Finding a Medigap Plan When You're Under 65

You can buy a Medigap plan before 65, but you'll pay more and have fewer options than someone on Medicare at 65

Medigap (also called Medi-gap or supplemental insurance) is private insurance that covers what Medicare doesn't — copayments, coinsurance, and deductibles. If you're under 65 and already on Medicare because of disability or end-stage renal disease, you can buy a Medigap plan, but the process is different from buying one at 65.

The main difference: insurance companies can charge you whatever they want for a Medigap plan before 65. At 65, federal rules cap how much they can charge based on your age. Before 65, they can use medical underwriting, meaning they can deny you, charge you more, or exclude certain conditions. You also have fewer plan types to choose from — most insurers don't sell all 10 Medigap plans to people under 65.

Start by calling your state's insurance commissioner's office or your State Health Insurance Assistance Program (SHIP). Both can tell you which insurers in your state actually sell Medigap to people under 65, because many don't. This one phone call saves you hours of dead ends.

Key Takeaways

• Insurance companies can charge you any price and use medical underwriting for Medigap plans before 65, so you'll pay significantly more than someone who waits until 65.
• Your state's insurance commissioner's office or SHIP can tell you which insurers sell Medigap to people under 65 in your area, since most don't.
• You'll likely have only 3 to 5 plan types available instead of the full 10 plans offered at 65, and you may face waiting periods for pre-existing conditions.
• If you can't find a Medigap plan, staying on Original Medicare with a separate prescription drug plan (Part D) is a legal option while you wait for 65.

Which insurers sell Medigap to people under 65

Most major insurers — UnitedHealthcare, Humana, Aetna, CIGNA — do not sell Medigap plans to anyone under 65. The insurers who do are usually smaller regional carriers or specialized supplemental insurance companies. Your state's insurance commissioner's office keeps a list of which companies are licensed to sell in your state and can tell you over the phone which ones offer plans to people under 65.

SHIP is a free counseling service run by your state. You can find your local SHIP office at shiptalk.org or by calling 1-877-839-2675. They'll tell you which insurers to contact and can walk you through what to ask when you call. This is genuinely free — no sales pitch attached.

Once you have a list of insurers, call each one directly. Don't use their website; call the number on the back of a Medigap plan brochure or ask the insurer's main line for their supplemental insurance department. Tell them you're under 65 and on Medicare due to disability or ESRD, and ask which Medigap plans they sell to people in your situation. Write down the plan names, the monthly premium, and whether they use medical underwriting.

What medical underwriting means for you

Medical underwriting is when an insurance company reviews your health history before deciding whether to sell you a plan and how much to charge. Before 65, they can use this to deny you coverage, charge you more because of a pre-existing condition, or exclude certain conditions from coverage for a waiting period (usually 6 to 12 months).

When you call an insurer, ask directly: "Do you use medical underwriting for applicants under 65?" and "If I'm approved, will there be any waiting periods or exclusions for my pre-existing conditions?" Write down their answers. Some insurers will tell you over the phone whether you're likely to be approved; others will require you to submit an application first.

If an insurer denies you or charges you an amount you can't afford, that's not the end of the road. Some states have high-risk pools or may provide-issue Medigap plans for people who can't get coverage elsewhere. Your state's insurance commissioner's office can tell you whether your state has one and how to reach it.

The Medigap plans available to you under 65

At 65, Medicare beneficiaries can choose from 10 standardized Medigap plans (Plan A through Plan N). Before 65, most insurers sell only 3 to 5 of these plans. Plan F and Plan C are the most common for people under 65, but availability varies by insurer and by state.

The plans work the same way regardless of your age: you pay a monthly premium to the insurance company, and the plan covers the costs that Original Medicare doesn't. Plan F covers the most (it covers the Part B deductible, which is $240 in 2024), but it's also the most expensive. Plan A covers less but costs less. Ask each insurer which plans they offer and what each plan covers — they should send you a comparison chart.

Don't assume that because a plan exists at 65 it will be available to you at your age. Call and ask. If the plans available to you are all expensive, it may be worth staying on Original Medicare with Part D (prescription drug coverage) until you turn 65, when you'll have access to all 10 plans and lower premiums.

