Medigap if you're under 65: what each state requires

The basics

Federal rule

Your guaranteed Medigap open enrollment starts at 65. Before that, federal law gives no guarantee.

State rules

17 states require insurers to sell to people under 65 with Medicare, 22 require it with limits (for example, only some plans, or not for ESRD), and 12 don't require it.

The window

Where it's required, you usually have 6 months from when your Part B starts to apply without health questions. Don't let it pass.

At 65

If you have Part B when you turn 65, you get a fresh 6-month Medigap open enrollment then, whatever happened before.

States that require it

Colorado

Colorado requires insurers to accept people under 65 on Medicare for any Medigap policy they sell, without health screening, if they apply within 6 months starting the month they enroll in Part B; the rule is not limited to disability and does not exclude ESRD.Price: Under-65 rates may be higher than age-65 rates, within limits set by state rule.

Delaware

Delaware requires insurers to offer any Medigap policy they sell to people under 65 who have Medicare because of a disability, including ESRD, with no medical underwriting if they apply in the first 6 months after enrolling in Part B.Price: Under-65 rates may differ from 65+ rates; they must be reasonable and are set as a separate group.

Florida

Florida requires Medigap insurers to let Florida residents under 65 with Medicare due to disability or ESRD enroll in a Medigap policy without health screening during the 6 months starting the first month they are enrolled in Part B (and for 2 months after losing group health coverage); the law does not say which plans must be offered.Price: No health-based pricing during the window; under-65 rates are set separately, with no cap tied to age-65 rates.

Georgia

Georgia requires insurers that sell Medigap to people 65 and older to also offer Medigap to residents under 65 who have Medicare because of a disability or ESRD, with an enrollment window of 6 months after enrolling in Part B.Price: Under-65 premiums may differ from 65+ premiums but can't be excessive or unfairly discriminatory.

Hawaii

In Hawaii, if you have Medicare before 65 (for a disability or kidney failure), you can buy any Medigap plan an insurer sells, with no health questions, if you apply within 6 months after your Part B starts.

Idaho

In Idaho, if you are under 65 and on Medicare for a disability or kidney failure (ESRD), you can buy any Medigap plan an insurer sells, with no health questions, if you apply within 6 months of the first month of your Part B.Price: Up to 150% of the age-65 premium; at 65 you pay the same rate as people who joined at 65.

Indiana

Since January 1, 2025, Indiana insurers must offer people under 65 with Medicare for a disability or kidney failure (ESRD) the same Medigap plans they sell to people 65 and older, with no health questions or waiting period, if you apply within 6 months of your Part B start (people already on Part B before 2025 had a one-time window from January 1 to June 30, 2025).Price: Plans A, B and D: no more than the age-65 rate. Other plans: up to 200% of it.

Kentucky

Since January 1, 2024, Kentucky insurers must sell every Medigap plan they offer to people under 65 who have Medicare for any reason other than age (including disability and kidney failure/ESRD), with no health questions, waiting period or pre-existing condition exclusion, if you apply within 6 months of your Part B start (people already on Part B before 2024 had a one-time window from January 1 to June 30, 2024).Price: Can't be more than the insurer's average premium for its policyholders 65 and older.

Louisiana

In Louisiana, if you are under 65 and on Medicare (for a disability or kidney failure), you can buy any Medigap plan an insurer sells, with no health questions, if you apply within 6 months after your Part B starts.

Maine

In Maine, if you get Medicare before 65 (for example, for a disability), you get a 6-month Medigap open enrollment when your Part B starts and another 6-month open enrollment when you turn 65; in either window any insurer must sell you the plan you choose, even with health problems.

Minnesota

Minnesota insurers cannot turn down people under 65 on Medicare because of a disability or kidney failure (ESRD), or charge them more for their health, if they apply within 6 months of starting Part B; Minnesota uses its own plans, and every insurer must offer a Basic plan and an Extended Basic plan.Price: Community rated: each insurer charges one rate regardless of age or health.

Nevada

Since October 1, 2025, Nevada insurers must let people under 65 on Medicare because of a disability or kidney failure (ESRD) buy any Medigap plan they sell to new customers 65 and older, with no health-based denial, if they apply within 6 months of starting Part B.Price: Plans A, B and D: no more than the age-65 rate. Other plans: up to 200% of it.

