Verified 09/23/2026 · re-checked every quarter
Medigap rules by state
Whether you can change your Medicare Supplement without health questions depends on where you live. We track every state and DC, cited to the state’s own law or insurance department.
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| State | Birthday or anniversary rule | Year-round guaranteed issue | Under-65 access |
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None. No. Federal rules only. Not required. Alabama does not mandate that Medigap insurers offer or issue policies to Medicare beneficiaries under age 65 who qualify by disability, ESRD, or ALS; these applicants are subject to full medical underwriting at the discretion of each carrier. The state does guarantee a six-month open enrollment window beginning the month the individual turns 65, during which ESRD patients are also included, but there is no separate six-month guaranteed-issue window for under-65 enrollees. No plan letters are mandated for under-65 applicants since there is no guaranteed-issue requirement, and carriers may charge substantially higher premiums for any under-65 policies they choose to sell. ESRD: Excluded. Sources: ALDOI – Medicare Disability Supplement Information · ALDOI – Medicare Disability Supplement Information · Verified 09/23/2026 None. No. Federal rules only. Not required. Alaska does not require Medigap insurers to sell policies to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS; there is no dedicated six-month open enrollment period for this group, and it begins only when the person turns 65 and enrolls in Part B. Because there is no state mandate, no specific plan letters are guaranteed to be offered and no rate cap applies to under-65 applicants; ACHIA, the state high-risk pool, offers a private backstop with premiums that vary by age and are highest for under-65 enrollees. ESRD: Excluded. Sources: Consumer Guide to Medicare Supplement Insurance (Medigap) 2025, State of Alaska Division of Insurance · Medicare | State of Alaska | Department of Health · Verified 09/23/2026 None. No. Federal rules only. Not required. Arizona does not mandate that Medigap insurers offer policies to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS; the state’s official SHIP consumer guide states that in Arizona there are limited options for Medicare beneficiaries younger than age 65 and directs consumers to contact SHIP for details. No plan letters are required to be offered to this population, and applicants under 65 are generally subject to full medical underwriting until they turn 65, at which point the federal six-month Medigap open enrollment period (guaranteed issue, no underwriting) begins. Arizona has no additional state-mandated six-month open enrollment window for under-65 enrollees, and no state rate cap applies to under-65 applicants since insurers are not required to sell to them at all. ESRD: Excluded. Sources: 20-1133 – Medicare supplement insurance; early enrollment discounts; applicability (Arizona Revised Statutes, via azleg.gov), corroborated by Arizona Senate Fact Sheet on SB1375 citing the Dept. of Insurance · Medicare Supplement (Medigap) Information (2026) – Arizona SHIP · Verified 09/23/2026 None. No. Federal rules only. Required. Arkansas Insurance Department Rule 27 (Section 25), implementing Act 684 of 2017, requires every Medigap insurer to guarantee-issue at least one of its standardized plans (insurer’s choice, almost always Plan A) to Medicare beneficiaries under age 65 who qualify by disability, ESRD, or ALS. There is no state-mandated rate cap or community-rating requirement for these under-65 enrollees, so insurers may charge substantially higher premiums than the age-65 rate. A separate six-month Medigap open enrollment/guaranteed-issue period is available again when the person turns 65, at which point any available plan can be purchased at standard age-65 rates. ESRD: Included. Arkansas Insurance Department Rule 27 provides a guaranteed-issue right for individuals who lose Medicaid eligibility and thus lose their Medigap open enrollment/guaranteed-issue window, allowing them 63 days from the Medicaid eligibility change to enroll in a Medicare Supplement plan without underwriting. Sources: RULE 27 MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES – Arkansas Insurance Department · Arkansas Insurance Department Rule 27: Minimum Standards for Medicare Supplement Policies (Section 25, implementing Act 684 of 2017) · Verified 09/23/2026 60 days beginning on the policyholder’s birthday (insurers must send notice 30 to 60 days before the birthday) equal or lesser benefits, any insurer, no medical underwriting and no new waiting period; benefits added by a plan (e.g., dental/vision riders) are disregarded when comparing benefit levels. Effective Current 60-day window effective since 2020 (window was expanded from 30 to 60 days by legislation enacted in 2019); the underlying birthday open-enrollment right itself dates to the 1990s. No. Federal rules only. Limited. California Insurance Code Section 10192.11 requires Medigap issuers to offer plans A, B, D, and G (and either K or L, or M or N, at the issuer’s discretion) to under-65 applicants who qualify for Medicare Part B due to disability, but this mandate explicitly excludes those who qualify solely due to end-stage renal disease. Disabled enrollees get a six-month guaranteed-issue open enrollment window starting with Part B enrollment, and a second six-month guaranteed-issue window opens at age 65 regardless of health condition, including ESRD. Insurers are expressly permitted to treat under-65 Medicare Part B enrollees as a separate rating class, so higher (non-community-rated, non-capped) premiums are allowed for this group. ESRD: Excluded. California Insurance Code 10192.12 gives Medicare Advantage enrollees a state guaranteed-issue right to a Medigap policy (from the same issuer or, since Jan. 1, 2007, an affiliated issuer) if their MA plan reduces benefits, raises cost-sharing/premium, or drops a treating provider without good cause, in addition to federal trial-right protections. Sources: Informing Senior – California Department of Insurance · California Code, Insurance Code – INS § 10192.11 | FindLaw · Verified 09/23/2026 None. No. Federal rules only. Required. Colorado requires every company selling Medigap in the state to also sell to Medicare beneficiaries under age 65 who qualify due to disability, giving them a six-month guaranteed-issue open enrollment window when they first enroll in Part B, separate from a second six-month guaranteed-issue window that begins in their 65th birth month. Insurers may charge higher premiums to under-65 disabled enrollees during that first window, but once the person turns 65 they get the standard age-65 rates and full plan choice during the second open enrollment. The state’s official guide does not limit the under-65 mandate to specific plan letters, implying the insurer’s full standardized lineup (A, B, C, D, F, G, K, L, M, N, plus high-deductible F/G where sold) must be offered. ESRD: Included. Colorado law (3 CCR 702-4, Series 4-3, Section 10) requires Medigap insurers to offer all standardized plans to Medicare beneficiaries under age 65 during the same six-month open-enrollment window that applies at age 65, and the Division of Insurance separately issued Bulletin B-4.129 recognizing a guaranteed-issue period for consumers losing Colorado Medicaid coverage after the end of the COVID-19 federal public health emergency. Sources: Medicare Supplement Insurance Policies in Colorado (DOI Medigap Guide, September 2025) · Medicare Supplement Insurance Policies in Colorado – September 2025 (Colorado Division of Insurance / SHIP consumer guide) · Verified 09/23/2026 None. Year-round. Continuous guaranteed issue: insurers must issue Medigap policies at any time of year to applicants 65 and older, with no medical underwriting. For enrollees under 65, continuous guaranteed issue applies to Plan A and, where the insurer offers them, Plans B, C and D. Required. Connecticut General Statutes Sec. 38a-495c(d) requires any insurer that sells Medigap plans A, B, C, or D to age-65 beneficiaries to also offer the same plans to persons who become Medicare-eligible by reason of disability, with Plan C limited to those Medicare-eligible before 2020 and Plan D (added effective July 1, 2021) required for those eligible on or after 2020. Sec. 38a-495c(a) mandates community rating with no variation by age, gender, claims history, or medical condition, and Connecticut provides continuous, year-round guaranteed issue for Medigap rather than a single six-month window, so under-65 enrollees receive the same rate and guaranteed-issue protections as enrollees at 65. The statute text itself refers generically to persons eligible for Medicare by reason of disability and does not separately name ESRD or ALS as qualifying categories. ESRD: Not specified. Connecticut law extends guaranteed issue to Medicare beneficiaries under age 65 who qualify by disability, requiring insurers to offer Plan A to all such applicants and any of Plans B, C (for those Medicare-eligible before 1/1/2020), or D that the insurer also sells to age-65-and-over enrollees; a pre-existing condition exclusion of up to 6 months may apply if there was no prior creditable coverage or a coverage gap. Sources: Medicare Supplement – Connecticut Insurance Department (CID) / Medigap Fact Sheet · Connecticut General Statutes Section 38a-495c – Medicare supplement premium rates charged on a community rate basis; coverage for the disabled and qualified Medicare beneficiaries · Verified 09/23/2026 60 days: begins 30 days before the policyholder’s birthday and continues at least 30 days after. same or lesser benefits, any insurer (current carrier or a new carrier), no medical underwriting; innovative benefits are disregarded when comparing benefit levels. Effective 01/01/2026. No. Federal rules only. Required. Delaware Senate Bill 42 (effective January 1, 2014) requires any insurer that sells Medigap policies to people 65 and older to offer the same plans to Medicare beneficiaries under 65 who qualify due to disability, giving them a six-month guaranteed-issue window from the time their Medicare benefits begin; a second six-month guaranteed-issue open enrollment applies again at age 65 under the standard federal rule. Insurers are permitted to charge higher premiums to under-65 enrollees than to age-65 applicants, and the state’s own Medigap