack50. Introduced January 2024.
  10. Vermont H366. BillTrack50. Introduced February 2024.
Medigap eligibility rules for Americans under age 65 vary by state | (2024)


Medigap eligibility rules for Americans under age 65 vary by state | ›

For people who are under 65 and eligible for Medicare due to a disability, Medigap availability depends entirely on state regulations, as there is no federal regulation requiring a guaranteed issue Medigap enrollment period for under-65 enrollees.

Can you get a Medigap plan if you are under 65? ›

It depends on your state.

Some states allow anyone with Medicare under 65 to buy a Medigap policy. If you have ESRD or a disability, you may not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law doesn't require companies to sell Medigap policies to people under 65.

What is the Medigap rule? ›

Generally, you must have Original Medicare — Part A and Part B — to buy a Medigap policy. A Medigap policy only covers one person, so if you and your spouse both want Medigap coverage, you each have to buy your own policy.

What are the three states that allow year-round enrollment in a Medigap? ›

There are currently three states that allow year-round enrollment in a Medigap: Washington, New York and Connecticut. The rules vary by state: Connecticut and New York — Year-round guaranteed issue is allowed without restrictions.

Are Medigap premiums based on age? ›

How Insurance Companies Set Prices. Insurance companies set prices for Medigap policies in 1 of 3 ways: Attained-Age Rating — This is the most common way policies are priced in California. Attained age-rated policies increase in price as you age, because as you get older, you typically require more health care.

What is the 6 month rule for Medigap insurance? ›

You have the right to purchase a Medigap policy for 6 months if you move out of the area served by your Medigap plan. For example, if you bought a plan while living in another state that will not cover you in your current state, you have 6 months to replace that plan.

Can you be turned down for Medigap insurance? ›

Can you be denied access to a Medicare Supplement insurance policy (also called Medigap)? That depends on your circ*mstances, where you live, if you are replacing certain coverage, and whether you're currently within your Medicare Open Enrollment period.

What is the downside to Medigap plans? ›

The downside of high-deductible Plan G can, of course, be your upfront cost before you receive help with out-of-pocket expenses. Assuming you have this high-deductible Medigap plan and receive a Medicare Part B-covered service, you'll be responsible for the Part B deductible, which is $240 in 2024.

Which is cheaper, Medicare Advantage or Medigap? ›

In general, a Medicare Advantage plan is cheaper and includes more add-ons, such as dental and prescription coverage.

What is the most common Medigap policy? ›

Medicare Supplement plans F, G and N are the most popular Medigap plans with the highest rates of enrollment nationwide. Which one is best depends on the beneficiary and their specific health care needs.

Do Medigap plans vary from state to state? ›

Medigap policies are standardized by the federal government, which means that Plan A, for example, will have the same benefits no matter where you live in the U.S. However, the premium you pay for your Medigap policy may differ from state to state.

Are Medigap policies being phased out? ›

For example, Medigap plans C and F will no longer be available to new Medicare recipients after January 1st, 2020. Private insurers can decide to stop offering some Medigap plans as well, even if legislation related to those plans has not changed.

What is the Medigap birthday rule? ›

What is the Medigap Birthday Rule? The birthday rule is the nickname for a law that allows those who are already on a Medigap plan to switch to another plan without medical underwriting. In CA, they have created an annual window of 60 days after your birthday to switch plans – hence the name “birthday rule.”

What plan G does not cover? ›

Plan G does not cover the Part B deductible or any service that Medicare does not cover. For example, Medicare does not cover routine dental, vision, or hearing; therefore, Plan G won't cover those services. Medicare pays first, and then Plan G pays the remaining amount after you pay the once-annual deductible.

Does income affect Medigap premiums? ›

Recap on Medicare insurance premiums based on how much money you make. High-income individuals may pay more for Medicare Part B, Medicare Part D and/or an MAPD plan due to IRMAA but will never pay more for Medigap.

Does AARP offer Medigap insurance? ›

Yes! We offer AARP® Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company. This supplemental insurance coverage, also known as Medigap, is for those enrolled in Medicare Parts A and B. Although AARP isn't an insurance company, we're in your corner.

Can you purchase Medicare coverage before age 65? ›

Before age 65, you are eligible for Medicare Part A at no cost if 1 of the following applies: You've been entitled to Social Security Disability Insurance (SSDI) benefits for 24 months. You receive a disability pension from the RRB and meet certain conditions.

Can I get AARP health insurance at 62? ›

The AARP-branded health insurance plans provided by UnitedHealthcare are Medicare plans, which means you usually have to be 65 years and older to enroll unless you are on Medicare due to a disability, then depending on the state, Medicare Supplement plans may be available.

What are the disadvantages of Medicare Part G? ›

The Cons Include . . .
  • Medicare Plan G plans can be more expensive than Medicare Advantage Plans if you compare upfront premiums payments.
  • To enroll, you will also have to sign up for a stand-alone Medicare Part D drug plan.
  • You will have to sign up for dental coverage separately.

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