New Hampshire

New Hampshire insurers must make every Medigap plan they sell available, at any age and with no health-based denial or pricing, to people who apply within 6 months of first enrolling in Part B, which includes people under 65 with a disability or kidney failure (ESRD).Price: Insurers may charge an under-65 rate, but must drop it once you turn 65.

New York

In New York, Medigap companies must accept anyone with Medicare Parts A and B at any time of year, including people under 65 with a disability or end-stage renal disease, and cannot charge more based on age or health.Price: Community rated: the same premium regardless of age or health.

Pennsylvania

In Pennsylvania, anyone who applies within 6 months of first enrolling in Part B (or of a retroactive Part B notice) must be offered every Medigap plan the company sells regardless of age, so people under 65 on Medicare qualify and cannot be turned down or charged more for health reasons.Price: No health-based pricing during the window; no rule tying under-65 rates to age-65 rates.

Tennessee

Since January 1, 2011, insurers that sell Medigap to people 65+ must offer the same plans to people under 65 who have Medicare because of a disability or kidney failure (ESRD), with a 6-month open enrollment window.

Wisconsin

If you are under 65 and on Medicare because of a disability or kidney failure (ESRD), insurers cannot turn you down for a Medigap policy during the 6 months after your Part B starts, and you get a second 6-month open enrollment at 65; Wisconsin does not use the national lettered plans (A-N) and instead sells its own Basic policy with optional add-on riders, plus cost-sharing and high-deductible versions.

States that require it, with limits

Arkansas

Arkansas requires each Medigap insurer to offer at least one standardized plan to people under 65 who have Medicare because of a disability, with no health screening if you apply in the 6 months starting the month you first enroll in Part B; the rule's definition covers Social Security disability (section 226(b)) and does not mention ESRD.Price: No price limit in the rule; under-65 rates may be set separately from 65+ rates.

California

California requires Medigap insurers to offer people under 65 with Medicare due to disability Plans A, B, D and G (if currently available) plus K or L and M or N, with guaranteed acceptance for 6 months after Part B enrollment, but people under 65 who have ESRD are excluded.Price: Insurers may charge people under 65 more than age-65 rates; no cap is set.

Connecticut

Connecticut insurers that sell Medigap Plans A, B, C or D to people 65 and older must sell the same plans to people under 65 who have Medicare because of a disability (Plan C only if you were eligible before 2020), at the same community rate; the law does not mention ESRD or set a special 6-month window.Price: Community rated: the same premium regardless of age or health.

Illinois

In Illinois, if you are under 65 and on Medicare because of a disability, insurers cannot turn you down and must offer every plan type they sell to people 65 and older, if you apply within 6 months after your Part B starts; the law does not mention kidney failure (ESRD).Price: Can't be more than the insurer's highest rate for the same plan for people 65 and older.

Kansas

In Kansas, if you are under 65 and on Medicare because of a disability, insurers cannot turn you down or ask about your health, and must offer every plan type they sell to people 65 and older, if you apply within 6 months of your Part B start; the statute does not mention kidney failure (ESRD).Price: Can't be more than the insurer charges 65-year-olds for the same plan.

Maryland

In Maryland, if you are under 65 and on Medicare because of a disability, insurers must sell you Plan A and Plan D, with no health questions, if you apply within 6 months after your Part B starts (or within 6 months of notice of retroactive enrollment); insurers may choose to offer other plans, and the law does not mention kidney failure (ESRD).Price: Plan A can't cost more than the average Plan A premium for people 65 and older; Plan D has no such cap.

Massachusetts

Massachusetts insurers must sell any Medigap plan they offer (Massachusetts uses its own Core, Supplement 1A and, if you got Medicare before 2020, Supplement 1 plans) to people under 65 on Medicare because of a disability who apply within 6 months of starting Part B or during the yearly February 1 to March 31 open enrollment, but they do not have to cover people under 65 who have Medicare only because of kidney failure (ESRD).Price: Community rated: the same premium regardless of age or health.

Michigan

Michigan has no rule written just for people under 65, but insurers that also sell group health insurance must sell a basic Medigap policy (like Plan A) or Plan D or G (C or F if you got Medicare before 2020) to anyone on Medicare who asks, with no age limit, though they can make you wait up to 6 months for coverage of pre-existing conditions.We couldn't confirm this with a state source; check with the state insurance department.