rate guide shows a separate, markedly higher rate class for under-65 ESRD applicants, indicating ESRD beneficiaries are included but rated separately and at a premium. ESRD: Included. Delaware also grants guaranteed-issue rights to purchase any Medicare Supplement policy available in the state for beneficiaries switching from Medicare Advantage back to Original Medicare during the federal Annual Open Enrollment (Oct 15–Dec 7) or Medicare Advantage Open Enrollment (Jan 1–Mar 31) periods, though carriers may still medically underwrite and price these applicants appropriately. Sources: Delaware Department of Insurance Bulletin DF No. 164 / PA No. 40 (SB 71 Medigap Enrollment Rights) · Delaware Medicare Assistance Bureau – Delaware Department of Insurance – State of Delaware · Verified 09/23/2026 None. No. Federal rules only. Not required. The DC Department of Insurance, Securities and Banking (DISB) states it does not regulate Medicare or Medigap policies, so no DC statute mandates insurers to sell Medigap to beneficiaries under 65 due to disability, ESRD, or ALS. Federal rules therefore control, meaning insurers may voluntarily choose to offer under-65 coverage but are not required to, there is no DC-mandated six-month under-65 open enrollment window, and no state rate cap applies to under-65 applicants; enrollees are guaranteed the standard six-month Medigap open enrollment only once they turn 65 and enroll in Part B. ESRD: Not specified. Sources: Chapter 37. Medicare Supplement Insurance. | D.C. Law Library · Do You Know Your Health Insurance Rights? · Verified 09/23/2026 None. No. Federal rules only. Required. Florida law (Fla. Stat. 627.6741) requires every insurer selling Medicare Supplement policies in the state to offer coverage to individuals under 65 who are Medicare-eligible due to disability or end-stage renal disease, with a 6-month guaranteed-issue open enrollment period beginning when the person is enrolled in Medicare Part A and B under that eligibility; a separate 6-month open enrollment period is also guaranteed when the person later turns 65 and enrolls in Part B. Insurers may charge higher premiums to under-65 enrollees than to age-65-and-over enrollees, and the enrollee becomes eligible for the lower age-65 rate only upon reaching 65, so there is no rate cap at the age-65 level for the under-65 period. Pre-existing condition exclusions of up to 6 months (with credit for prior creditable coverage) may still apply. ESRD: Included. Sources: Medicare Supplement Insurance Overview | Consumer Services | Florida Department of Financial Services · Medicare Supplement Insurance Overview | Consumer Services | Florida Department of Financial Services · Verified 09/23/2026 None. No. Federal rules only. Required. Georgia law (O.C.G.A. section 33-43-3(g)) requires that any insurer selling Medigap to people 65 and older must also offer the same policies to Georgians who are eligible for and enrolled in Medicare due to disability or end-stage renal disease, with all the same benefits, protections, policies, and procedures. Subsection (h) creates a dedicated six-month guaranteed-issue enrollment window starting when the under-65 disabled or ESRD individual enrolls in Medicare Part B, and a separate six-month open enrollment period also applies once the person turns 65 and is enrolled in Part B (per Ga. Comp. R. and Regs. 120-2-8-.11). Insurers may charge different (higher) premiums to under-65 enrollees under subsection (j), so rates are not capped at the age-65 level or community-rated, only limited by a general statutory standard that pricing differences not be excessive, inadequate, or unfairly discriminatory; a 2025-2026 bill (HB323) that would cap under-65 premiums at or near age-65 rates has not been enacted as of the response date. ESRD: Included. Georgia law grants a six-month guaranteed-issue enrollment window not only for standard federal triggers but also when a person is retroactively enrolled in Part B due to a Social Security Administration eligibility decision, and for any additional ‘qualifying event’ the Commissioner identifies by regulation. Sources: Georgia Code Title 33, Chapter 43 – Medicare Supplement Insurance, § 33-43-3 (Duplicate benefits prohibited; establishment of standards) · O.C.G.A. section 33-43-3 – Duplicate benefits prohibited; establishment of standards (2024 Georgia Code, Title 33, Chapter 43) · Verified 09/23/2026 None. No. Federal rules only. Required. Hawaii Administrative Rules section 16-12-6.2 requires every Medigap issuer to make each policy or certificate it currently sells available to all applicants without regard to age, and bars denial or health-based price discrimination, during the six-month period beginning the first day of the first month the person is enrolled in Medicare Part B, which covers people under 65 who qualify via disability, ESRD, or ALS. Because this window is not restricted to age 65, and federal law separately grants a standard six-month OEP the first time a person is both age 65 and enrolled in Part B, most under-65 enrollees who keep Part B effectively get an initial disability-based window and a second window at 65. Pricing during these guaranteed-issue windows cannot be adjusted for health status, so an under-65 enrollee is charged the same rate structure as anyone else applying for that plan (no separate high-risk surcharge), though normal attained-age premium increases over time still apply. ESRD: Included. Haw. Code R. §16-12-6.2 extends the federal-style 6-month Medigap open enrollment/guaranteed-issue window to all applicants regardless of age, so a person enrolling in Medicare Part B due to disability or ESRD gets the same guaranteed-issue rights and community-rated pricing as a 65-year-old, which goes beyond the federal minimum (federal law only guarantees this window at age 65). Sources: Haw. Code R. § 16-12-6.2 – Open enrollment · Hawaii Administrative Rules section 16-12-6.2, Open enrollment (Medicare Supplement Insurance Minimum Standards, Title 16, Chapter 12) · Verified 09/23/2026 63 days beginning on the policyholder’s birthday. equal or lesser benefits; any insurer (policyholder may change insurance companies and/or plan); no holding-period requirement specified by the Department. Effective March 1, 2022 (rule effective for changes made after February 28, 2022). No. Federal rules only. Required. Idaho Department of Insurance rule IDAPA 18.04.10 requires Medicare Supplement (Medigap) insurers doing business in the state to make policies available to people under age 65 during their Medicare Initial Enrollment Period or any applicable guaranteed-issue period, mirroring the six-month guaranteed-issue window used for age-65 enrollees. Insurers may charge these under-65 enrollees up to 150% of the premium charged to people who become eligible for Medicare based on age, and that premium must be reduced to the standard age-65 rate once the enrollee turns 65. The rule does not carve out a separate, shorter list of mandatory plan letters or exclude any eligibility category, so ESRD- and ALS-based Medicare entitlement fall within the same under-65 access requirement as disability-based entitlement. ESRD: Included. Idaho requires Medigap insurers to offer coverage to Medicare beneficiaries under 65 who qualify due to disability or ESRD during a 6-month initial enrollment/guaranteed-issue window, and caps their premiums at 150% of the age-65 community rate. Sources: Recent Changes to Medicare Supplement Law and Rules • Medicare Supplement/Medigap • Idaho Department of Insurance · Medicare Under 65 – New to Medicare – Idaho Department of Insurance · Verified 09/23/2026 45 days beginning on the birthday, each year, ages 65 to 75 only. Equal or lesser benefits, from the same insurer or an affiliate authorized in Illinois (affiliates added by Public Act 103-0747 effective January 1, 2026); the right ends after age 75. Effective January 1, 2022 (215 ILCS 5/363); affiliate expansion effective January 1, 2026. Annual or partial. One insurer, currently Blue Cross Blue Shield of Illinois, voluntarily operates as a ‘Guaranteed Issue Company’ selling certain Medigap plans year-round to anyone 65+ regardless of health status, but Illinois law does not require every insurer to do this. Required. Illinois law (215 ILCS 5/363(6)) prohibits Medicare supplement issuers from denying coverage to an under-65 applicant who becomes Medicare-eligible by reason of disability and applies within 6 months of first enrolling in Part B, and requires the issuer to make available each type of Medicare supplement policy it sells to age-65 enrollees. Under-65 enrollees who qualify get a second full 6-month guaranteed-issue open enrollment when they later turn 65. Premiums for these under-65 enrollees are capped by statute at no more than the issuer’s highest filed rate for that plan charged to enrollees age 65 or older (i.e., capped at the age-65 rate, not community rated and not allowed to be higher). ESRD: Not specified. Illinois law separately requires the initial 6-month Medigap open-enrollment/guaranteed-issue period to apply to people who become Medicare-eligible by disability under age 65, not just those aging in at 65, bars insurers from charging these under-65 enrollees more than the issuer’s highest on-file rate for enrollees 65 and older, and (per IDOI Bulletin CB 2023-09) added a 63-day guaranteed-issue period for people who lose dual Medicare/Medicaid enrollment. Sources: Illinois Department on Aging SHIP, Medicare Choices Guide 2026 · Illinois Department of Insurance Company Bulletin CB2023-09 (Medicare Supplement omnibus legislation), citing 215 ILCS 5/363 · Verified 09/23/2026 63-day window beginning 31 days before the policyholder’s birthday and ending 31 days after (originally a 60-day window beginning on the birthday under the law as first effective Jan 1, 2026; secondary industry sources report the window was changed by a 2026 amendment, HEA 1260, effective for policies delivered/issued/renewed on or after March 15, 2026) same plan letter (including plan variations, e.g. G to G, N to N) with any Indiana-licensed insurer offering that plan letter; no stated holding-period requirement. Effective January 1, 2026 (HEA 1226); window amended effective March 15, 2026 per HEA 1260. No. Federal rules only. Required. Indiana law (SEA 215, codified as IC 27-8-13-9.1, effective January 1, 2025) requires any insurer that sells a Medigap policy to persons 65 and older to make the equivalent plan available to individuals