Medigap Under 65 State Rules

Find out how people under 65 can purchase Medigap in your state.

by Chris Mihm+ on Apr 02, 2020 | 3 Comments

Share this article!

Americans under 65 (U65) are able to enroll in Medicare due to disability or ESRD (End Stage Renal Disease). Some states require you to receive disability benefits for at least two years before you can enroll in Medicare. If you qualify for Medicare then you MAY also be able to enroll in Medigap to get additional coverage. There has been a lot of confusion on this subject due to state and federal laws, so we have created this article to help break down U65 Medigap by state.

General Medigap Review

Medigap is a set of standardized plans that supplement what Medicare doesn’t cover. They can pay for deductibles, copays, and co-insurance not covered by Medicare. Those who are Medicare eligible when they first turn 65 are guaranteed to be approved for Medigap regardless of their health and usually have many Medigap plans to choose from. This is not the case for those under 65.

Under 65 Medigap Review

Federal laws do not guarantee access to Medigap coverage if you are under 65 even if you are eligible for Medicare due to disability or ESRD. There are also no federal guidelines on pricing so insurance providers can charge much more for coverage for those under 65, than those over 65. Some companies can charge hundreds higher just because you are under 65. Even if you are approved on a Medigap plan and can afford it, insurers can impose a pre-existing condition waiting period of up to 6 months, if you did not have at least 6 months of continuous coverage before your enrollment.

Just getting an Under65 Medigap Quote can be a frustrating process as most online tools (including Senior65.com’s) don’t have the ability to generate pricing for those under 65. If, after reading this article, you want to get a quote or apply for Medigap under65 give us a call at 800-903-7956. There is never a charge for our service and it allows us to continue posting useful articles like this one.

Good News for Medigap Under65

Most states have issued laws to provide Medigap options for those under 65. Some states require that insurance providers make at least one Medigap plan available with guaranteed issuance. Other states have pricing guidelines to find an affordable plan. These rules vary dramatically by state as outlined in our chart below.

State Rules for Under 65 Enrolling in Medigap

As you may imagine, gathering information about Medigap for under 65s from every state is quite challenging. All the information is condensed on the table below but if you continue reading you will find even more detailed info. We will try our best to regularly update this page but if you know of state laws not reflected in this document, please let us know in the comments (include the source please). 

The following states require insurance companies to offer at least one type of Medicare Supplement plan before you turn 65 (U65). If you do not see your state on this list, then we have no record of Under65 protections. If your state does not offer under 65 Medigap protections, you may be better off enrolling in Medicare Advantage which treats everyone the same regardless of age. You can learn about Medicare Advantage and Get MA pricing here.

State Can companies charge U65 more? Is the amount charged regulated? Which U65 Medigap plans are required?
California Yes No A, B, D G, K or L, M or N
Colorado Yes Yes All plans
Connecticut No Yes A, B and C
Delaware Yes No All plans
Florida Yes No All plans
Hawaii No* Yes All plans
Georgia Yes Yes Plan with least amount of benefits**
Illinois Yes Yes All plans
Idaho Yes Yes Plan with least amount of benefits**
Kansas No Yes All plans
Louisiana Yes No All plans
Maine No Yes All plans
Maryland Yes No A and C (if company sells C)***
Massachusetts Yes No All plans
Michigan Yes No A and C***
Minnesota No Yes All plans
Mississippi Yes Yes All plans
Missouri Yes Yes All plans
Montana Yes No Plan with least amount of benefits**
New Hampshire Yes Yes All plans
New Jersey Yes Yes Plan D
New York No Yes All plans
North Carolina Yes No A, C and F (C and F if company sells them)***
Oklahoma No Yes Plan with least amount of benefits**
Oregon No Yes Plan with least amount of benefits**
Pennsylvania No Yes All plans
South Dakota Yes Yes All plans
Tennessee Yes No All plans
Texas Yes No Plan A
Vermont Yes No All plans
Wisconsin Yes No All plans

*There have been unconfirmed reports of companies charging more to U65 in Hawaii
**Probably Plan A
***Due to the 2020 changes to Medigap if you became Medicare eligible in 2020 you will not be able to get Plan C or F. In that case, you get to enroll in D or G depending on the company.