Mississippi

Mississippi gives people under 65 on Medicare because of a disability a 6-month Medigap open enrollment starting the month they qualify for Medicare (and another one at 65), but the state guide does not say which plans must be offered or mention kidney failure (ESRD).Price: The state guide says these policies usually cost more, as much as 50% more than at 65. That's typical pricing, not a legal cap.

Missouri

Missouri insurers must sell any Medigap policy they offer, with no health questions, to people under 65 on Medicare because of a disability who apply within 6 months of enrolling in Part B (with another open enrollment at 65); the sources do not clearly say whether people on Medicare only because of kidney failure (ESRD) are included.Price: Can't exceed the insurer's lowest or average rate for people 65 and older.

Montana

Montana insurers must sell any Medigap policy they offer to people who become eligible for Medicare because of a disability, with no health-based denial or pricing, but you must apply within 63 days of being told you qualify, and the rule does not mention kidney failure (ESRD).Price: No health-based pricing; no limit on charging more than age-65 rates.

Nebraska

Since January 1, 2025, Nebraska insurers that sell Medigap to people 65 and older must offer at least one plan (currently only Plan A) to people under 65 on Medicare because of a disability, with no health questions during the same 6-month open enrollment people get at 65, but people with only kidney failure (ESRD) cannot buy a Medigap plan until 65.Price: Can be higher than for 65-year-olds, but no more than 150% of their premium.

New Jersey

New Jersey lets people under 65 on Medicare because of a disability buy Medigap Plan D (Plan C if eligible before 2020) if they apply within 12 months of enrolling in Part B, from every Medigap insurer if they are 50 to 64 or from one designated insurer if they are under 50; the state page does not mention kidney failure (ESRD).Price: No more than the age-65 rate for the same policy.

North Carolina

North Carolina companies must sell people under 65 on Medicare because of a disability at least Plan A, plus Plan D or G if they sell those to 65-year-olds (Plan C or F for those eligible before 2020), if you apply within 6 months of first enrolling in Part B; the law does not mention ESRD.Price: Insurers may set separate, possibly higher, rates for people under 65, with state approval.

Oklahoma

Oklahoma companies must offer people on Medicare because of a disability at least one of the standard Medigap plans during a 6-month open enrollment that starts when Part B begins, at a price no higher than their lowest age-65 rate for that plan; the guide does not mention ESRD.Price: Can't be more than the insurer's lowest rate for the same plan for people 65 and older.

Oregon

Oregon companies must sell every Medigap plan they offer to people on Medicare because of a disability if they apply within 6 months of their Part B start, and cannot charge them more than 65-year-olds; the rule does not mention ESRD.Price: Can't be more than the insurer charges 65-year-olds.

Rhode Island

Rhode Island companies must sell Plan A only to people under 65 on Medicare because of a disability or ESRD if they apply within the first 6 months after first becoming eligible for Part B, with no medical underwriting; at 65 they get a 6-month window to buy any plan.Price: No special under-65 rate rule; rates are approved by the state.

South Carolina

South Carolina does not make private insurers sell Medigap to people under 65, but the state's health insurance pool (SCHIP), which the Department of Insurance says is open to new applicants who can't get Medicare Supplement coverage privately, must offer Medigap coverage (it lists Plans A, C and D) to people under 65 who have Medicare Parts A and B for reasons other than age.Price: Pool rates must be reasonable for the benefits.

South Dakota

If you get Medicare because of a disability, you can buy any Medigap policy without health questions if you apply within 6 months of your Part B start date (applies if you became Medicare-eligible on or after July 1, 1999); the rule names disability only and does not mention kidney failure (ESRD).Price: Rates may be higher, up to the insurer's rate for a 75-year-old.

Texas

If you are under 65 and on Medicare because of a disability, insurers must sell you at least Plan A with no health questions during the 6 months after your Part B starts; since September 1, 2025, people under 65 with kidney failure (ESRD) or ALS must be offered the same plans sold to people 65+, also in a 6-month window after Part B starts.Price: Disability: insurers may charge more. ESRD or ALS: Plans A, B and D at the age-65 rate; other plans up to 200% of it.

