Medigap Underwriting and Guaranteed Issue Rights for Agents in 2027

Research date: October 7, 2026 • For 2027 coverage planning

A client wants to leave Medicare Advantage. Another wants a lower Plan G premium. A third has a serious health condition and assumes changing coverage is impossible.

Each conversation should begin with the same question:

What right allows this client to buy the proposed Medigap policy, from the proposed insurer, on the proposed date?

For 2027 reviews, agents need to distinguish initial Medigap enrollment, federal guaranteed issue, first-year trial rights, state protections, and ordinary medical underwriting. The answer affects which policies are available, whether health can affect acceptance or pricing, and how to coordinate the change.

Use this guide to identify the right, verify its conditions, and document the application. Federal rules are the starting point; state law and the specific policy can provide additional protections.

What agents should prioritize for 2027

Review actual Medicare Advantage nonrenewal notices. A true termination or service-area reduction may support Medigap guaranteed issue. Ordinary benefit changes and routine plan consolidations require a different analysis. cms.gov

Add newly expanded state rights to the review. New Mexico’s birthday protection begins January 1, 2027. Minnesota, Rhode Island, Maryland, Delaware, and West Virginia also have recent changes that can affect 2027 decisions. Their eligibility and pricing conditions differ; see the state sections below. nmlegis.gov

Recheck the client’s original Medicare eligibility date. The common federal guaranteed-issue plan choices differ for beneficiaries eligible before 2020 and those newly eligible afterward. Plan G is not automatically protected for every applicant. cms.gov

Use the published 2027 high-deductible amount. The annual deductible for high-deductible Medigap options is $3,050 for 2027. Account for it when comparing premiums and a possible deductible reset after replacement. cms.gov

First distinguish the five application paths

The federal statute and Medicare’s buying guidance establish the federal framework. State insurance departments explain additional protections. THE PUBLIC HEALTH AND WELFARE

At intake, record the client’s state, date of birth, first Medicare eligibility date, Part B effective date, current coverage, prior Medigap and MA history, and any coverage-loss notice. A current Medicare card alone may not answer every historical eligibility question.

AEP does not create a nationwide Medigap open enrollment period

October 15–December 7, 2026 is the annual Medicare election period for 2027 health and drug coverage. The MA Open Enrollment Period runs January 1–March 31, 2027 for people enrolled in MA.

Neither period, by itself, guarantees access to Medigap under federal law. An applicable state right can change the result. medicare.gov

Initial Medigap enrollment and federal guaranteed issue

The initial federal Medigap Open Enrollment Period lasts six months, beginning with the first month the person is both 65 or older and enrolled in Part B.

Buying a policy during that period does not use up the remaining months. The person can still apply for a different policy while the period remains open. Medicare

Two client groups deserve attention:

• People who delayed Part B: If Part B begins at 68, the initial Medigap period generally begins then. If Part B already began at 65, later retirement does not automatically restart that federal period.
• People who had Medicare before 65: A beneficiary with disability-based Medicare still receives the federal age-65 Medigap enrollment opportunity. Review these clients when they approach 65, even if they already have Medigap. Under-65 access before that point depends heavily on state law and the applicable circumstances. Medicare

Acceptance and preexisting-condition coverage are separate questions

During initial Medigap open enrollment, health cannot be used to reject the applicant or increase the premium. However, a permitted preexisting-condition waiting period can remain when prior creditable coverage does not eliminate it.

Federal guaranteed-issue protection also bars a preexisting-condition exclusion. THE PUBLIC HEALTH AND WELFARE

For every protected application, document three answers:

1. Must the insurer accept this applicant for this policy?
2. Can health affect the premium?
3. Can a preexisting-condition waiting period apply?

State-created enrollment opportunities do not always answer all three questions the same way. Delaware’s MA transition rule and Minnesota’s statutory surcharge illustrate why the file should name the exact protection. delcode.delaware.gov

Common federal guaranteed-issue events

This table identifies frequent cases. The trial rights are explained separately. For each event, confirm the complete conditions in Medicare’s Medigap guidance and its event-specific buying tool. medicare.gov

Which plan letters are protected?

