Last reviewed: 6 October 2026
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Medigap open enrollment and guaranteed-issue rights: what the federal statute and Medicare.gov say
The short answer: federal law gives you a 6-month Medigap open enrollment period that starts the first month you are 65 or older and enrolled in Medicare Part B. In that window an insurer may not deny you a Medigap policy or charge you more because of your health.[1][2] After it, you can still buy a policy without health screening only in specific situations the law calls guaranteed-issue rights, and most come with a 63-day deadline.[1] This page describes the rules. It does not say which policy to choose.
The short version
- The open enrollment period is 6 months long and starts the first month you are 65 or older and enrolled in Part B. The statute covers applications submitted before or during that period.[1]
- During it, an insurer may not deny or condition a policy, or price it differently, because of health status, claims experience, receipt of health care or medical condition.[1]
- Medicare.gov says it is a one-time period that does not repeat every year.[2]
- Outside it, an insurer may be allowed to deny you unless one of the listed guaranteed-issue situations applies.[2][1]
What happens during open enrollment
- Medicare.gov says you can enroll in any Medigap policy, that the insurer cannot refuse any of the medical policies it offers, and that it cannot use medical underwriting to decide whether to accept your application.[2]
- It says the insurer cannot charge you more because of pre-existing health problems, and cannot make you wait for coverage to start, except for coverage related to a pre-existing condition.[2]
- It says your policy generally begins the first of the month after you apply, unless you ask for a different effective date.[2]
- The statute allows a policy to exclude benefits during its first 6 months for a condition you were treated for or diagnosed with in the 6 months before it took effect. If you had at least 6 months of creditable coverage when you applied, it may not exclude benefits for a pre-existing condition. With less than 6 months, the exclusion period must be reduced by the coverage you had.[1]
- The statute also bars denying, conditioning or pricing a Medigap policy on the basis of genetic information.[1]
If you are under 65 or miss the window
- Medicare.gov says that if you have Medicare because of a disability or End-Stage Renal Disease and are under 65, you might not be able to buy a Medigap policy until you turn 65. It says federal law generally does not require insurance companies to sell Medigap policies to people under 65, and that in some states insurance companies do offer Medigap policies to people under 65.[2]
- Outside your open enrollment period, Medicare.gov says you may pay more, may have fewer policy options, and the insurer is allowed to deny you if you do not meet its medical underwriting requirements.[2]
- Medicare.gov says to check with your State Insurance Department, because you may have additional rights under state law.[2]
The guaranteed-issue situations in the statute
Federal law lists these situations. In each, the insurer may not deny or condition the policy, may not price it on health status, claims experience, receipt of care or medical condition, and may not impose a pre-existing condition exclusion, if you apply during the window described below and send proof of the date your earlier coverage ended.[1]
| Situation (paraphrased from the statute) | Where it appears | Source |
|---|---|---|
| Your employer plan that supplements Medicare ends, or stops providing all supplemental benefits | Section 1395ss(s)(3)(B)(i) | [1] |
| You are in a Medicare Advantage plan (or, at 65 or older, a PACE program) and there are circumstances that would let you leave it, such as the plan being discontinued or no longer serving your area, a move that makes you ineligible, a substantial violation of the plan contract, or a material misrepresentation in marketing the plan to you | Section 1395ss(s)(3)(B)(ii), which refers to 1395w-21(e)(4) | [1][3] |
| You are in certain other managed-care arrangements or a Medicare Select policy, that enrollment ends in similar circumstances, and (for a Medicare Select policy) state law has no provision for continuing or converting the coverage | Section 1395ss(s)(3)(B)(iii) | [1] |
| Your Medigap insurer goes bankrupt or insolvent, or your coverage is otherwise involuntarily ended with no state continuation or conversion right; or the insurer substantially violated a material provision of the policy; or the insurer or its agent materially misrepresented the policy in marketing it to you | Section 1395ss(s)(3)(B)(iv) | [1] |
| You had a Medigap policy, joined a Medicare Advantage plan or similar arrangement for the first time, and leave it within the first 12 months | Section 1395ss(s)(3)(B)(v) | [1] |
| At first eligibility for Part A at 65 you joined a Medicare Advantage plan or PACE, and you leave it within 12 months of joining | Section 1395ss(s)(3)(B)(vi) | [1] |
One situation in that table concerns the person who sold you the policy: the statute lists a Medigap insurer or its agent materially misrepresenting the policy in marketing as a guaranteed-issue trigger.[1] If you think that happened to you, see how to file a complaint against an insurance agent.