How much you'll pay and when rates change

Medigap premiums for people under 65 are typically 50% to 100% higher than premiums for the same plan at 65. A Plan F that costs $150 a month at 65 might cost $250 to $300 a month at 55. The exact amount depends on the insurer, your age, your health history, and your state.

When you turn 65, your premium will drop significantly — this is called the "age 65 adjustment." However, you may not be able to switch to a different Medigap plan at 65 without going through medical underwriting again, depending on your state's rules. Ask the insurer before you buy: "When I turn 65, can I switch to a different Medigap plan without medical underwriting?" The answer varies by state and by insurer.

Premiums also increase each year due to inflation and claims experience. The insurer should tell you whether they use age-based rating (your premium goes up as you age), community rating (everyone in your area pays the same), or some combination. This affects how much your premium will increase over time.

If you can't find or afford a Medigap plan

If no insurer will sell you a Medigap plan, or if every plan you can find is unaffordable, you have options. You can stay on Original Medicare and buy a separate Part D prescription drug plan. This combination covers less than a Medigap plan would, but it's legal and it's what many people under 65 do.

To find a Part D plan, go to Medicare.gov, click "Find Care Providers & Suppliers," then "Prescription Drug Plans." You can compare plans by monthly premium, deductible, and which drugs they cover. Part D plans are standardized, so every insurer offers the same plan types (Bronze, Silver, Gold, Platinum). Premiums are usually $10 to $50 a month, though they vary by plan and by region.

You can also ask your state's insurance commissioner's office whether your state has a high-risk pool or a may provide-issue Medigap program for people who can't get coverage. A few states still have these programs, though most were phased out after the Affordable Care Act. It's worth asking.

What happens to your Medigap plan when you turn 65

When you turn 65, you don't automatically lose your Medigap plan. You keep it, and your premium will drop. However, you may have limited options for switching plans at 65, depending on your state and your insurer.

Some states have "may provide issue" rights at 65, meaning you can switch to any Medigap plan without medical underwriting. Other states don't. Before you buy a plan under 65, ask the insurer: "What are my options for switching plans when I turn 65?" and "Will I need to go through medical underwriting again?" Write down the answer. If the insurer can't tell you, call your state's insurance commissioner's office.

If you're unhappy with your plan at 65 and your state doesn't allow you to switch without medical underwriting, you're stuck with that plan unless you move to a state that does allow switching. This is one reason to think carefully about which plan you buy under 65 — you may have it for years.

Frequently Asked Questions

Can I buy a Medigap plan if I'm under 65 and on Medicare for disability?

Yes, you can buy a Medigap plan if you're on Medicare due to disability (after 24 months on SSDI) or end-stage renal disease. However, most insurers don't sell Medigap to people under 65, so you'll need to call your state's insurance commissioner's office or SHIP to find out which ones do in your area.

Will my Medigap premium go down when I turn 65?

Yes, significantly. Most people see their premium drop 30% to 50% when they turn 65, because federal rules cap how much insurers can charge based on age. However, you may not be able to switch to a different plan at 65 without medical underwriting, depending on your state.

What if I get denied for a Medigap plan?

Call your state's insurance commissioner's office and ask whether your state has a high-risk pool or may provide-issue Medigap program. If not, you can stay on Original Medicare with a Part D prescription drug plan until you turn 65, when you'll have access to all Medigap plans without medical underwriting.

Is it better to buy Medigap now or wait until I'm 65?

If you can afford the higher premiums, buying now locks in your age for rating purposes at some insurers. However, if premiums are unaffordable, staying on Original Medicare with Part D until 65 is a reasonable choice. At 65, you'll have access to all 10 Medigap plans and lower premiums, with may provide-issue rights in most states.

Can I use a Medigap plan with Medicare Advantage instead of Original Medicare?

No. Medigap plans only work with Original Medicare. If you're on a Medicare Advantage plan, you cannot buy a Medigap plan. The two are separate paths. If you want Medigap, you need to be on Original Medicare (Part A and Part B).