For common federal coverage-loss rights in states using the standard lettered plans, the baseline choices are:

The MACRA substitutions and plan choices appear in the NAIC model regulation. CMS also cautions that beneficiaries eligible before 2020 may not have guaranteed-issue access to D or G under the ordinary federal MA-exit right. content.naic.org

Plan N is outside this common federal list. It can still be available during initial open enrollment, under an applicable trial or state right, or through underwriting. A carrier may also offer broader acceptance than the federal minimum.

The 2020 distinction concerns original Medicare eligibility, not today’s application date. Someone entitled to Medicare because of disability before 2020 who turns 65 in 2027 can remain eligible for C or F.

Massachusetts, Minnesota, and Wisconsin have different Medigap standardization systems. Use the state’s policy descriptions rather than applying this letter table mechanically. THE PUBLIC HEALTH AND WELFARE

Moving from Medicare Advantage to Medigap for 2027

An MA-to-Original-Medicare recommendation needs both a valid Medicare election and a workable Medigap application path. Check the beneficiary’s actual notice and enrollment history before promising a change.

Identify what changed

A genuine nonrenewal or service-area reduction can create protection. A beneficiary transferred to another MA plan after a true nonrenewal may retain relevant rights. A routine consolidation, changed plan ID, premium increase, or benefit reduction does not establish the same event. cms.gov

A provider leaving the network requires further review. A CMS-determined significant network change can support protected Medigap enrollment. Medicare can also evaluate an individual request for an exceptional-circumstance Special Enrollment Period.

Keep the determination and resulting notice. The agent’s assessment of how disruptive the change feels is not the determination. cms.gov

Track three different dates

CMS’s enrollment guidance and Medicare’s Medigap timing guidance address different parts of this coordination. cms.gov

2027 example: If the client’s MA coverage ends December 31, 2026, a 63-day post-termination Medigap window reaches March 4, 2027. CHRISTUS’s actual 2027 nonrenewal guidance uses that deadline.

The client should still arrange a January 1 start if continuous supplemental coverage is the goal. A later application can leave earlier Original Medicare deductibles and coinsurance uncovered. christushealthplan.org

Do not assume every application must wait until 60 days before coverage ends. Depending on the event, receipt of an involuntary termination notice can open the application period earlier.

For loss of secondary employer coverage, the latest applicable coverage-end, notice, or claim-denial date can control the final deadline. Save the notice and envelope and record the calculation. content.naic.org

The two federal trial rights

These are different rights with different policy choices. Check Medicare’s explanation of trial rights before treating a case as protected. Medicare

For the second right, the former policy could be Plan N. If that is the policy the client gave up and the former carrier still offers it, the return right may protect it. That does not create an unrestricted right to choose any new Plan N carrier.

Do not assume everyone gets a fresh trial period whenever they join a different MA plan. If a first-year plan ended involuntarily or the history is unusual, verify the extension provisions with the state insurance department or SHIP. Medicare

State Medigap birthday rules for 2027

These are selected state switching protections, checked October 7, 2026, including New Mexico’s enacted 2027 change. They generally require existing Medigap coverage. A birthday alone does not turn MA coverage into a protected Medigap purchase.

The window below concerns applying for coverage. Verify the state’s effective-date rules, residency requirements, covered policy types, and any additional eligibility conditions. “Any insurer” means an insurer offering the qualifying policy. Employer or labor group arrangements can be subject to exclusions.

Use the legal benefit comparison

“Same plan,” “same benefits,” and “equal or lesser benefits” are different standards. A lower premium does not establish eligibility.

For example, Indiana and Virginia do not protect G-to-N under their birthday rules. Check the state matrix for standard versus high-deductible policies and any treatment of additional benefits. Indiana SHIP fact sheet Medigap Birthday Rule

West Virginia needs an additional calendar control: a replacement restarts its 24-month coverage requirement. Its birthday window therefore should not be presented as an unrestricted annual switching opportunity.

The exception allowing another insurer is also narrow: the current issuer and affiliates must have stopped accepting qualifying same-or-lesser applications for at least 12 months. wvlegislature.gov

Additional state protections that matter for 2027

Minnesota: First-time Medigap applicants ages 65 through 70

Minnesota’s new protection took effect August 1, 2026. It is limited to applicants ages 65–70 who have never held Medigap. It generally does not protect a current or former Medigap policyholder seeking a replacement. mn.gov

The surcharge depends on when the person enrolls:

The surcharge continues for the policy’s duration and is additional to normal premium changes. Qualifying institutionalized applicants have another enrollment opportunity described in the state bulletin.

