Medigap Under 65 State Rules

Americans under 65 (U65) are able to enroll in Medicare due to disability or ESRD (End Stage Renal Disease) but they are not guaranteed to be approved on Medigap in most states. Also Medigap insurers in many states are allowed to charge exorbitant rates to those under 65. Here we go over the rules and outline those states who have passed specific rules to provide more options and price protections for those seeking Medigap who are under 65 and on Medicare.

There is 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. These rules change regularly so please add to the comments if you learn about access for under 65 that isn’t outlined in this article.

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 in general.

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 for 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) can not 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 the commissions we earn directly from the insurance providers when we help you enroll allow us to continue posting useful articles like this one.

Good News for Medigap Under65

Many 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 offer 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 in the table below but if you continue reading you will find more info in the State Details section below. 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 or health. You can learn about Medicare Advantage and Get MA pricing here.

*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.

State Details

If your state is not listed below, it usually means that no laws have been passed requiring insurance providers to offer Medigap to those on Medicare under 65. Below are states where we have information about state laws that provide regulation for Medigap Under65. If you know of any updates in your state, please add them to our Senior65.com comments below. We are committed to keeping this article up to date. Thanks!

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 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.

Indiana: Tammy’s law (392) states that insurers must offer Medigap Plan A to those under 65 who are eligible for Medicare due to disabilities.

Kansas: Disabled beneficiaries have a six-month open enrollment period to buy supplemental coverage after they qualify for Medicare Part B. Medigap plans must be sold at the same rate as for seniors who turn 65. Disabled Medicare enrollees cannot be turned down for any MedSupp plan being sold in Kansas during the initial six-month open enrollment period. Note: the same preexisting condition limitation applies to those who are 65. There will be a second enrollment period when the candidate turns 65. (source)

Kentucky: Automatic approval for all Medigap plans to applicants aged 50 to 64 who are eligible for Medicare because of disability or end-stage renal disease. Under-65 rates can not be not more than the weighted average for 65+ rates.

Maine: Premiums cannot vary based on age, and that provision also includes people under age 65.

Massachusetts: Only available to those without end-stage renal disease. Premiums cannot vary based on age.

Mississippi: Insurers 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 usually amounts to a premium around 35% higher than average.

New Hampshire: Insurers 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: Oklahoma requires all Medigap providers to offer at least 1 Medigap to those on Medicare under 65. The rate cannot be higher than for those over 65 (OAC 365:10-5-129(d)). Most of Oklahoma’s Medigap insurers have decided to offer Plan A as their option for beneficiaries under the age of 65, but in the past some have offered Plan B or high-deductible Plan F. Give us a call at 800-930-7956 to see what is available in your area.

Oregon: The premium cannot exceed the premiums that are charged to enrollees who are 65.

Pennsylvania: In Pennsylvania, Medigap insurance companies are required to sell those under 65 but Medicare Eligible due to a disability or End Stage Renal a Medigap policy if they are in their open enrollment period.

Rhode Island: Insurers must offer Medigap Plan A to those under 65 who are eligible for Medicare due to disabilities.

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.

Virginia: Plan A will be available to consumers ages 50-64 who have Medicare due to disability or ESRD and are within 6 months of enrolling in Medicare Part B, or are within 6 months of receiving notice that they have been retroactively enrolled in Medicare Part B, or within 63 days of losing or dropping employer coverage. Plan rates will be the same as those for individuals age 65.

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. There is never a fee or hidden charge to work with Senior65.com.  Since Medicare insurance pricing is regulated, no one can sell you the same plan for less than we can. 

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