under 65 who qualify for Medicare due to disability or end-stage renal disease, expanding a prior 2020 rule that only mandated Plan A. Under-65 applicants who became Medicare-eligible before January 1, 2025 had a one-time guaranteed-issue window from January 1 to June 30, 2025, while those becoming eligible after that date get their own six-month guaranteed-issue window starting when their coverage begins, separate from the standard six-month window that begins at age 65 with Part B enrollment. Plans A, B, and D must be priced the same as the insurer’s age-65 rate for under-65 enrollees, while other lettered plans may be priced up to 200% of the age-65 rate. ESRD: Included. Under Senate Enrolled Act 215, Indiana requires a six-month guaranteed-issue window for people who become eligible for Medicare before age 65, starting the first day of the month their Medicare begins (effective for those enrolling on or after Jan. 1, 2025). Sources: SHIP: State Health Insurance Assistance Program (SHIP) · Medicare Supplement Guaranteed Issue (SHIP fact sheet on SEA 215) · Verified 09/23/2026 None. No. Federal rules only. Not required. Iowa does not mandate that Medigap insurers offer or guarantee issue policies to Medicare beneficiaries under age 65 who qualify by disability or ESRD; the state SHIIP program confirms there is no open enrollment period before age 65, and the six-month guaranteed-issue open enrollment applies only once the person turns 65. A small number of carriers voluntarily sell Medigap policies to under-65 enrollees and a few of those are guarantee issue, but these are not required by law and may carry higher premiums; the state-run HIPIOWA high-risk pool is available as a supplemental option for under-65 beneficiaries who cannot obtain private Medigap coverage. No plan-letter mandate, ESRD/ALS-specific rule, or rate cap tied to the age-65 rate exists for the under-65 population under current Iowa rules. ESRD: Excluded. Sources: Supplemental Insurance | Iowa SHIIP and SMP · For People with Disabilities | Iowa SHIIP and SMP · Verified 09/23/2026 None. No. Federal rules only. Required. Kansas statute (K.S.A. 40-2221) requires Medigap issuers not to deny coverage to an under-65 applicant who becomes Medicare-eligible by reason of disability, provided application is made within six months of first enrolling in Medicare Part B, and to make available to that applicant every type of Medicare supplement policy the issuer sells to age-65 enrollees, with no underwriting on health status, claims experience, or medical condition during that window. A second six-month guaranteed-issue open enrollment applies when the person turns 65, and the statute (as administered by the Kansas Insurance Department) requires the under-65 rate to equal the age-65 rate rather than a higher disabled-rate; state guidance also notes that those first Medicare-eligible on or after January 1, 2020 cannot buy plans containing Part B deductible coverage, consistent with the federal MACRA change. ESRD: Not specified. Kansas requires insurers to offer Medigap on a guaranteed-issue basis to all Medicare Part B enrollees, regardless of age, during a six-month open enrollment window starting when Part B begins, and separately guarantees a 63-day no-health-questions purchase right for people who lose coverage due to reasons such as an MA plan terminating or moving out of its service area, or loss of Medicaid eligibility. Sources: Disability and Medicare | Department for Aging and Disability Services (KDADS/SHICK) · 40-2221 – Kansas State Legislature / Kansas Revisor of Statutes · Verified 09/23/2026 60 days beginning on the enrollee’s birthday. same plan letter, any insurer (must already hold a Medigap policy; no minimum holding-period specified in DOI guidance) Effective January 1, 2024. No. Federal rules only. Required. Kentucky law (KRS 304.17-311, implementing 2023 HB 345 effective 2024) requires Medigap insurers to guarantee issue their full lineup of standardized plans to Medicare beneficiaries under 65 who apply within six months of Medicare Part B enrollment, mirroring the age-65 open enrollment window. Premiums charged to these under-65 enrollees cannot exceed the insurer’s weighted average rate charged to its age-65-and-older policyholders, and the law also created an annual 60-day birthday-rule window letting under-65 (and other) enrollees switch to another insurer’s plan of the same letter on a guaranteed-issue basis. ESRD: Included. HB 345 (2023) also added restrictions on pre-existing-condition waiting periods and benefit exclusions for eligible under-65 applicants and created a new 6-month Medigap open-enrollment/guaranteed-issue period for people who become Medicare-eligible under age 65. Sources: Advisory Opinion 2023-06 – Medicare Supplement Products (Kentucky Department of Insurance) · Kentucky Revised Statutes 304.17-311 – Medicare supplement insurance for persons not eligible for Medicare by reason of age · Verified 09/23/2026 63 calendar days beginning on the individual’s birthday. equal or lesser benefits (same or lower plan letter), issuer of choice limited to the same insurer or any affiliate of that insurer authorized to transact business in Louisiana; no holding-period requirement is stated in the statute. Effective 2022-08-01 (enacted by Acts 2022, No. 459); expanded in 2023 (Acts 2023, No. 71) to allow switching to an affiliate of the current insurer, not just the same insurer. No. Federal rules only. Required. People who qualify for Medicare before 65 by disability get the same six-month Medigap open enrollment period as people who qualify by age, and a second six-month open enrollment period when they turn 65. Premiums for under-65 enrollees run substantially higher than age-65 rates. Louisiana law also gives a 63-day guaranteed-issue open enrollment period to a Medicare-eligible individual who has no existing Medigap policy but was covered under an employer group plan when they became Medicare-eligible, running from termination of that employer coverage. Confirm this state with its insurance department before relying on it. Sources: Louisiana Revised Statutes §22:1112 – Medicare supplement guaranteed issue; open enrollment periods; prohibited conditioning of coverage; notice to policyholders · Louisiana Department of Insurance – Regulation 33, Medicare Supplement Insurance Minimum Standards (Louisiana Administrative Code Title 37, Part XIII, Chapter 5) and R.S. 22:1112 · Verified 09/23/2026 None. Annual or partial. Two separate state protections: every insurer must offer Medigap Plan A on a guaranteed-issue basis during one designated month each year (the month is set by each carrier, and richer plans are not required), and a policyholder may switch to a plan with equal or lesser benefits at any time without underwriting as long as there has been no gap in Medigap coverage longer than 90 days. Required. Maine law (24-A M.R.S. section 5010-A) requires every Medigap issuer to offer coverage under all of its standardized plans, regardless of age, to individuals entitled to Medicare due to disability during that person’s six-month open enrollment period tied to Part B enrollment; a second six-month guaranteed-issue window opens again when the person turns 65. Outside that initial open enrollment window, issuers need only offer standardized Plan A during the state’s mandatory one-month annual guaranteed-issue period (24-A section 5012). Premiums are community rated under 24-A section 5011, meaning rates may not vary based on age, so under-65 enrollees are charged the same community rate as older enrollees rather than a higher or age-65-capped rate. ESRD: Not specified. Maine law requires (1) a one-month annual guaranteed-issue window for Plan A from every insurer, (2) a continuous right for existing enrollees to switch to a same-or-lesser-benefit plan with any insurer if they have not had a coverage gap greater than 90 days, (3) a 3-year (rather than federal 1-year) Medicare Advantage ‘trial right’ to return to Medigap, (4) guaranteed issue if a Medicare Advantage plan is involuntarily terminated, and (5) an extra 6-month open enrollment at age 65 for those who enrolled in Part B before turning 65. Sources: Maine Bureau of Insurance: Buy or Switch Outside Open Enrollment (Rule 275) · Title 24-A, section 5010-A: Coverage of the disabled (Maine Revised Statutes) · Verified 09/23/2026 30 days following the policyholder’s birthday (Maryland Insurance Administration describes the window as the birthday plus the following 30 days) equal or lesser benefits; any insurer (policyholder is not required to stay with current carrier); no holding-period requirement is stated in the statute. Effective July 1, 2023. No. Federal rules only. Required. Maryland law requires carriers to make Medicare supplement Plans A and D available on a guaranteed issue basis to individuals under age 65 who are eligible for Medicare due to disability, if they apply within the six month period after Part B enrollment or after retroactive enrollment notice; insurers that also sell Plan C to 65-plus enrollees who were Medicare eligible before 2020 must offer it to this group too. During that under-65 open enrollment window carriers may not deny, condition, or medically underwrite the policy or its pricing, and Plan A premiums for under-65 enrollees cannot exceed the average premium charged to enrollees age 65 and older; enrollees then get a second six month open enrollment window at age 65 giving access to any Medigap plan sold in the state. The statute’s language covers those eligible for Medicare due to disability generally and does not state an express carve-out for ESRD or ALS, but agents should confirm current MIA guidance since some secondary sources note state ESRD/disability carve-outs vary and this point is not explicitly spelled out in the statute text reviewed. ESRD: Not specified. Policyholders who were previously medically underwritten and received less than the preferred rate are entitled to the preferred rate during the annual birthday guaranteed-issue period, and separate guaranteed-issue triggers apply for events such as carrier insolvency, material misrepresentation, or termination of a policy followed by enrollment in Medicare Advantage. Sources: Section 15-909 – Policy Provisions; Policy Replacement; Cancellation, Nonrenewal, or Termination of Policies · Maryland Code, Insurance Article, Section 15-909 – Policy Provisions; Policy Replacement; Cancellation, Nonrenewal, or Termination of