A January 2027 effective date does not automatically mean a 20% surcharge. mn.gov

Rhode Island: Annual enrollment with qualifying coverage history

Rhode Island expanded its annual Medigap enrollment right in 2026, as explained in the September 2026 bulletin.

For eligible current MA or Medigap enrollees, qualifying history can include MA, Medigap, and other creditable coverage, with no gap exceeding 90 days measured from the Medigap Open Enrollment Period.

Applications during October 15–December 7 are for coverage beginning January 1 of the following year. The right can reach any available Medigap policy the client is eligible to buy. Qualifying applicants under 65 are limited to Plan A under the under-65 provision. ohic.ri.gov

Build a coverage timeline. Do not use the superseded 2025 bulletin or assume that any current employer-plan enrollee automatically qualifies.

Delaware: Acceptance and pricing require separate review

Delaware separately protects access to a Medigap policy when an MA enrollee returns to Original Medicare during AEP or MA OEP.

Under this route, insurers may individually rate the applicant and apply a permitted preexisting-condition limitation. It therefore differs from the state’s birthday replacement protection and from federal guaranteed issue.

Confirm the actual premium and coverage terms before completing the MA exit. delcode.delaware.gov

Maryland and West Virginia: Medicaid-loss protections

Maryland’s July 2026 change can protect someone who enrolled in Part B while on Medicaid and remained on Medicaid at least six months afterward. Apply within 63 days of the later of Medicaid termination or its notice.

Maryland also expands policy choices for certain pre-2020 Medicare beneficiaries who have a qualifying federal guaranteed-issue event. Being eligible before 2020 alone is insufficient. insurance.maryland.gov

West Virginia separately provides qualifying people age 65+ a 63-day application opportunity following Medicaid loss, including loss of full or partial dual eligibility. MA disenrollment alone does not establish that right. wvlegislature.gov

Other switching protections are not birthday rules

New York has year-round acceptance protections, although a preexisting-condition waiting period can still require analysis.

Maine permits certain same-or-lesser replacements based on continuous supplemental coverage and has its own extended MA trial rights.

Missouri uses the policy anniversary rather than the birthday for its same-letter replacement protection.

These examples show why a state omitted from the birthday table still needs review. Department of Financial Services

When medical underwriting applies

Outside an applicable protection, the proposed insurer may evaluate health, decline the application, or offer coverage at a different rate, subject to state law. Existing Medigap coverage does not guarantee acceptance by a new insurer. Medicare

A useful prescreen starts with the proposed insurer’s current application and underwriting guide. Review the questions about diagnoses, treatment dates, pending tests or procedures, hospital or facility stays, prescriptions, functional limitations, height and weight, and tobacco use.

These are areas to check against the actual form, not a universal list of disqualifying conditions.

Explain the process accurately:

• Answer the question as written, including its lookback period.
• Do not infer a diagnosis solely from a medication or omit information because the client feels well.
• Resolve ambiguous answers with the carrier and retain its written guidance.
• Describe a prescreen as preliminary. Only the insurer can make the final decision.
• Track outstanding requirements so a pending application does not consume the time needed for another option.

If a protected applicant receives a health-based decline, review whether the application was coded under the correct right and whether evidence is missing. Ask for the reason in writing.

Escalate an unresolved conflict to the insurer’s compliance team or the state insurance department while preserving the deadline.

A practical replacement and coverage-transition workflow

1. Document what the client has and wants to change

Record the current policy, carrier, plan variation, premium, discounts, original effective date, and reason for review. Identify any employer benefits that could be lost.

Compare the client’s preferred providers, anticipated care, prescription coverage, travel needs, and ability to sustain the premium.

2. Match the right to the exact proposed policy

Write the applicable authority, qualifying facts, protected plans, eligible insurers, application window, and proof required.

If more than one protection applies, compare the options each permits. Do not reduce the file entry to “GI.”

3. Compare total cost

Use annual premiums and realistic cost-sharing differences. Check household discounts, how long discounts last, rating method, available rate history, added benefits, and possible overlap costs.

For a high-deductible replacement, obtain written confirmation of whether accumulated expenses carry over. Oregon expressly warns that a midyear high-deductible replacement can restart the deductible.

