State-Specific Medigap Rules

Federal vs. State Medigap Rules

While Medigap is standardized federally, states can add protections beyond federal minimums. Some states offer significantly better consumer protections than others.

States with Continuous or Annual Guaranteed Issue

These states allow you to buy or switch Medigap plans without medical underwriting:

Connecticut

• Continuous open enrollment for residents 65+
• Can switch plans anytime without underwriting

Maine

• Annual open enrollment every year
• Can switch plans with equal or lesser benefits

Massachusetts

• Different plan structure (not letters A-N)
• Continuous guaranteed issue

New York

• Continuous open enrollment
• Community-rated premiums only

States with "Birthday Rules"

Special enrollment windows around your birthday:

California

• 30 days after your birthday each year
• Can switch to equal or lesser benefits
• Must have current plan for 12+ months

Idaho

• 63-day window around your birthday each year
• Can switch to a plan with equal or lesser benefits
• Must have held current plan for at least 6 months

Illinois

• 45-day window beginning on your birthday each year
• Can switch to a plan with equal or lesser benefits from any carrier
• Must have had your current plan for at least 12 months

Kentucky

• Annual enrollment period around your birthday
• Can switch to a plan with equal or lesser benefits
• Must have had your current plan for at least 12 months

Louisiana

• 30-day window beginning 30 days before your birthday each year
• Can switch to a plan with equal or lesser benefits from any carrier
• Must have had your current plan for at least 12 months

Maryland

• 30-day window around your birthday each year
• Can switch to a plan with equal or lesser benefits
• Must have had your current plan for at least 6 months

Nevada

• 60-day window beginning 30 days before your birthday each year
• Can switch to a plan with equal or lesser benefits from any carrier
• Must have had your current plan for at least 6 months

Oklahoma

• 60-day window beginning 30 days before your birthday each year
• Can switch to a plan with equal or lesser benefits
• Must have had your current plan for at least 6 months

Oregon

• 30 days after birthday
• Switch to equal or lesser benefits

Washington's Year-Round Open Enrollment

Washington state provides one of the strongest Medigap consumer protections in the country — though it is not tied to a birthday rule:

Washington

• Guaranteed issue year-round for all Medigap plans
• No medical underwriting at any time for residents 65+
• Can switch to any Medigap plan from any carrier at any point during the year
• This is not a birthday-based rule — it is continuous open enrollment similar to New York and Connecticut

Missouri's Anniversary Rule

• Can switch plans once per year
• Must be within 30 days before or after policy anniversary
• Must switch to equivalent or lesser benefits

States Prohibiting Part B Excess Charges

These states don't allow doctors to charge excess fees:

• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont

In these states, Part B excess charge coverage is irrelevant!

Different Plan Structures

Massachusetts, Minnesota, Wisconsin

These states don't use the standard A-N lettered plans. Instead, they have their own unique plan structures.

If you live in one of these states, contact a licensed agent for state-specific information.

States with Additional Protections

28 states require guaranteed issue when employer retiree coverage changes involuntarily (beyond federal requirements).

Check with your state insurance department for specific protections in your state.