If your state is not on this list then we have no state protections on record for Under 65 Medigap applicants. You may want to consider a Medicare Advantage plan


STATE DETAILS

California Excludes those under 65 and with end-stage renal disease. Insurance companies must offer plans A, B, D and G. If the insurer offers either Plan K or Plan L, or Plan M or Plan N, then it must also offer one of those to under 65s.
Delaware Only available to those with end-stage renal disease.
Georgia: Under 65 beneficiaries can be charged higher premiums, but that the premium variation “shall not be excessive, inadequate, or unfairly discriminatory and shall be based on sound actuarial principles and reasonable in relation to the benefits provided.” Even having that restriction, Georgia rates tend to be quite higher than those for people over 65.
Idaho: Insurer cannot charge more than 150% of the premium for those 65 and older.
Illinois: Insurer can charge more but cannot be charged more than the insurer’s highest on-file rate for people over age 65. This means that a company could charge a 50 year old the same amount it charges an 80 year old, but not have a completely different set of rates for people under 65.
Kansas: Insurer can charge more but is required to charge younger, disabled beneficiaries the same premiums that apply to a 65-year-old.
Maine: Premiums cannot vary based on age, and that provision also includes people under age 65.
Massachusetts: Only available to those with end-stage renal disease. Premiums cannot vary based on age.
Mississippi: Insurer can charge up to 50% higher than the rates that apply to people who are 65 years old.
Missouri: Under 65 Medigap rates must be equal to the “weighted average aged premium rate.” This basically amounts to a premium somewhat around 35% higher.
New Hampshire: Insurer can charge no more than the highest advertised rate for those over 65.
New Jersey: No more than the lowest advertised rates for those 65 and older. New Jersey divides enrollees into two categories.

  • Under age 50: coverage is guaranteed issue only with the state’s contracted carrier (Horizon Blue Cross Blue Shield of New Jersey)
  • Between 50 and 64: coverage is guaranteed issue with any insurer in New Jersey that offers Medigap plans.

North Carolina: Companies must offer at least Plan A. If the insurer also offers either Plan C or Plan F, they must also make that plan available to beneficiaries under age 65. These plans are probably becoming D and G because of the 2020 Medigap changes.
Oklahoma: Most of Oklahoma’s Medigap insurers have decided to offer Plan A as their option for beneficiaries under the age of 65, but Globe Life & Accident offers Plan B, and United American Insurance offers Plan B and high-deductible Plan F.
Oregon: The premium cannot exceed the premiums that are charged to enrollees who are 65.
South Dakota: Medigap insurers cannot charge under age 65s more than they charge enrollees who are 75.
Vermont: Excluding those under 65 and with end-stage renal disease.

Whether you are under 65 or not, if you are looking to enroll in Medigap or Medicare Advantage, call us at 800-930-7956. You can also apply for Medigap online. Remember we charge nothing for our services and guarantee the lowest price allowed by law.

Learn More about Medigap Get a Medigap QuoteApply for Medigap

Learn More about Medicare Advantage Get an MA Quote



On a final note, there are some states with other instances of guaranteed issuance for Medigap. These have some different periods when you can either switch or enroll in Medigap without having to answer health questions.

Print Friendly Version

Share this article!

Reader Comments and Questions

By Matthew on May 19, 2020

when you say plan with least amount of benefits what do you mean?

Matthew,
Since some states are only required to offer the Medigap plan with the least amount of benefits, most insurance companies will settle on Plan A. The majority of states have laws that require companies to also offer plans with more benefits, like Plan F or Plan G. -Michelle from Senior65.com


By Sam on May 19, 2020

nice to read they cant charge more in Maine, thank you!


By Steve on April 17, 2020

I'm from Maine, disabled and 62. Does this mean I can enroll in Medigap and they can't charge me a ridiculous amount? How do I go about enrolling?

Steve,
That's right! You can enroll in Medigap and what's more you can choose whatever plan you want. We suggest you check our article on Medigap Most Popular Plans. Once you know which plan you want just give us a call at 800-930-7956 to enroll. We will also answer every question you may have.

If you prefer. you can also apply online.
-Michelle from Senior65.com










PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.

We will not publish your last name or email if you submit this form.

Share this article!


It's 100% FREE to work with Senior65

Call our licensed agent today at 800-930-7956. Click here to learn 5 great reasons to work with Senior65.com