Medigap Coverage Rules When You're Under 65 and on Medicare

Medigap is harder to get before 65, but not impossible

If you're under 65 and enrolled in Medicare, most Medigap insurers will not sell you a policy — but some will, and the rules depend on which state you live in. The main barrier is that Medigap is designed for people 65 and older, so insurers can legally turn you down based on age alone. However, a handful of states have passed laws requiring insurers to offer Medigap to younger Medicare enrollees, and a few insurers sell to this group nationwide regardless of state law.

Your path forward depends on three things: your state, your reason for being on Medicare before 65 (disability, end-stage renal disease, or ALS), and whether you're willing to pay higher premiums than someone 65 would pay for the same coverage. Start by calling your state insurance commissioner's office or your State Health Insurance Assistance Program (SHIP) — they know which insurers in your state will actually talk to you.

Key Takeaways

• Most Medigap insurers legally can and do refuse to sell policies to people under 65, even if you're on Medicare.
• A small number of states — including New York, Massachusetts, and Connecticut — require insurers to sell Medigap to younger Medicare enrollees at the same rates as people 65 and older.
• A few national insurers like AARP/UnitedHealthcare will sell Medigap to people under 65 in most or all states, though premiums are typically higher than for someone 65.
• Your state insurance commissioner's office or your SHIP can tell you which insurers will sell to you and what the actual premiums are in your area.
• If no Medigap insurer will sell to you, Medicare Advantage (Part C) is usually available to people under 65 on Medicare and may be your only supplemental coverage option.

States that require Medigap sales to people under 65

Three states have laws on the books requiring Medigap insurers to sell to Medicare enrollees under 65: New York, Massachusetts, and Connecticut. In these states, insurers must offer the same Medigap plans at the same rates they charge people 65 and older — meaning age cannot be a reason to deny you or charge you more.

If you live in one of these states and are on Medicare before 65, you have a real path to Medigap coverage. Call your state insurance commissioner's office to ask which insurers are currently selling Medigap in your state, then contact them directly. You'll need to provide proof of your Medicare enrollment and your reason for being on Medicare before 65 (your Social Security statement or Medicare card will show this).

Even in these three states, not every insurer may be actively selling Medigap at any given moment — some may have closed their books to new enrollees. Your state insurance commissioner's office can tell you which ones are currently taking applications.

National insurers who sell Medigap to people under 65

AARP/UnitedHealthcare is the most widely available option for people under 65 seeking Medigap. They sell in most states and have a track record of accepting younger Medicare enrollees. Premiums are typically higher than what a 65-year-old would pay, but the coverage is the same.

A few other national insurers may sell Medigap to people under 65 in certain states, but availability changes and is not may provide. Your best move is to call your state insurance commissioner's office and ask them to give you the names of insurers currently selling to your age group in your state. Do not rely on calling insurers cold — many customer service representatives will simply say "we don't sell to people under 65" without checking whether exceptions exist.

When you do reach an insurer willing to discuss coverage, ask about their underwriting process. Some will require medical underwriting (reviewing your health history), while others will not. Medical underwriting can result in higher premiums or exclusions for pre-existing conditions, so this matters.

How premiums work when you're under 65

Medigap premiums for people under 65 are not standardized the way they are for people 65 and older. Insurers can charge whatever they want, and they typically charge more for younger enrollees than for older ones — which seems backwards, but reflects the fact that younger people on Medicare tend to have serious chronic conditions (they're on Medicare because of disability, ESRD, or ALS, not age). Insurers price accordingly.

This means you cannot compare a premium quote from one insurer to another without understanding what you're actually comparing. A Plan G from AARP might cost $150 a month, while the same Plan G from another insurer costs $200 — both are legal, and both are for the same coverage. Call multiple insurers and ask for quotes on the same plan letter (A, B, D, G, K, L, M, or N) to see what's actually available in your area.

Your state insurance commissioner's office may have a list of average premiums by plan and insurer in your state, which can help you spot outliers. Ask for this when you call.

