How do Medigap guaranteed‑issue and underwriting rules vary by state for Medicare beneficiaries in 2025?
Executive summary
Medigap guaranteed‑issue and underwriting rules in 2025 rest on a federal floor — a six‑month open enrollment at age 65 and limited federal guaranteed‑issue triggers — while states layer on dramatically different protections, from year‑round guaranteed issue in some states to narrow birthday or anniversary windows in others . Key recent state changes in 2025 (Minnesota, Nebraska, Virginia, and others) have expanded access for younger beneficiaries or created annual switching windows, but those protections vary widely in scope, which affects who can buy Medigap without medical underwriting and which plans must be offered [1].
1. Federal baseline: a limited safety net everyone must start from
Federal law guarantees a one‑time, six‑month Medigap open enrollment period beginning when a person turns 65 and enrolls in Medicare Part B and provides guaranteed issue only in a handful of narrowly defined “qualifying events,” so the federal standard is protective at initial enrollment but otherwise restrictive .
2. States that go further: continuous or year‑round guaranteed issue
A small group of states requires insurers to sell Medigap year‑round or provide continuous guaranteed‑issue rights, meaning residents can obtain coverage without underwriting at any time; Connecticut, New York, and — depending on the source — Massachusetts and Vermont are cited as offering continuous or year‑round protections in 2025, and Washington is also described as having broad year‑round rights for plan‑to‑plan moves . Maine’s approach is idiosyncratic: carriers must allow at‑least Plan A on a guaranteed‑issue basis in a designated month and otherwise permit switching to equal or lesser benefits year‑round in some accounts .
3. Birthday and anniversary rules: short windows that matter
Many states have adopted a “birthday rule” or anniversary guaranteed‑issue windows that let beneficiaries switch carriers without medical underwriting for 30–63 days around a birthday or policy anniversary; examples include California, Idaho, Illinois, Nevada, and Oregon with 30‑day birthday rules and Missouri with a 60‑day anniversary window, while newer statutes have created 30–63 day windows in other states and sometimes allow only switches to equal or lesser benefits . Virginia enacted a carrier‑change birthday rule effective July 1, 2025 permitting enrollees to keep the same lettered plan but switch carriers within 60 days of their birthday without underwriting, illustrating how states can target narrow but meaningful market mechanics [1].
4. Access for younger Medicare beneficiaries: uneven progress
State rules about those under 65 on Medicare diverge sharply: KFF reports 36 states require at least one Medigap policy be offered to under‑65 beneficiaries, with 25 of those requiring insurers to sell all plan types during the guaranteed‑issue window; Nebraska began requiring at least one type of Medigap for under‑65 beneficiaries on Jan 1, 2025, and Indiana expanded offerings for under‑65s as of 2025, while other states still provide no protections for this group . Recent state legislative activity (Minnesota’s new guaranteed issue periods, Nebraska, Texas limits tied to ESRD/ALS) reflects sustained pressure from advocates but also creates a patchwork where eligibility and premiums for younger beneficiaries depend on state law .
5. Market mechanics, premiums and the politics behind the rules
States not only vary on when guaranteed issue applies but also on rules about what plans must be offered, whether premiums can vary by age or other factors during guaranteed issue, and limits on practices like agent “churning”; KFF and consumer groups note states set rating rules and consumer protections that shape affordability and access, and advocates press for federal expansion while insurers and some states resist sweeping mandates because of premium and market‑stability concerns . Reporting highlights both consumer advocates’ calls for nationwide guaranteed‑issue expansions and the insurance industry’s incentives to limit underwriting exposure — an implicit political and financial tug‑of‑war shaping 2025 policy outcomes .
6. What this means in practice and limits of this account
In practice, residents must check their state’s specific rules — some have year‑round guaranteed issue, some offer brief birthday/anniversary windows, and others largely rely on federal triggers — and recent 2025 changes mean the landscape is shifting; available sources document many state examples (Minnesota, Nebraska, Virginia, Connecticut, New York, Washington, Missouri, California and others) but do not provide a single exhaustive state‑by‑state table here, so readers should consult state insurance departments or SHIP counselors for definitive, current rules .