Vermont

If you get Medicare because of a disability, insurers must offer you the same Medigap policies they sell to people 65+, with at least a 6-month enrollment window after you become eligible; this does not apply to people who qualify only because of kidney failure (ESRD).Price: Community rated; a separate, usually higher rate is allowed until you turn 65.

Virginia

If you are under 65 and on Medicare because of a disability (and, since 2024, kidney failure/ESRD), each Medigap insurer must let you enroll in at least one of its plans during the 6 months after you become Medicare-eligible (or 63 days after losing group coverage), and since January 1, 2024 it cannot charge you more than it charges a 65-year-old.Price: Since 2024, can't be more than the rate for a 65-year-old in the same plan.

States that don't require it

Alabama

Alabama does not guarantee Medigap to people under 65 who have Medicare because of a disability; companies can use medical underwriting and decide whether to sell to you, and your guaranteed six-month window starts the month you turn 65.

Alaska

Alaska does not give people under 65 with Medicare (disability or ESRD) a Medigap open enrollment until they turn 65; insurers can turn them down, though the state high-risk pool ACHIA may offer coverage to people under 65 on Medicare.

Arizona

Arizona does not require insurers to sell Medigap to people under 65; a 2026 bill (HB 2433) that would have required it for people with kidney failure (ESRD) or ALS was held in committee and did not become law.We couldn't confirm this with a state source; check with the state insurance department.

District of Columbia

The District of Columbia does not require insurers to sell Medigap to people under 65 on Medicare, according to the NAIC chart (we could not find a DC government page saying this directly).We couldn't confirm this with a state source; check with the state insurance department.

Iowa

Iowa does not require insurers to sell Medigap to people under 65, and there is no Medigap open enrollment before 65; a few companies choose to sell to disabled people under 65 (the 2026 state guide lists only United American and Wellmark, and only Wellmark lists a guaranteed-issue plan, Plan A), and anyone who has Part B at 65 gets a 6-month open enrollment then.Price: Not regulated for under-65 buyers, and premiums can be high.

New Mexico

New Mexico does not require Medigap companies to sell to people under 65; the state's guaranteed open enrollment starts only when you are 65 or older and enrolled in Part B, and the Insurance Superintendent warns that people under 65 with a disability or ESRD may not be able to buy a policy.

North Dakota

North Dakota does not require Medigap companies to sell to people under 65; people on Medicare because of a disability get their guaranteed six-month open enrollment only when they turn 65.

Ohio

Ohio law does not require Medigap companies to sell to people under 65; the guaranteed open enrollment begins only when you are 65 or older and enrolled in Part B, and a bill to add under-65 access (HB 24) has not passed.

Utah

Utah does not require insurers to sell Medigap to people under 65; the state's 6-month Medigap open enrollment starts only when you are 65 and on Part B, and a 2026 bill to change this did not pass.

Washington

Washington does not require insurers to sell a first Medigap policy to people under 65, but if you already have a Medigap policy through disability or kidney failure (ESRD), you can switch to another plan without health questions.Price: Community rated; insurers may keep a separate rate for people eligible through disability or ESRD.

West Virginia

West Virginia does not require insurers to sell Medigap to people under 65; the guaranteed 6-month open enrollment starts only when you are 65 and enrolled in Part B.

Wyoming

Wyoming does not require insurers to sell Medigap to people under 65; the guaranteed 6-month open enrollment starts only when you are 65 and enrolled in Part B.

What to do next

1. 1

   Note your Part B start date

   In most states that require it, the 6-month window counts from there.
2. 2

   Ask for quotes from several insurers

   Prices for people under 65 vary a lot. An independent agent who represents several companies can compare them.
3. 3

   Confirm the rule with your state

   Rules change, and a few states have exceptions. Your state's page has the insurance department's number and its free SHIP counseling program.

Common questions

Keep reading

• Medigap birthday rule: which states let you switch plans each yearFifteen states now give Medicare Supplement holders a yearly window to switch without health questions, and several more have year-round rights. The full list for 2026, with how each state's rule works.
• Medicare Advantage or Medigap? The questions that decide itNeither is better for everyone. How the two common Medicare set-ups differ, the questions that point to one or the other, and why the first choice is the hardest to undo.
• Have Medicare and Medicaid? What changes, and how an agent can helpIf you qualify for both Medicare and Medicaid, you have extra help with costs, special plans, and more chances to change coverage. What to know, the 2025 rule changes, and what to watch for.