What happened
On October 13, 2026, KFF Health News published an overview of federal and state Medigap guaranteed issue rules, finding that protections remain limited and uneven. Medigap, sold by private insurers, helps cover Medicare Part A and Part B cost sharing. It covered 12.9 million beneficiaries in 2024, or 46% of all traditional Medicare beneficiaries. Federal law provides guaranteed issue protections during the first six months after first enrolling in Medicare Part B and for certain qualifying events, including the Medicare Advantage trial period or if a Medicare Advantage plan terminates coverage in a beneficiary’s area.
Outside those windows, federal law allows Medigap insurers to use medical underwriting to deny coverage or charge higher premiums. KFF said eight states have relatively generous continuous or annual guaranteed issue protections. Connecticut, Massachusetts, Maine, and New York require either continuous or annual protections for all beneficiaries ages 65 and older regardless of medical history. Delaware, Illinois, Minnesota, and Rhode Island have expanded protections that are less comprehensive. Rhode Island enacted legislation in 2025 to create annual guaranteed issue protections for people 65 and older with Medicare Advantage seeking Medigap. In Minnesota, annual guaranteed issue protections for individuals ages 65 to 70 took effect August 1, 2026.
Why it matters
The practical read: Medigap remains a highly fragmented market, not a uniform federal benefit design. KFF’s summary makes clear that the baseline federal framework still leaves many beneficiaries exposed to underwriting if they try to buy Medigap after the initial six-month window or switch from Medicare Advantage to traditional Medicare outside the initial 12-month trial period.
For plans, brokers, and investors, access is shaped less by national Medicare branding than by state-by-state insurance rules and the beneficiary’s timing. That also raises the stakes for Medicare Advantage enrollment decisions. Moving back to traditional Medicare can carry very different supplemental coverage risk depending on where a person lives.
One likely implication is that policy pressure will keep building around portability and access for people with pre-existing conditions and for beneficiaries under age 65 with long-term disabilities, which KFF specifically flags as an area of unequal protection. The state activity cited here also suggests the market is still moving through incremental legislative change rather than a single federal reset. Analysts will watch whether more states follow the path of Rhode Island or Minnesota, and whether insurers respond by adjusting product strategy or pricing in states with broader guaranteed issue requirements. For employer-side benefits context, see PharmaBenefits.ai.
