Medicare Supplement Guaranteed Issue Rights by State 2027: Which States Add Extra Switching Rules

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 27, 2026

Outside your first six months, a Medigap application usually means health questions, unless your state says otherwise. A retiree in Hartford can change policies in any month without a single medical question, while a neighbor across the line in Rhode Island may only get that chance in the fall, and only after leaving Medicare Advantage.

Below, every state’s extra rule sits in one table built from the NAIC chart (May 11, 2026), KFF’s October 2026 review and the statutes behind them, with start dates for the seven states that acted between mid-2025 and January 2027.

Federal guaranteed issue situations, such as an employer plan ending or a Medicare Advantage plan leaving your area, apply in every state, usually with a 63-day deadline. Our side-by-side of open enrollment vs. guaranteed issue covers each federal trigger, so this page focuses on what states add.

State extras fall into four groups: year-round sales, birthday windows, anniversary or continuous-coverage rules, and fixed annual windows for Medicare Advantage members. None of them replace your one-time Medicare Supplement open enrollment period at 65. They matter later, when you want a cheaper insurer, a different plan letter or a way out of Medicare Advantage.

Each row below comes from the state’s own statute, regulation or insurance department page, cross-checked against the NAIC chart. States not listed have no year-round, birthday or annual window for people 65 and older, though many add extra qualifying events; KFF counts 37 states with some beyond-federal trigger, such as retiree coverage changes.

Sources: NAIC Medigap birthday rule and under-65 chart (May 11, 2026); KFF state review (Oct. 13, 2026); Cal. Ins. Code §10192.11; Va. Code §38.2-3611; Minn. Stat. §62A.31; Mo. 20 CSR 400-3.650; Maine Bureau of Insurance; Washington OIC; Indiana HEA 1226 fact sheet; Utah Bulletin 2025-5; W. Va. HB 4869.

These three states take medical questions off the table for people 65 and older, but each gets there differently.

Because anyone can buy at any time, starting premiums here tend to run higher than attained-age policies elsewhere. Massachusetts also uses its own plan designs rather than the standard letters described in our Medicare Supplement plans guide.

Maine’s protections hinge on never letting your supplement coverage lapse. If you haven’t had a gap of more than 90 days since your initial open enrollment, any insurer must accept you for a plan with the same or lesser benefits, at any time. Each Maine insurer also picks one month a year when it must take any applicant for Plan A.

Maine stretches the Medicare Advantage trial idea too. The Bureau of Insurance says someone who joins Medicare Advantage at first eligibility and returns to Original Medicare within 36 months can buy any Medigap plan within 90 days. The federal Medigap trial right allows only 12 months and a 63-day window.

Washington’s insurance commissioner describes a simpler rule: move from any plan B through N to another B through N at any time with no health questionnaire, or from Plan A to Plan A. Coming from other coverage, questions may still apply.

Birthday rules are the most common state extra, and the key split is whether you can leave your current insurer. In California, Idaho, Oregon, Nevada, Virginia and New Mexico you can take your business elsewhere. In Illinois, Louisiana and Utah the move must stay with your current insurer or its affiliates, which limits price shopping. West Virginia lets you go to another company only when your insurer doesn’t offer the lesser plan.

Missouri is the lone anniversary state. Under 20 CSR 400-3.650, a policyholder who switches within 30 days of the policy’s anniversary date can buy the same plan from any company that sells it, and a renewal or billing notice is enough proof of the date.

For a date-by-date walkthrough of the original model, see the California Medicare Supplement birthday rule.

Three states give a calendar window aimed at people who want to return to Medigap from Medicare Advantage, a move that otherwise usually means underwriting after the first year.

Elsewhere, leaving Medicare Advantage after the trial year means facing Medigap underwriting questions. Read switching from a Medicare Supplement to Medicare Advantage before giving up a Medigap policy you might want back.

State rules have moved quickly, and a few of the newest laws carry details that are easy to miss:

Bills are still filed every session, so a state with no rule today may have one by 2028.

Federal law doesn’t force insurers to sell Medigap to people under 65 on Medicare due to disability or kidney failure, so this is entirely a state matter. KFF’s October 2026 review found that 27 of the states requiring coverage for disabled under-65 enrollees require every plan type, not just one. Twelve states and DC require none.

Connecticut requires Plan A for disabled enrollees under 65. New Jersey requires at least Plan D and caps the under-65 rate at the age-65 rate. Texas added ALS and ESRD protections on June 1, 2025. California, Massachusetts, Vermont and Nebraska explicitly leave out ESRD, while 28 states explicitly include it. Alabama, Arizona, North Dakota, Utah, Washington and Wyoming are among the states with no requirement.

Whatever your state does before 65, you still get a full open enrollment window when you turn 65. If you have health conditions, our guide to Medicare Supplement and pre-existing conditions explains how waiting periods work.

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