Medicare Supplement Plans by State: Rules, Costs and Best Options

Why Medigap Rules Vary So Much by State

Medicare itself is a federal program, but Medicare Supplement insurance is regulated at the state level. The federal government sets a baseline (the standardized letter plans A through N, the six-month Medigap Open Enrollment Period, and certain guaranteed-issue triggers), but every state can layer additional consumer protections on top of those rules. The result is a patchwork: a Plan G in Florida is the same benefit package as a Plan G in Oregon, but the price, the carriers available, and your ability to switch later are dramatically different.

Three big variables drive most of the differences:

1. Plan standardization. Most states use the federal A-N letter system. Three (Wisconsin, Minnesota, Massachusetts) do not.
2. Switching rights. Some states let you change Medigap plans every year with no health questions. Most do not.
3. Pricing method. Some states require community-rated pricing (everyone pays the same age-blind premium); most allow attained-age or issue-age pricing.

The Three States with Their Own Medigap Designs

Wisconsin, Minnesota, and Massachusetts are the only states that do not use the federal A-N letter system. Instead, they have their own standardized Medigap structures that pre-date or replace the federal framework.

Wisconsin

Wisconsin offers a single Basic Medigap plan with a menu of optional rider benefits that can be added on, including Part A deductible, additional home health care, and Medicare Part B copayment riders. Rather than choosing between ten lettered plans, Wisconsin residents pick a base policy and customize it.

Minnesota

Minnesota uses a Basic plan plus an Extended Basic plan, with optional riders that add coverage for the Part A deductible, Part B deductible, and other benefits. The Extended Basic plan is roughly comparable to the federal Plan F, while the Basic plan with select riders can approximate Plan G or Plan N.

Massachusetts

Massachusetts sells three plan types: Core, Supplement 1, and Supplement 1A. Supplement 1A is the closest equivalent to the federal Plan G for people who became Medicare-eligible on or after January 1, 2020.

If you move into or out of one of these states, you cannot simply transfer your old plan. You will need to shop the local standardized policies and may need to go through underwriting unless you qualify for a guaranteed-issue right.

Birthday Rule States: Switch Plans Without Underwriting

In most states, once your six-month Medigap Open Enrollment Period ends, switching plans requires medical underwriting. Insurers can ask health questions and deny you or charge more. Birthday rule states protect existing Medigap enrollees by giving them an annual window to switch plans without underwriting.

As of 2026, sixteen states have some version of a birthday rule. Here are the nine featured states and how each one works:

*Missouri technically uses an anniversary rule (tied to your policy start date) rather than a birthday rule, but the practical effect is the same: one guaranteed switching window per year.

Guaranteed-Issue States: Year-Round Access

A small group of states go even further, requiring insurers to sell Medigap to any Medicare beneficiary 65 or older, regardless of health status, either continuously or during an annual open window.

• New York and Connecticut: Continuous, year-round guaranteed issue. You can apply or switch any month with no health questions.
• Massachusetts: Annual guaranteed-issue period each year (typically February 1 through March 31).
• Maine: Plan A is guaranteed issue for one month each year, plus broader switching rights for existing Medigap enrollees.

Washington has notable but narrower rules: year-round guaranteed-issue rights apply only when switching between Medigap plans of equal or lesser benefits, not when buying Medigap for the first time outside open enrollment. Vermont uses community-rated pricing but does not provide statewide continuous guaranteed-issue protections for all 65+ enrollees.

Plan G Costs in the Six Largest Medicare Markets

Plan G is the most popular Medigap plan for new enrollees in 2026, and its average national premium runs around $220 per month at age 65. But the spread between states is wide. Here are estimated average monthly premiums for a 65-year-old non-tobacco user in 2026:

Florida is unusually variable because metropolitan counties (especially Miami-Dade) have much higher medical costs, with Plan G premiums there reaching $305 to $440 per month, while quieter counties like Palm Beach can run $185 to $245.