Policies · Verified 09/23/2026 None. Year-round. Continuous guaranteed issue: insurers must issue a Medigap policy to applicants 65 and older at any time of year, and the state also runs an annual open enrollment period from February 1 to March 31. Massachusetts uses its own standardized plans under a federal waiver. Limited. Massachusetts regulation 211 CMR 71.10 defines an Eligible Person as anyone enrolled in Medicare Part B regardless of age, and requires issuers to make every currently sold Medicare Supplement policy available to all Eligible Persons and to price without regard to age or health status, effectively giving under-65 disability-based enrollees the same guaranteed-issue, community-rated access as those turning 65. However, the same regulation explicitly states issuers are not required to cover a person under 65 who is eligible for Medicare solely due to end-stage renal disease, though a carrier may voluntarily choose to cover ESRD enrollees under the same nondiscrimination rules if it does. Rather than a separate six-month window solely for under-65 enrollees, the anti-discrimination provision applies at any time, and a distinct six-month open enrollment tied to turning 65 and enrolling in Part B is also specified for age-based eligibility. ESRD: Excluded. The same regulation bars any waiting period or pre-existing-condition limitation or exclusion in a Medicare Supplement policy, and separately requires a 12-month holding period before a newly enrolling person can move from a Supplement 1 plan to a Supplement 1A plan with the same issuer. Sources: 211 CMR 71.10 – Open Enrollment and Guarantee Issue for Medicare Supplement Insurance (Massachusetts Division of Insurance) · 211 CMR 71.00: MEDICARE SUPPLEMENT INSURANCE AND EVIDENCES OF COVERAGE · Verified 09/23/2026 None. No. Federal rules only. Limited. Michigan law (MCL 500.3831) requires insurers that also sell major medical/group health coverage to make available on a guaranteed issue basis only Medicare Supplement Plan A and Plan G (formerly Plan C before 2020) to Medicare beneficiaries under age 65; only a small subset of carriers meet this major-medical trigger, so most Medigap insurers in the state are not required to offer any plan to under-65 enrollees. Insurers that must offer these plans are permitted to charge under-65 enrollees higher premiums than the age-65 rate, and if the applicant lacked prior major medical coverage with that insurer a pre-existing condition waiting period of up to six months may be imposed. The state’s official six-month guaranteed-issue open enrollment window described by DIFS applies specifically when a person turns 65 and enrolls in Part B; DIFS materials do not describe a separate statutory six-month open enrollment window solely for under-65 disabled enrollees, instead describing a continuous guaranteed-issue obligation on qualifying insurers. ESRD: Not specified. Sources: Medicare Supplement Policies – Michigan Department of Insurance and Financial Services (DIFS) · Medicare Supplement Policies – Michigan Department of Insurance and Financial Services (DIFS) · Verified 09/23/2026 None. Annual or partial. One-time guaranteed-issue window during the Annual Enrollment Period (Oct 15 to Dec 7) for ages 65 to 70 who have not previously had Medigap, effective August 1, 2026; a premium penalty applies (15 percent in 2026, rising 5 points a year to 35 percent from 2029) for as long as the policy stays in force. Minnesota also extends the 6-month Medigap open enrollment to all Part B enrollees regardless of age. Required. Minnesota’s Medicare Supplement law (Minn. Stat. 62A.31) applies its core consumer protections regardless of whether the individual has attained age 65, guaranteeing issue and prohibiting pricing discrimination based on health status, medical condition, or age during the six-month window beginning the first day of the month the individual first enrolls in Medicare Part B and during the statutory open enrollment period. Because Minnesota uses its own standardized plan set (Basic and Extended Basic plans, plus riders, rather than the federal A-N letters), issuers must make the Basic and Extended Basic plans available at initial enrollment regardless of age or health status. A newly enacted annual guaranteed-issue open enrollment structure (adding subdivisions 1u/1w) was originally set for August 1, 2025 but has been delayed and is now set to take effect August 1, 2026, and per legislative summaries is intended to extend two additional annual guaranteed-issue windows (Oct 15-Dec 7 and Jan 1-Mar 31) to both age 65+ and under-65 disabled enrollees. ESRD: Not specified. Minnesota’s Medicare supplement statute (Minn. Stat. §62A.31, subd. 1u) provides a guaranteed-issue enrollment right for eligible persons who submit evidence of termination or disenrollment from prior coverage, and a 2025 amendment gives an individual who is or was previously enrolled in Medicare Part B due to disability status another six-month enrollment period beginning the first day of the month the individual turns 65; separately, effective August 1, 2026, Minnesota created a new guaranteed issue situation allowing individuals aged 65 to 70 who missed their initial open enrollment to enroll during the Medicare Annual Election Period (Oct 15-Dec 7) without medical underwriting, usable only once between ages 65 and 70, subject to a premium surcharge starting at 15% and rising 5 percentage points per year to a maximum of 35%. Sources: Minn. Stat. 62A.31, Medicare Supplement Benefits; Minimum Standards · Sec. 62A.31 MN Statutes · Verified 09/23/2026 None. No. Federal rules only. Required. Mississippi’s Insurance Department guide confirms that beneficiaries who become Medicare-eligible under age 65 due to disability receive a disability open enrollment period, and the guide explicitly states that if you are under age 65 and bought a Medigap policy during your disability open enrollment, you will have a new six-month open enrollment period when you turn 65. The same source notes that disability Medigap policies are usually priced higher than those sold to people 65 and older, confirming higher premiums are permitted for under-65 enrollees rather than strict community rating. The primary source text located does not itemize which specific plan letters must be offered or state an exact rate-cap percentage, though secondary industry sources commonly cite a 150% (50% higher) age-65 rate cap for Mississippi. ESRD: Not specified. Beyond the federal Medigap Open Enrollment Period and federal guaranteed-issue triggers, Mississippi’s main state-added protection is a mandatory 6-month guaranteed-issue enrollment window for people who become Medicare-eligible under age 65 due to disability; the state does not otherwise offer a birthday rule, anniversary rule, or year-round guaranteed issue. Sources: Medicare Supplement Shopper’s Guide – Mississippi Insurance Department · Medicare Supplement Shopper’s Guide, Mississippi Insurance Department · Verified 09/23/2026 apply within 30 days before to 30 days after the policy anniversary each year No. Federal rules only. Limited. Missouri requires carriers that sell Medigap to offer at least one supplement policy to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS, and gives them the same six-month guaranteed-issue window tied to Part B enrollment that age-65 enrollees get, plus a fresh six-month guaranteed-issue window when they turn 65 and can move to any carrier’s plan at standard age-65 rates. Under-65 enrollees are not guaranteed access to every lettered plan a carrier sells (carriers can limit which plans they offer this group), and under state regulation (20 CSR 400-3.650) their premiums are not required to equal the age-65 rate but are capped at the insurer’s weighted average aged premium rate, so under-65 premiums run higher than, but not drastically higher than, age-65 premiums. ESRD: Included. Anniversary rule (20 CSR 400-3.650(13)): a current Medigap policyholder who terminates the policy within 30 days of its annual anniversary becomes a guaranteed-issue eligible individual and may take the SAME plan letter from any carrier with no underwriting. It does not allow a change of plan letter, and it is tied to the policy start date, not the birthday. Sources: 20 CSR 400-3.650, Medicare Supplement Insurance Minimum Standards (Missouri Secretary of State, Code of State Regulations) · Missouri Medigap Shopping Guide – Missouri Department of Commerce and Insurance · Verified 09/23/2026 None. No. Federal rules only. Required. Montana’s insurance department confirms that companies that offer Medicare supplement policies to people over age 65 also offer coverage to those under age 65 who have Medicare due to disability, and disabled enrollees receive a fresh six-month guaranteed-issue open enrollment period when they turn 65 in addition to their initial disability-based enrollment window. Secondary industry sources indicate this under-65 mandate began around 2013 and that insurers may charge substantially higher premiums to under-65 enrollees (no age-65 rate cap), with standard age-65 open-enrollment rates applying only once the person turns 65. ESRD: Not specified. Beyond the federal guaranteed-issue triggers (e.g., loss of employer/retiree coverage, Medicare Advantage plan termination), Montana’s main state-added protection is the under-65 disability guaranteed-issue requirement noted below; no separate birthday or anniversary continuous-switch right was found in state sources. Sources: Medicare – Montana Commissioner of Securities and Insurance (CSI) · Medicare – Montana Commissioner of Securities and Insurance · Verified 09/23/2026 None. No. Federal rules only. Limited. Nebraska law (Neb. Rev. Stat. section 44-3614, enacted by LB 852, effective January 1, 2025) requires every Medigap issuer that offers policies to age-65 enrollees to also make available at least one plan to individuals under 65 who are eligible for and enrolled in Medicare due to disability; in practice all Nebraska carriers have chosen to offer only Plan A to this group. Premiums for under-65 enrollees may be higher than the age-65 rate (statute allows differential rates, with legislative history citing a cap of 150% of the age-65 premium). Under-65 disabled enrollees get a guaranteed-issue window when first eligible and then a second full six-month Medigap open enrollment period with access to any plan and age-65 rates beginning the first day of the month they turn 65; the Nebraska