Medicare Supplement for Disabled Under 65: State Rules for 2027

The federal Medigap open enrollment period starts the month you are both 65 or older and enrolled in Part B. Someone who gets Medicare at 45 or 58 because of a disability does not meet the age part of that rule. That means federal law gives them no protected window to buy a policy without health questions.

Without a state rule, an insurance company can decline to sell to you, ask medical questions, or simply not offer coverage to anyone under 65. Many carriers choose not to, because younger Medicare members on disability tend to use more care. That is why your state of residence matters more than almost anything else in this decision.

According to KFF’s October 2026 review of state Medigap laws, 38 states require insurers to offer at least one Medigap policy to people under 65 who have Medicare because of a disability, usually during a set enrollment window after they get Part B. The remaining 12 states and Washington, D.C. have no such requirement.

Even inside the 38 states, the rules differ a lot. Some require only one plan, often Plan A, the most basic option. Others require every plan the company sells. Some limit the window to six months after you get Part B, while a few have broader rights.

Source: KFF analysis of state Medigap laws, October 2026. State rules change, so confirm with your state insurance department.

People with end-stage renal disease face an extra layer of rules. KFF reports that 28 states explicitly require Medigap sales to people with ESRD, while California, Massachusetts, Vermont and Nebraska explicitly do not. The rest are silent, which can leave the outcome up to the insurer. For ALS, 25 states spell out a right to buy.

Since 2021, people with ESRD have also been allowed to join Medicare Advantage plans, which was not true before. That gives kidney patients another route if Medigap is not available or affordable where they live.

Premiums for under-65 buyers are often much higher than for someone who is 65. Insurers price these policies separately in many states, and a smaller pool of younger members with serious health needs pushes costs up. Some states limit how much more insurers can charge, while others leave pricing open.

Because prices vary so much, ask for quotes from every company that sells in your state. Our page on Medicare Supplement insurance rates explains what drives premiums. A high-deductible Plan G, with a 2027 deductible of $3,050, can lower the monthly cost if you can handle a bigger bill in a bad year.

This is the most important rule for younger Medicare members. When you turn 65, you get the full federal 6-month Medigap open enrollment period, even if you already had Medicare for years. During that window, no insurer can deny you, charge more for your health, or limit your plan choices.

If a Medigap policy is not offered or costs too much, you still have choices. The right one depends on your income, your doctors and how much care you expect to use.

In 2027, Part D plans will have a $2,400 out-of-pocket cap on covered drugs, which helps anyone with high prescription costs. Medigap policies sold today do not cover drugs, so pair any supplement with a separate Part D plan.

If you miss your state window, you may face health questions. Our guide to medical underwriting for Medigap explains what insurers ask and how answers affect approval.