What it is
Medigap is private insurance that may help pay some costs Original Medicare does not cover, such as certain deductibles, copays and coinsurance. It works alongside Original Medicare (Parts A and B). It is not the same as Medicare Advantage.
Most people get Medicare at 65. Some get it sooner because of a disability or other qualifying conditions. These beneficiaries are often called "under-65" Medicare beneficiaries.
Federal rules do not require every state to guarantee Medigap access to people under 65. Some states require insurers to offer plans to them, and others do not. Plan choices, rules and underwriting may differ. Massachusetts, Minnesota and Wisconsin standardize Medigap differently from other states.
Only certain plan letters are sold to people newly eligible for Medicare: Plans A, B, D, G, K, L, M and N, plus high-deductible Plan G. Plans C and F, and high-deductible F, are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. People still search for Plan H, but it is not available.
How it’s traditionally been approached
Many people under 65 have relied on Original Medicare alone, or paired it with other coverage such as Medicaid, an employer plan or a retiree plan. Others chose Medicare Advantage, which is often valued for an annual out-of-pocket maximum, extra benefits and, in many plans, drug coverage.
Others have looked at Medigap for its features. These include the ability to see any provider nationwide that accepts Medicare, no networks or referrals, and more predictable cost-sharing. Trade-offs may include generally higher monthly premiums and a separate Part D plan for drugs. Medigap also does not usually cover routine dental, vision or hearing.
Timing has traditionally mattered. A Medigap open enrollment period usually begins when you are enrolled in Part B. Outside open enrollment or guaranteed issue situations, an insurer may use medical underwriting in some states. Because rules vary and change over time, many people confirm current details with Medicare.gov, their State Health Insurance Assistance Program (SHIP), or a licensed agent.
How the right licensed agent may help
A Medigap agent may help you understand what is offered in your state for people under 65. A licensed independent agent may also explain which companies sell plans where you live and how enrollment timing could affect you. No agent can promise acceptance, savings or a "best" plan.
A conversation is usually informational. The agent may ask your state, your Medicare start date, your current coverage, which doctors you see and how you use prescriptions. It helps to bring your Medicare card and a list of your providers and medications.
Good questions to ask include: Does my state require insurers to offer Medigap to people under 65? Is my open enrollment window active? Will I face medical underwriting? How might my rates change as I age? How would a Medigap plan compare with Medicare Advantage for my situation? Call 1-800-MEDIGAP for more information.
The bigger picture
Coverage choices can affect more than finances. Living with a disability or health condition can already be demanding, and uncertainty about medical bills can add stress. Understanding your options may bring some peace of mind.
Take your time and lean on trusted people. Whichever path you choose, Medigap or Medicare Advantage, the goal is coverage that fits your health, budget and life. If you are also looking for care providers, Providers.plus may be one place to explore.
Keep in mind
- Medigap access for people under 65 varies by state and insurer, and rules can change.
- Confirm current rules with Medicare.gov, your SHIP or a licensed agent before deciding.
- Medigap and Medicare Advantage each have strengths and trade-offs, and neither is right for everyone.
- 1-800-MEDIGAP is an independent educational directory, not Medicare.gov, CMS, Social Security or any government agency, and it does not give insurance, legal, tax or medical advice.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
Can you get Medigap if you are under 65?
Sometimes, depending on your state and the insurer. Some states require companies to offer Medigap to people under 65 with Medicare, and others do not. Confirm current rules with Medicare.gov, your SHIP or a licensed agent.
What is medigap for people under 65?
It is the same kind of private Medigap insurance sold to people 65 and older, offered to Medicare beneficiaries who qualify before 65. It may help with some costs Original Medicare does not cover. Availability, plan choices and rules differ by state.
Which Medigap plans can people under 65 buy?
For people newly eligible, plans sold are A, B, D, G, K, L, M and N, plus high-deductible Plan G, where offered. Plans C and F are limited to those eligible before January 1, 2020. Plans E, H, I and J are discontinued. Massachusetts, Minnesota and Wisconsin work differently.
Is there a Medigap open enrollment period for people under 65?
In many cases there is, and it generally begins when you are enrolled in Part B. Details vary by state and can change. A licensed agent or your SHIP can help you confirm your window.
Is Medigap or Medicare Advantage better for people under 65?
Neither is best for everyone. Medigap offers nationwide provider choice and predictable cost-sharing but generally higher premiums and a separate drug plan. Medicare Advantage often has lower premiums, an out-of-pocket maximum and extra benefits, but may use networks and prior authorization.
How can a Medigap agent help if I am under 65?
A Medigap agent may explain what your state allows, which companies sell plans there and how timing could matter. They cannot guarantee acceptance or savings. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.