How long you have: the windows the statute sets
| If this happened | The statute's window |
|---|---|
| Employer supplemental coverage ends | From the date you receive notice that all supplemental benefits are ending (or, if no notice, notice that a claim was denied because of it) until 63 days after that notice.[1] |
| Medicare Advantage, PACE or similar enrollment ended involuntarily (clauses (ii), (iii), (v) and (vi) of the list above) | From the date you receive a notice of termination until 63 days after the coverage ends.[1] |
| Your Medigap insurer's insolvency or similar involuntary end | From the earlier of the date you get notice or the date coverage ends, until 63 days after coverage ends.[1] |
| You leave voluntarily, in the situations in clauses (ii), (iii), (iv)(II), (iv)(III), (v) or (vi) of the list above | From 60 days before the effective date of leaving until 63 days after that date.[1] |
| Other listed cases | From the effective date of leaving until 63 days after it.[1] |
The statute also requires the organization or insurer that ends your coverage to notify you of these rights at the time of the event.[1]
Which policies you can buy
- For most situations, the statute names Medigap policies with benefit packages it classifies as A, B, C or F that the insurer offers to new enrollees. In a state that classifies packages differently, it refers to comparable packages.[1]
- Separate rule for people newly eligible for Medicare: on or after January 1, 2020, a Medigap policy that covers the Part B deductible may not be sold or issued to a "newly eligible Medicare beneficiary," meaning someone who had not turned 65 before that date and was not entitled to, or deemed eligible for, Part A under 42 U.S.C. 426(a), 426(b) or 426-1 before it. For such a person, the statute reads any reference to a package classified as C or F as a reference to D or G, respectively, unless the Secretary provides otherwise.[1]
- If you are using the 12-month "trial" right in the Medigap-then-Medicare-Advantage situation, the statute points first to the policy you were most recently enrolled in, if the same insurer still offers it, and otherwise to those packages. For the first-eligibility-at-65 situation, it says any Medigap policy.[1]
- An insurer that fails these requirements is subject to a civil money penalty of up to $5,000 for each failure.[1]
This page does not list which lettered plans insurers currently sell to new enrollees. Read your state insurance department's Medigap page for that.
How to verify this yourself
Read section (s) of the statute and the "Get ready to buy" page on Medicare.gov, both listed below. Then write down the exact date your earlier coverage ended or will end, because the windows above run from dates and notices. Ask your State Insurance Department whether state law gives you more time or additional rights.
What this page does not cover
We do not say whether you should buy a Medigap policy or which one. We do not cover premiums, how insurers price policies, the narrow rules that apply to older Medigap policies with prescription drug coverage when you join a Part D plan, or any state law. State rules can add protections. This is general information, not insurance or legal advice. For your own situation, ask your agent or insurer, or contact your state insurance regulator.
Your next step
If one of the situations above fits you, find the date and notice that start your window and put the deadline on your calendar before you apply. If none fits, check the date your open enrollment period began. Our Medicare Parts A, B, C and D guide explains where Medigap fits.
Related checks
Our standard explains how we check an agent's license and disciplinary history. Check an agent reports our findings at category level, as a method and not a verdict. Neither reviews any insurer, plan or product. For the two rulebooks that apply to the agent selling you a Medicare plan, see Medicare Advantage vs. Medigap marketing rules. To look up a state regulator, see State insurance regulators: what five consumer pages list. More plain-language guides are in the agent guides.
When we will update this page
We re-read the sources when they change. If something here is out of date, tell us. Corrections are dated on the page.
References
- [1] Cornell Law School Legal Information Institute, text of 42 U.S.C. § 1395ss (Medicare supplemental policies), subsections (s), (v) and (z), read 6 October 2026 — law.cornell.edu/uscode/text/42/1395ss
- [2] Medicare.gov, "Get ready to buy" (Medigap), read 6 October 2026 — medicare.gov/health-drug-plans/medigap/ready-to-buy
- [3] Cornell Law School Legal Information Institute, text of 42 U.S.C. § 1395w-21(e)(4) (special election periods), read 6 October 2026 — law.cornell.edu/uscode/text/42/1395w-21
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