DOI states individuals who qualify for Medicare based on End-Stage Renal Disease (ESRD) are not covered by this guarantee and remain ineligible for a Medicare Supplement policy prior to age 65. ESRD: Excluded. Sources: Nebraska Revised Statute 44-3614 – Medicare supplement policy or certificate; eligibility by reason of disability; availability; premiums · Nebraska Revised Statute 44-3614 (Medicare Supplement Insurance Minimum Standards Act) · Verified 09/23/2026 60 days beginning on the first day of the enrollee’s birthday month. equal or lesser benefits, any insurer (current or a new carrier); no medical underwriting; no holding-period requirement specified. Effective 01/01/2022. No. Federal rules only. Required. Effective October 1, 2025 under SB292, Nevada requires every insurer that offers Medicare supplement policies in the state to sell any policy it offers to those 65+ to individuals under 65 who are eligible for and enrolled in Medicare due to disability or end-stage renal disease, with no added limitations beyond what applies to enrollees 65 and older. A mandatory six-month open enrollment applies when the under-65 person first enrolls in Medicare Part B (with a one-time transitional window from Oct 1, 2025 to Apr 1, 2026 for those already enrolled), and a separate federal six-month open enrollment applies again at age 65. Premiums for Plans A, B, and D must equal the age-65 rate, while premiums for other lettered plans may not exceed 200% of the age-65 rate. ESRD: Included. Sources: AB 250 Medicare Supplement “Birthday Rule” Guidance — Nevada Division of Insurance · Bulletin 25-006: Unfair Trade Practices in the Sale of Medicare Supplement Policies – Nevada Division of Insurance · Verified 09/23/2026 None. No. Federal rules only. Required. New Hampshire has required Medigap insurers since the late 1990s to offer all standardized Medigap plans to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS, guaranteed-issue during a six-month window beginning when the person enrolls in Medicare Part B. A second six-month Medigap open enrollment period is available when the enrollee turns 65. Insurers may charge higher premiums to under-65 enrollees (the increase varies by carrier), but a 2021 law (SB124) prohibits insurers from continuing to charge the higher under-65 rate once the enrollee turns 65, so premiums must reset to the standard age-65 rate at that point. ESRD: Included. Beyond the NAIC-model guaranteed-issue events codified at N.H. Admin. Code Ins 1905.14, New Hampshire statute requires that upon a Medicare eligible disabled member attaining the age of 65, no issuer shall continue to charge that member the under age 65 premium. Sources: N.H. Rev. Stat. Ann. Chapter 415-F, Medicare Supplemental Insurance · New Hampshire’s Guide to Medicare Supplement Insurance (2026), New Hampshire Insurance Department · Verified 09/23/2026 None. No. Federal rules only. Required. New Jersey requires guaranteed-issue Medigap access for under-65 Medicare beneficiaries eligible due to disability or end-stage renal disease, split into two guaranteed-issue tracks: under age 50 (only the state Contracted Carrier, Horizon BCBSNJ, must offer Plan D, or Plan C for those Medicare-eligible before 1/1/2020, if applied for within 12 months of Part B enrollment) and ages 50-64 (every carrier selling Medigap in NJ must offer Plan D, or Plan C for pre-2020 eligibles, within 6 months of Part B enrollment for pre-2020 disability cases or 12 months for post-2020 cases). Rates for these under-65 policies cannot exceed the lowest rate the carrier charges for the same plan to enrollees age 65 and over. A separate new six-month Medigap open-enrollment period begins again the month the person turns 65 with Part B, allowing purchase of any plan from any carrier. ESRD: Included. Beyond the federal GI triggers, New Jersey runs a state-mandated Medicare Supplement ‘Under 50’ program and an Age 50-64 program that give people under 65 who are on Medicare due to disability or ESRD a one-time six-month guaranteed-issue window tied to their Part B enrollment. Sources: IMPORTANT INFORMATION (Medigap Open Enrollment and Guaranteed Issue) – New Jersey SHIP · Medicare Supplement Coverage for Individuals Eligible for Medicare due to Disability, NJ Department of Banking and Insurance · Verified 09/23/2026 60 days beginning on the first day of the policyholder’s birthday month. equal or lesser value plan; any insurer offering Medigap in the state (not limited to same carrier); applies only to persons already enrolled in a Medicare supplement policy; no explicit minimum holding period stated. Effective 01/01/2027. No. Federal rules only. Not required. New Mexico’s Medicare Supplement Act (NMSA 1978 Section 59A-24A-3, as confirmed in the 2026 legislative fiscal impact report for Senate Bill 21) defines an eligible policyholder for guaranteed-issue and open-enrollment protections as a Medicare beneficiary who is 65 years of age or older, with no parallel provision extending guaranteed issue, a required plan letter, or a dedicated six-month open enrollment to beneficiaries under 65 who qualify by disability, ESRD, or ALS. Insurers may voluntarily sell to under-65 applicants but are not required to, and may medically underwrite and charge higher premiums for that population; under-65 enrollees do get the standard federal six-month guaranteed-issue open enrollment once they turn 65 and are enrolled in Part B. Senate Bill 21 (2026) adds an annual 60-day birthday-rule open enrollment starting in 2027, but this new right is likewise limited by statute to eligible policyholders who are 65 or older and does not change under-65 access. ESRD: Excluded. Sources: SB0021 (amending the New Mexico Medicare Supplement Act, Section 59A-24A-3 NMSA 1978) · New Mexico Legislature Fiscal Impact Report (FIR) for Senate Bill 21 (2026), amending NMSA 1978 Section 59A-24A-3, Medicare Supplement Act · Verified 09/23/2026 None. Year-round. Continuous guaranteed issue and community rating: insurers must accept Medigap applicants at any time of year without medical underwriting, and the same protection extends to Medicare beneficiaries under 65. Required. New York regulation 11 NYCRR 360.4(h) requires that all Medicare supplement policies be offered on an open enrollment basis to persons enrolled in Medicare whether enrolled by reason of age or by reason of disability, and the NY Department of Financial Services confirms these Open Enrollment and Portability provisions protect enrollees whether Medicare-eligible by age or disability and that the provisions also apply to beneficiaries with end stage renal disease. Because New York mandates continuous, year-round guaranteed issue rather than a one-time six-month window, under-65 disabled and ESRD enrollees get the same ongoing open enrollment as age-65 enrollees, can choose any plan letter sold by a carrier, and pay the same community-rated premium as older enrollees with no age surcharge. ESRD: Included. New York also limits and can reduce/waive the Medigap pre-existing-condition waiting period, since under state regulation insurers must reduce the up-to-six-month pre-existing condition waiting period by the number of days the applicant had prior creditable coverage, as long as there was no break in coverage of more than 63 days. Sources: Medicare and Medigap Insurance in New York – DFS.NY.gov · Protections for Medicare Beneficiaries Residing in New York – NYS Department of Financial Services · Verified 09/23/2026 None. No. Federal rules only. Required. North Carolina law (N.C.G.S. 58-54-45) requires every Medigap insurer to guarantee-issue at least Plan A to Medicare beneficiaries under 65 who qualify due to disability, and if the insurer sells Plan C or F (pre-2020 eligibles) or Plan D or G (2020-or-later eligibles) to age-65+ enrollees it must also offer that same lettered plan to the under-65 disabled applicant. Eligible individuals get a one-time six-month open enrollment window starting the first month they are enrolled in Medicare Part B, with guaranteed issuance, a pre-existing condition waiting period capped at six months (waived with prior creditable coverage), and then receive a brand-new six-month open enrollment window when they turn 65. Insurers may file and charge a separate, generally higher premium schedule for the under-65 disabled class (rates are not capped at the age-65 rate), though all under-65 enrollees must be charged the same class rate during the open enrollment period. ESRD: Not specified. Beyond the federal one-time Medigap open enrollment period, North Carolina’s only state-added GI protection identified is its under-65 disability guarantee (see under65 fields); no separate birthday, anniversary, or year-round switching right was found on NCDOI sources. Sources: Medicare Supplement (Medigap) Plans | NC DOI · Medicare Supplement (Medigap) Plans | NC DOI · Verified 09/23/2026 None. No. Federal rules only. Not required. North Dakota has no standing state law requiring Medigap insurers to sell policies to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS; the state Insurance Department’s official Medicare Supplement guidance describes only the standard six-month guaranteed-issue open enrollment period that begins at age 65 with Part B enrollment, plus limited guaranteed-issue rights tied to loss of employer coverage or leaving a Medicare Advantage trial period. A narrow, temporary guaranteed-issue right (Plans A, B, C, F, high-deductible F, G, K, or L) was created only for existing enrollees of the state’s CHAND high-risk pool who lost that coverage when CHAND stopped new enrollments on May 1, 2025 and wound down by the end of 2025, but that transitional provision (Century Code ch. 26.1-08.1) was itself scheduled for repeal effective December 31, 2025, so it is no longer an active ongoing pathway. There is no dedicated recurring six-month open enrollment for under-65 enrollees distinct from the one at age 65, and no community-rating or rate-cap rule applies to under-65 applicants because insurers are not obligated to issue to them at all outside the expired CHAND transition. ESRD: Not specified. A 2025 law (SB 2032) ended new enrollments in the state’s CHAND high-risk pool as of May 1, 2025, and gives existing CHAND enrollees who lose that coverage a guaranteed-issue right to buy Medigap Plans A, B, C, F, high-deductible F, G, K, or L, but it created no other under-65 guaranteed-issue mandate. Sources: Medicare Supplement | North Dakota Insurance Department · Medicare Supplement | North Dakota Insurance Department · Verified 09/23/2026 None. No. Federal rules only. Not required. Ohio does not require Medigap insurers to sell any Medicare Supplement plan to beneficiaries under 65 who qualify by disability, ESRD, or ALS; the Ohio Department of Insurance’s official guidance states that the six-month guaranteed-issue open enrollment period applies only once a person is age 65 and enrolled in Part B, with no equivalent mandated window before age 65. A bill (Ohio HB400, introduced 2024) would have created under-65 guaranteed issue with premiums capped at the age-65 rate, but it has not been enacted, so current law provides no under-65 offer mandate, no protected plan letters, and no rate cap for this population; disabled enrollees instead get their first guaranteed-issue opportunity at age 65 at standard age-65 rates. ESRD: Not specified. Sources: Medicare 101 – Ohio Department of Insurance · Medicare 101 – Ohio Department of Insurance · Verified 09/23/2026 60 calendar days beginning on the policyholder’s birthday. equal or lesser benefits, any insurer (same or different carrier), holding-period requirement: no gap in Medicare supplement coverage greater than 90 days since initial enrollment. Effective September 1, 2023. No. Federal rules only. Required. Oklahoma statute (36 O.S. Section 3611.1(B)) directs the Insurance Commissioner to issue regulations creating an open enrollment period for Medicare beneficiaries who qualify as disabled, and OAC 365:10-5-129(d)/129.1(a)(5) implement this by requiring each issuer to offer at least one standardized Medigap plan (issuer’s choice) to under-65 disabled applicants, with the premium capped at the lowest available age-based rate for that plan (no higher premium allowed) since September 15, 2017. Enrollment occurs during a limited window tied to Part B enrollment (cross-referenced to the same timeframe rule used for the standard OEP), and OAC 365:10-5-129(g) separately requires issuers to notify these under-65 policyholders of a second guaranteed open-enrollment opportunity when they turn 65. ESRD: Not specified. Oklahoma requires Medigap issuers to offer at least one standardized plan (in practice, all carriers have chosen Plan A) to Medicare beneficiaries under age 65 who qualify by disability, has capped premiums for these enrollees since September 15, 2017, and requires insurers to notify under-65 enrollees before their 65th birthday that their guaranteed-issue window to buy any plan is approaching. Sources: Medicare Supplement Open Enrollment FAQs – Oklahoma Insurance Department · Medicare Supplement Open Enrollment FAQs – Oklahoma Insurance Department · Verified 09/23/2026 60-day window: beginning 30 days before and ending 30 days after the person’s birthday. equal or lesser benefits; may switch to the same insurer or a new insurer (no same-plan-letter or same-insurer restriction found in the rule text, and no holding-period requirement stated) No. Federal rules only. Required. Oregon’s insurance code (ORS 743.683(3)) directs the Division of Financial Regulation to write Medigap eligibility rules that are not limited to persons qualifying for Medicare by age, and OAR 836-052-0138 implements this by giving a six-month guaranteed-issue open enrollment window beginning the first day of the first month an individual is enrolled in Medicare Part B, applicable without regard to age, so people under 65 who qualify due to disability (and by extension ESRD/ALS eligibility for Part B) get the same guaranteed-issue right as those turning 65. During that window every Medigap policy the issuer currently sells must be offered on a guaranteed-issue basis (not just Plan A), and the rule expressly caps the premium charged to an enrollee 65 or younger at no more than the issuer’s premium for a 65-year-old. It is not clear from the rule text whether a person who already used this window before age 65 is given a second, separate six-month window upon turning 65; agents should confirm this scenario directly with DFR. ESRD: Included. Oregon extends the federal-style 6-month Medigap open-enrollment guaranteed-issue period to people who become Medicare-eligible before age 65 due to disability (and, per the state’s own Medigap guaranteed-issue matrix, ESRD or ALS), not just people turning 65, and separately provides guaranteed-issue rights under OAR 836-052-0142 for events such as a Medigap plan leaving the market or service area. Sources: OAR 836-052-0143 – Annual Opportunity to Select Another Medicare Supplement Policy or Certificate (Oregon Secretary of State Administrative Rules) · Or. Admin. Code section 836-052-0138 – Open Enrollment (Oregon Division of Financial Regulation Medicare Supplement rule, adopted under ORS 743.683) · Verified 09/23/2026 None. No. Federal rules only. Required. 31 Pa. Code Section 89.778 bars issuers from denying, conditioning issuance, or price-discriminating based on health status for any application submitted during the six-month period beginning the first day of the first month an individual is enrolled in Medicare Part B, and this rule explicitly applies without regard to age, so beneficiaries under 65 (via disability, ESRD, or ALS) get the same guaranteed-issue open enrollment as those turning 65. Every Medicare supplement policy and certificate currently sold by an issuer must be made available to qualifying applicants, not just a single plan. A separate Pennsylvania Bulletin notice confirms that a second six-month open enrollment window is triggered again at age 65 for anyone already on Medicare Part B, regardless of prior enrollment, giving under-65 enrollees a second guaranteed-issue window when they turn 65; the regulation bars health-status-based pricing during these windows but does not on its face cap under-65 premiums at the age-65 rate, so age-based rate differences may still apply. ESRD: Included. Beyond the federal minimum, Pennsylvania’s open-enrollment regulation (31 Pa. Code § 89.778) requires every Medigap plan an insurer sells to be offered without regard to age during the 6-month window that begins the first day of the month the person is enrolled in Medicare Part B, and the Insurance Department also issued a temporary guaranteed-issue bulletin for people losing Medicaid during the post-COVID unwinding period. Sources: 31 Pa. Code § 89.778. Open enrollment (Pennsylvania Code & Bulletin, official state code) · 31 Pa. Code Section 89.778. Open enrollment. · Verified 09/23/2026 annual guaranteed-issue window each year during the Medicare Annual Enrollment Period (October 15–December 7), with new coverage effective January 1 Annual or partial. Annual guaranteed-issue opportunity tied to the Medicare Annual Enrollment Period (October 15 to December 7) rather than a birthday: an enrollee whose Medigap or Medicare Advantage coverage has had no gap longer than 90 days since initial Medicare enrollment may switch to any available Medigap plan with no medical underwriting. Added to R.I. Gen. Laws 27-18.2-3(h) by the 2025 amendments (H5494 / S0610) and implemented by OHIC Bulletin 2025-05, effective September 26, 2025. Required. Rhode Island General Law 27-18.2-3(g) requires every Medicare Supplement insurer to make Plan A available to applicants under age 65 who are eligible for Medicare due to disability or end-stage renal disease (ESRD), provided the applicant applies within six months of their initial Medicare Part B eligibility (or an alternate enrollment period set by the Commissioner); issuers cannot use medical underwriting or condition issuance on health status during that window. Only Plan A is mandated (not the full lettered lineup), and OHIC guidance and rate filings show under-65 enrollees are charged separate, generally higher premiums rather than being capped at the age-65 rate. Under-65 enrollees are not statutorily guaranteed a second under-65 open enrollment at 65 beyond the standard federal 6-month Medigap open enrollment window that begins for everyone at 65 and Part B enrollment; a 2025 bill (H5494/S0610) proposing a dedicated new 6-month window at attainment of 65 for this population had been introduced but its enactment/effective status should be double-checked. ESRD: Included. The 2025 amendments also give under-65 enrollees a fresh six-month open enrollment period when they turn 65. Rhode Island Medigap premiums are community rated. Sources: OHIC Bulletin 2025-05, Medicare Supplement (Rhode Island Office of the Health Insurance Commissioner) · Chapter 18.2 Medicare Supplement Insurance Policies (R.I. Gen. Laws 27-18.2-3) · Verified 09/23/2026 None. No. Federal rules only. Limited. South Carolina does not require private Medigap insurers to sell any plan letter to Medicare beneficiaries under 65; the state Insurance Department confirms applicants may be refused if they are under 65 and disabled or have ESRD. Instead, guaranteed-issue coverage for under-65 beneficiaries eligible for Medicare due to disability is provided only through the state high-risk pool, the South Carolina Health Insurance Pool (SCHIP), which offers Plan A, Plan D, and (for those first eligible before 2020) Plan C at SCHIP-set premiums that are far higher than standard 65-and-older market rates, not capped at the age-65 rate. All SC Medigap enrollees, including those who used SCHIP under 65, receive the standard federal six-month Medigap open enrollment period beginning the month they turn 65 and are enrolled in Part B; there is no separate statutory six-month open enrollment window for under-65 private-market Medigap purchases. ESRD: Not specified. Sources: Medicare Supplement Insurance 2026 Shopper’s Guide · Medicare Supplement Insurance | Department of Insurance, SC – Official Website · Verified 09/23/2026 None. No. Federal rules only. Required. South Dakota law (ARSD 20:06:13:84, implementing SDCL 58-17A-2 and 58-17A-17) entitles any individual who becomes eligible for Medicare by reason of disability, regardless of age, to guaranteed-issue open enrollment into any Medicare supplement policy the carrier sells, during a six-month window beginning on enrollment in Medicare Part B; a second six-month guaranteed-issue window opens again when the person turns 65. Insurers may class-rate under-65 enrollees but the rate cannot exceed what the carrier charges an age-65-eligible enrollee who is age 75, which the South Dakota Division of Insurance and Attorney General’s office describe as a six-month open enrollment right with guaranteed acceptance regardless of