Why New York Premiums Are So High

New York requires community-rated pricing, which means everyone pays the same premium for a given plan and carrier in a given region, regardless of age, gender, or health status. Combined with year-round guaranteed issue, this creates two effects:

1. Higher starting premiums at 65. Younger, healthier enrollees subsidize older and sicker ones. A 65-year-old in New York pays much more than a 65-year-old in Arizona for an identical Plan G.
2. Flatter premium curves over time. Your premium does not jump every year just because you are getting older, which can be a real advantage by your late 70s and 80s.

For someone who plans to stay on Medigap for decades and prefers predictability, community-rated pricing can be a feature, not a bug. For someone who is healthy and willing to shop every few years, it can feel expensive.

A Framework for Researching Your State's Options

The right Medigap plan depends not just on your health and budget but on the rules of your state. Use this five-step framework to research your options for 2026.

Step 1: Identify your state's plan structure

If you live in Wisconsin, Minnesota, or Massachusetts, you will be comparing state-specific plan designs rather than federal letter plans. Everywhere else, focus on Plans G, N, and high-deductible G as the most cost-effective options for new enrollees.

Step 2: Confirm your enrollment status and rights

Are you in your six-month Medigap Open Enrollment Period? Do you have a federal guaranteed-issue trigger (losing employer coverage, leaving Medicare Advantage during a trial right)? Does your state offer a birthday rule, anniversary rule, or year-round guaranteed issue? Each of these answers changes which plans you can buy without underwriting.

Step 3: Pull rates from at least three carriers

Premiums for the exact same plan letter can vary by hundreds of dollars per year between carriers. Use Medicare.gov's Medigap plan finder to see the companies licensed in your state, then request quotes from at least three. Ask whether their pricing is attained-age, issue-age, or community-rated.

Step 4: Contact your State Health Insurance Assistance Program (SHIP)

Every state has a free, federally funded SHIP office that provides one-on-one counseling about Medigap options, costs, and consumer protections specific to your state. You can find your local SHIP through shiphelp.org or by calling 1-877-839-2675. SHIP counselors are unbiased and do not sell insurance.

Step 5: Verify rules with your state insurance department

Your state insurance department regulates Medigap carriers, publishes rate comparison guides, and handles complaints. The National Association of Insurance Commissioners (NAIC) website has contact information for every state. If a carrier denies you coverage you believe is guaranteed, this is the agency to call.

Frequently Asked Questions

Are Medigap plans the same in every state?

No. While most states use the federally standardized A-N letter plans, Wisconsin, Minnesota, and Massachusetts have their own plan designs. Even in states that use the letter plans, premiums and the carriers offering each plan can vary substantially. Your zip code is one of the biggest factors in your final monthly premium.

Can I switch Medigap plans without answering health questions?

It depends on your state. In sixteen birthday rule states, you get an annual window each year to switch carriers without underwriting. In New York, Connecticut, Massachusetts, and Maine, you have ongoing or annual guaranteed-issue rights. Everywhere else, switching outside a federal guaranteed-issue trigger usually requires passing medical underwriting.

Why is Medigap so expensive in New York?

New York requires community-rated pricing, meaning premiums do not vary by age or health, and provides year-round guaranteed issue. This combination attracts a sicker risk pool and forces insurers to charge higher base rates so younger enrollees subsidize older ones. The trade-off is that your premium does not increase with age, which can save money in the long run.

What is the difference between attained-age, issue-age, and community-rated pricing?

Attained-age pricing means your premium increases as you get older. Issue-age pricing locks in your rate based on the age you were when you bought the policy, so it does not rise with age but can still increase for inflation. Community-rated pricing charges everyone the same premium regardless of age, which makes it more expensive at 65 but cheaper at 85.

How do I find the best Medigap plan in my state?

Start by contacting your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling. Then compare quotes from at least three licensed carriers for the plan letter you want (most commonly Plan G or Plan N). Check whether your state offers a birthday rule or guaranteed-issue window, so you know whether you can switch later if rates rise.