What happens at 65 if you have Medigap now

If you buy Medigap before 65 and keep it continuously, your coverage does not change when you turn 65. You stay on the same plan with the same insurer. However, your premiums may change — some insurers will lower them at 65 (because you're now in the "normal" age group), while others may raise them. Check your policy documents or call your insurer to understand what will happen to your rate on your 65th birthday.

This is one reason to buy Medigap before 65 if you can: once you have continuous coverage, you have more stability and predictability than someone trying to buy Medigap for the first time at 65 or later. You also avoid the risk that you'll develop a new health condition between now and 65 that an insurer might use to deny you or charge you more.

Medicare Advantage as an alternative if Medigap is not available

If no Medigap insurer will sell to you in your state, Medicare Advantage (Part C) is almost always available to people under 65 on Medicare. Medicare Advantage is an alternative to Original Medicare plus Medigap — it's a managed care plan (like an HMO or PPO) that covers hospital, medical, and usually prescription drug benefits in one plan.

Medicare Advantage plans are required to accept anyone on Medicare regardless of age or health status. Premiums are often lower than Original Medicare plus Medigap, and many plans have $0 premiums. The trade-off is that you have a network of doctors and hospitals, and you may need prior authorization for certain services. If you travel frequently or want to see any doctor who accepts Medicare, Medigap is more flexible — but if Medigap is not available to you, Medicare Advantage is worth exploring.

You can switch between Medicare Advantage and Original Medicare during the general enrollment period (January 1 to March 31 each year), so choosing Medicare Advantage now does not lock you in forever.

How to find out what's available in your state right now

Do not start by calling insurers. Start by calling your State Health Insurance Assistance Program (SHIP). SHIP is a free counseling service in every state, and they know which insurers are currently selling Medigap to people under 65 in your area. You can find your state's SHIP by calling 1-800-MEDICARE or visiting Medicare.gov and searching "SHIP".

When you call SHIP, tell them your age, your state, and that you're on Medicare before 65. Ask them which Medigap insurers are currently accepting applications from people your age. They may also be able to tell you approximate premium ranges, though they won't quote you directly.

After SHIP, call your state insurance commissioner's office. They regulate Medigap insurers in your state and can tell you if any state laws require insurers to sell to you. They may also have complaint data on file if you want to know whether an insurer has a history of problems.

Frequently Asked Questions

Can an insurer deny me Medigap because I'm under 65?

Yes, in most states. Medigap insurers can legally refuse to sell to people under 65 based on age alone. The exceptions are New York, Massachusetts, and Connecticut, where state law requires insurers to sell Medigap to younger Medicare enrollees. Even in those states, an insurer can deny you for other reasons — like if you don't have valid Medicare enrollment or if you're applying outside their service area.

Will my Medigap premiums go down when I turn 65?

Maybe. Some insurers lower premiums at 65, while others keep them the same or raise them. It depends on the insurer and their pricing model. Check your policy documents or call your insurer to find out what will happen on your 65th birthday. This is a good question to ask before you buy, so you know what to expect.

What if I'm on Medicare before 65 but no insurer will sell me Medigap?

Medicare Advantage is your main alternative. It's available to everyone on Medicare regardless of age, and many plans have low or no premiums. You can also stay on Original Medicare without supplemental coverage, though you'll pay more out-of-pocket for hospital and medical expenses. Talk to your SHIP counselor about which option makes sense for your situation.

Do I need to do anything special to prove I'm on Medicare before 65?

Yes. When you apply for Medigap, the insurer will ask for proof of your Medicare enrollment and your reason for being on Medicare before 65. Your Medicare card shows your entitlement code (disability, ESRD, or ALS), and that's usually all they need. Have your card ready when you call.

Can I switch Medigap plans if I buy one now?

Yes, but it depends on your state and your health. In some states, you can switch plans without medical underwriting during certain windows. In others, switching may trigger medical underwriting, which could result in higher premiums or exclusions. Ask your insurer about their switching rules before you buy, so you know what flexibility you have.