health. ESRD: Not specified. South Dakota administrative rule extends the standard six-month Medigap open enrollment period to any individual who becomes Medicare-eligible by reason of disability (not just age), with the period beginning on enrollment in Part B rather than being limited to age 65-plus enrollees, which goes beyond the federal minimum. Sources: S.D. Admin. R. 20:06:13:84 – Open enrollment required for Medicare eligible individuals regardless of age · Division of Insurance Medicare Supplement Policies · Verified 09/23/2026 None. No. Federal rules only. Required. Tennessee law (Tenn. Code Ann. Section 56-7-1503) requires that any insurer offering Medigap to people 65 and older must make the same plans available to people under 65 who are eligible for Medicare due to disability or end-stage renal disease, and provides these individuals a six-month guaranteed-issue enrollment window tied to Part B enrollment (or loss of other coverage). The statute does not set a premium cap for this under-65 population, so insurers may charge higher rates than the age-65 rate; a 2026 bill to cap under-65 premiums at the weighted average 65-plus rate was still pending and not yet law as of the verification date. Under-65 enrollees who keep coverage into age 65 also become eligible for a standard federal Medigap open enrollment period at that time, at age-65 rates. ESRD: Included. Tennessee state law requires Medicare Supplement insurers that offer plans to people 65 and older to also offer coverage to people under 65 who are within six months of their Medicare Part B enrollment, a guaranteed-issue right not required under federal law. Sources: Medicare Supplement Insurance Companies (Tennessee Department of Commerce and Insurance) · Tennessee Code Section 56-7-1503 – Contents of policies and certificates – Duplicate benefits – Preexisting conditions – Rules and regulations · Verified 09/23/2026 None. No. Federal rules only. Required. Texas mandates guaranteed issue of Medigap Plan A for any Medicare beneficiary under 65 who qualifies by disability, available during a six month open enrollment period beginning with Part B enrollment, with a second six month guaranteed issue window opening for any plan when the person turns 65; carriers may charge higher premiums to this general under 65 disabled group. Since September 1, 2025 under House Bill 2516 Insurance Code Sections 1652.059 and 1652.060, individuals under 65 who qualify for Medicare due to ESRD or ALS must instead be offered the same full plan lineup sold to those 65 and older, at the same rates as age 65 enrollees for Plans A, B and D, and at no more than 200 percent of those rates for other plan letters, with no medical underwriting, waiting period, or pre-existing condition exclusion. TDI has proposed (not yet confirmed adopted as of this check) an additional guaranteed issue window for ESRD/ALS enrollees from October 15, 2026 through March 31, 2027 under new rule 28 TAC 3.3312(d)(6), so agents should verify current adoption status. ESRD: Included. Beyond the federal 6-month Part B open enrollment period, Texas grants guaranteed issue rights (usually a 63-day window) for people who lose certain other coverage, including loss of Medicaid, involuntary termination of a Medicare Advantage plan, and the standard federal trial-right/loss-of-coverage triggers, and (new) full plan parity for under-65 ESRD/ALS enrollees under HB 2516. Sources: Medicare supplement insurance guide (Texas Department of Insurance) · Commissioner’s Bulletin B-0010-25 · Verified 09/23/2026 60 days beginning on the enrollee’s birthday. equal or lesser benefits (comparable or lower-tier plan), same insurer only, no minimum holding-period requirement identified. Effective 05/07/2025. No. Federal rules only. Not required. Utah does not mandate that Medigap insurers sell policies to Medicare beneficiaries under age 65 who qualify by disability or ESRD; the Utah Insurance Department states a consumer might not be able to buy a Medigap policy if they are under age 65 and disabled or have End-Stage Renal Disease. Guaranteed issue is limited to the standard six-month window starting at age 65 with Part B enrollment, or federally required guaranteed-issue events; there is no separate state-mandated six-month open enrollment for under-65 enrollees. Because there is no state mandate, insurers that voluntarily offer under-65 coverage may medically underwrite or charge higher premiums, with no community-rating or age-65-rate cap required by law. ESRD: Excluded. Sources: Medicare / Medigap / Med Advantage | Utah Insurance Department · Medicare / Medigap / Med Advantage | Utah Insurance Department · Verified 09/23/2026 None. Year-round. Vermont law bars medical underwriting for Medigap: premiums must be community rated and the rules may not permit medical underwriting or screening, so applicants are not charged more or refused for health reasons (8 V.S.A. 4051, recodified from 4080e effective September 1, 2025). Insurers may set a different community rate for people eligible by disability than for people eligible by age, and enrollment timing follows the DFR Medicare Supplement minimum standards regulation. Limited. Vermont law (8 V.S.A. Section 4051, recodifying former Section 4080e) requires any insurer that sells Medigap policies to age-eligible Medicare beneficiaries to make the same policies and plan letters available to people who become Medicare-eligible due to disability, with an initial six-month guaranteed-issue window starting when the person becomes eligible by reason of disability and any additional enrollment periods given to age-65 enrollees also extended to the under-65 disabled group. This guaranteed-issue mandate expressly does not apply to persons eligible for Medicare due to end-stage renal disease, and Medicare-by-disability enrollees are moved into the age-65 community-rated pool once they turn 65 per a Department of Financial Regulation bulletin interpreting Section 4080e(b). Insurers may use a separate, higher community rate for the under-65 disabled pool rather than charging the age-65 rate, so premiums for under-65 enrollees can legally be higher than for 65-plus enrollees. ESRD: Excluded. State law requires a separate community-rated pool and a 6-month guaranteed-issue enrollment window for Medicare beneficiaries under 65 who qualify by disability (with another 6-month window opening again at age 65), but this state-added protection does not extend to people under 65 who qualify due to ESRD. Sources: 8 V.S.A. 4051, Medicare supplement insurance policies; community rating; disability (Vermont General Assembly) · 8 V.S.A. Section 4051 – Medicare supplement insurance policies (Vermont Statutes Online) · Verified 09/23/2026 60 days beginning on the enrollee’s birthday. equal (same) benefits, any insurer, no minimum holding-period requirement stated. Effective July 1, 2025. No. Federal rules only. Required. Virginia law requires every insurer that sells individual Medicare supplement policies to offer at least one actively marketed Medigap plan to Virginia residents under age 65 who are Medicare-eligible by reason of disability (including ALS) or ESRD, provided they are or will be enrolled in Medicare Parts A and B. Effective January 1, 2024, insurers may not charge these under-65 disabled/ESRD enrollees a premium higher than the rate charged to 65-year-old applicants for the same plan, and a separate six-month guaranteed-issue open enrollment period applies for under-65 eligibles (running from Part B enrollment), with a new six-month open enrollment period granted again when the person turns 65. Insurers are not required to offer all ten standardized plans to this under-65 group, only at least one plan they actively market (most choose Plan A). ESRD: Included. Beyond the birthday rule, Virginia requires every Medigap insurer to offer at least one policy (in practice, almost all insurers choose Plan A) on a guaranteed-issue, guaranteed-renewable basis to Medicare beneficiaries under 65 who qualify by disability or ESRD, at the same premium charged to 65-year-old applicants. Sources: Virginia SCC – Medigap Birthday Rule · Virginia Medigap Guide – State Corporation Commission · Verified 09/23/2026 None. Annual or partial. No annual window is needed: an existing Medigap policyholder may switch plans at any time of year with no health screening within the same plan group, Plan A to Plan A or any plan B through N to another B through N. Rates are community-rated for enrollees 65 and older. Moving up from Plan A into the B-N group is not settled by the statute, so confirm with the OIC. Not required. Washington does not require Medigap insurers to offer any standardized plan letter to Medicare beneficiaries under 65 who qualify by disability, ESRD, or ALS, so under-65 applicants can be medically underwritten and denied by carriers that choose not to sell to this population. A separate federally guaranteed six-month open enrollment right applies only when the person turns 65 and is enrolled in Part B, at which point community-rated premiums apply; there is no dedicated state-mandated six-month open enrollment window for under-65 enrollees. Carriers that voluntarily offer under-65 coverage may charge higher premiums than the age-65 community rate, and Washington’s high-risk pool (WSHIP) is available as a fallback at a higher premium for those who cannot obtain private coverage. ESRD: Not specified. Washington law requires replacing issuers to waive any preexisting-condition, waiting, elimination, or probationary periods to the extent already satisfied under the prior policy once that policy has been in force at least three months, effectively capping the pre-existing condition look-back at 3 months instead of the federal 6-month maximum. Sources: RCW 48.66.045, Mandated coverage for replacement policies; community rating · Medigap (Medicare Supplement) plan coverage and costs | Office of the Insurance Commissioner · Verified 09/23/2026 60 days beginning on the first day of the individual’s birth month. same or lesser standardized benefits, same insurer or an affiliated insurer only, plus a 24-month continuous-coverage holding period on the existing policy before it may be replaced. Effective June 11, 2026. No. Federal rules only. Not required. West Virginia’s Medicare supplement regulation (114CSR24, Section 9) ties the mandatory guaranteed-issue open enrollment period specifically to the first month in which an individual is both 65 years of age or older and enrolled in Medicare Part B, with no parallel provision for under-65 disability, ESRD, or ALS enrollees. Insurers are not required to offer any Medigap plan letter to under-65 beneficiaries; a few carriers voluntarily do so but may medically underwrite and charge higher-than-age-65 premiums. Once the individual turns 65 and enrolls in Part B, the standard six-month guaranteed-issue open enrollment period begins at that time, giving access to any plan at standard (non-medically-underwritten) rates. ESRD: Not specified. The same 2026 law (new W. Va. Code Article 33-15F) also grants a separate 63-day guaranteed issue right to purchase any Medicare supplement policy actively offered to new enrollees for individuals age 65+ who lose Medicaid eligibility, with the period beginning on the date Medicaid eligibility ends. Sources: West Virginia Code Section 33-15F-1 (Guaranteed Issue Rights for Medicare Supplement Policies) · 114CSR24 West Virginia Legislative Rule, Insurance Commissioner Series 24 (Medicare Supplement Insurance Minimum Standards) · Verified 09/23/2026 None. No. Federal rules only. Required. Wisconsin regulation (Wis. Admin. Code Ins 3.39(3r)(a)) requires insurers to guarantee issue of Medicare supplement (Basic Plan) coverage, without health underwriting, during a six-month window that begins either when an under-65 disabled or ESRD beneficiary first enrolls in Medicare Part B, or again when that person turns age 65, giving under-65 enrollees a dedicated open enrollment plus a second one at 65. Only the standardized Wisconsin Basic Plan is guaranteed-issue for under-65 applicants as a matter of course; optional cost-sharing (50%/25%) and high-deductible riders are not universally offered to this group since few insurers extend them below age 65. Rates are not capped at the age-65 level: insurers may charge higher, age/disability-based premiums for under-65 policyholders and are not required to reduce premiums to the age-65 rate when the insured turns 65, though the guaranteed second open enrollment period at 65 lets the person shop for an age-65-rated policy at that time. ESRD: Included. Beyond the standard 6-month Part B open enrollment and federal-type triggering events, Wisconsin’s rule extends guaranteed issue to people who left an employer welfare benefit plan to enroll in a Medicare Advantage plan and disenroll within 12 months, and ties a guaranteed-issue period to the Medicare Part D initial enrollment window (60 days before through 63 days after Part D coverage begins). Sources: 2026 Guide to Health Insurance for People with Medicare in Wisconsin (OCI PI-002) · Wisconsin Legislature: Ins 3.39(3r)(b) – Standards for disability insurance sold to the Medicare eligible · Verified 09/23/2026 63 days beginning on the policyholder’s birthday. equal or lesser benefits (a plan is comparable/lesser unless it has a significant benefit not in the current policy); any insurer; no holding-period requirement specified in the rule. Effective June 4, 2025 (rule references voluntary plan terminations/enrollments occurring on or after June 1, 2025). No. Federal rules only. Not required. Wyoming has no statute or regulation requiring private Medigap insurers to offer or sell policies to Medicare beneficiaries under age 65 who qualify by disability, ESRD, or ALS; insurers may choose to offer coverage but often charge much higher premiums or decline applicants through medical underwriting. As an alternative, the state-run Wyoming Health Insurance Pool (WHIP), overseen by the Wyoming Department of Insurance under Wyo. Stat. Section 26-43-102, offers a Medicare Disabled Plan that functions like a Medigap policy (covering Part A and B deductibles) for people under 65 on Medicare due to disability who cannot obtain standard Medigap coverage. There is no dedicated six-month guaranteed-issue open enrollment window for under-65 enrollees comparable to the federal six-month window that begins at age 65 with Part B enrollment. ESRD: Not specified. Sources: Wyoming Administrative Code, Chapter 35, Section 35-12 – Guaranteed Issue for Eligible Persons · WHIP – Wyoming Department of Insurance · Verified 09/23/2026Read the full text for every state
Alabama
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Alaska
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Arizona
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Arkansas
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
California
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Colorado
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Connecticut
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Delaware
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
District of Columbia
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Florida
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Georgia
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Hawaii
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Idaho
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Illinois
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Indiana
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Iowa
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Kansas
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Kentucky
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Louisiana
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Maine
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Maryland
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Massachusetts
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Michigan
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Minnesota
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Mississippi
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Missouri
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Montana
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Nebraska
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Nevada
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
New Hampshire
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
New Jersey
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
New Mexico
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
New York
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
North Carolina
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
North Dakota
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Ohio
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Oklahoma
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Oregon
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Pennsylvania
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Rhode Island
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
South Carolina
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
South Dakota
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Tennessee
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Texas
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Utah
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Vermont
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Virginia
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Washington
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
West Virginia
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Wisconsin
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Other protections
Wyoming
Birthday or anniversary rule
Year-round or annual guaranteed issue
Medigap access under 65
Your federal rights, in every state
State rules sit on top of these. If one of them applies to you, no insurer can ask about your health. Our Medicare guide walks through each one.
Your 6-month open enrollment
Starts the month you are 65 and enrolled in Part B. Any plan, any insurer, standard price.
Guaranteed-issue events
Losing employer or union coverage that pays after Medicare, or your Medicare Advantage plan leaving your area.
The Medicare Advantage trial right
Joined Medicare Advantage for the first time? You can switch back to Medigap within 12 months.
Questions people ask
What is the Medigap birthday rule?
In some states, a Medigap policyholder gets a set number of days each year, starting on or near their birthday, to switch to another Medigap plan without answering health questions. The window length, the plans you can move to, and whether you can change insurers are set by each state.
Which states let you change Medigap plans without underwriting all year?
Connecticut, Massachusetts, New York and Vermont require insurers to accept applicants at any time. A handful of other states have narrower annual or partial protections. Everywhere else, switching outside a guaranteed-issue window usually means medical underwriting.
Can someone under 65 on Medicare buy a Medigap plan?
Federal law does not require it. Most states require insurers to offer at least one plan to people who qualify for Medicare by disability, and a smaller number extend that to end-stage renal disease or ALS. Plan choice and premiums vary widely by state.
Does the birthday rule let you upgrade to a better plan?
Usually not. Most states limit the switch to a plan with equal or lesser benefits, and several require the same plan letter or the same insurer.
What guaranteed-issue rights exist in every state?
Federal law gives a six-month Medigap open enrollment period starting when you are 65 and enrolled in Part B, plus guaranteed-issue rights in specific situations such as losing employer coverage, a Medicare Advantage plan leaving your area, or a first-time Medicare Advantage trial within 12 months.
Use this data
Every row is cited to a state statute, insurance department or SHIP page and re-verified each quarter. Reporters, researchers and planners are welcome to use it with attribution and a link.
Media questions: press@getsmartquotes.com
Keep reading
- How Medigap plans work, letter by letter
- Comparing Medigap plans G, N, K and L
- Medicare Advantage vs Medigap
- Turning 65: the enrollment checklist
- Medicare in Illinois
- Medicare in Texas
- Medicare in Florida
- Medicare in Michigan
- Medicare in Maryland
- Medicare in Washington
- Medicare in Ohio
- Medicare in Arizona
Not sure what your state allows for you?
A licensed advisor can check your state’s windows against your plan and your dates, at no cost.
Smart Insurance Agents is an independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. This tracker summarizes state rules for general information and is not legal advice; confirm details with your state insurance department before acting.