A small premium saving may be outweighed by lost deductible credit. dfr.oregon.gov

4. Submit the application and supporting evidence

Include required disclosures and replacement forms. Verify submission receipt, requested effective date, and outstanding requirements.

Guaranteed issue does not remove replacement obligations. content.naic.org

When an MA exit under a qualifying SEP supports the application, request the MA organization’s written Medigap-rights notice if additional proof is needed. CMS’s 2027 guidance specifically addresses this documentation in section 60.1.8 and MA Exhibit 24. cms.gov

5. Coordinate the transition appropriate to the coverage

Medigap to Medigap: Receive and review the new policy, confirm its premium and effective date, and follow the 30-day free-look process and applicable state replacement instructions.

Keep the existing policy until the client has decided to retain the replacement. Explain any period when both premiums are payable, and follow state requirements for nonoverlapping effective dates where applicable, including West Virginia. Medicare

MA to Original Medicare: For an elective switch requiring medical underwriting, obtain the Medigap insurer’s final acceptance and confirmed effective date before MA disenrollment becomes effective.

A quote, prescreen, or application receipt is not approval. Confirm the valid Medicare election and coordinate effective dates without allowing either deadline to expire.

Medigap cannot start while MA coverage remains effective. Arrange separate Part D coverage when needed; buying Medigap does not itself enroll the client in a drug plan. Medicare

Four cases to practice before an appointment

The long-time MA client whose premium increased

The client wants Original Medicare and Plan G for January 2027.

Start with state rights, initial enrollment history, and any qualifying event. A premium increase and an AEP election do not alone establish federal Medigap guaranteed issue. cms.gov

The beneficiary first eligible for Medicare in 2018 whose MA plan is ending

Confirm the nonrenewal and apply the pre-2020 plan-choice rules.

Do not promise Plan G solely because the case has federal guaranteed issue. Check state expansion, another qualifying right, or the insurer’s broader acceptance practices. cms.gov

The Virginia Plan G client requesting Plan N

The birthday rule protects same-benefit replacements.

Identify another protected route or underwriting for the proposed G-to-N change. Also compare the benefit differences, not only premiums. Medigap Birthday Rule

The 69-year-old Minnesota MA client who has never had Medigap

Evaluate the new first-time enrollment right, coverage coordination, and the permanent surcharge.

Fall 2026 enrollment for January 2027 coverage uses 15%; enrollment during a 2027 window uses 20%. Record which window the application uses. mn.gov

Printable agent case checklist

Client reference: ____________________
State: __________
Review date: __________

Eligibility and history

• Date of birth and first Medicare eligibility date verified.
• Part A and Part B effective dates recorded.
• Current policy, plan variation, premium, and coverage dates verified.
• Prior Medigap, first MA/SELECT enrollment, and relevant gaps documented.

Right and policy choice

• Exact federal, state, trial, initial-enrollment, or underwriting path identified.
• Requested plan and insurer qualify under that path.
• Acceptance, pricing, and preexisting-condition treatment confirmed.
• Supporting notice, policy history, and current authority saved.

Medicare election deadline: ____________________

Medigap application deadline and calculation: ____________________

Original Medicare / Medigap / Part D effective dates: ____________________

Application and follow-through

• Total cost, discounts, and any deductible reset compared.
• Required disclosures and replacement forms completed.
• Application receipt, outstanding items, and final decision tracked.
• Issued premium and effective date checked against the recommendation.
• Free-look decision and prior-policy cancellation documented when applicable.
• Client received written confirmation of what starts, what ends, and when.

Frequently asked questions

Can someone apply for Medigap outside AEP?

Yes. A Medigap application is not restricted to AEP. Whether the applicant has protected access depends on initial enrollment, a qualifying event, trial rights, state law, or carrier underwriting. Medicare

Does moving create guaranteed issue?

Moving outside an MA or Medicare SELECT service area can create a qualifying situation. Moving with an ordinary Medigap policy does not automatically create the same federal right to buy a different policy.

Check the move, current coverage type, and destination-state rules. medicare.gov

Is Plan F being eliminated in 2027?

The federal restriction concerns people newly eligible for Medicare on or after January 1, 2020. It does not require eligible existing Plan F policyholders to drop their policies.

Eligibility for a new F application and the right to obtain it without underwriting remain separate questions. THE PUBLIC HEALTH AND WELFARE

Does a birthday rule let every MA client buy Medigap?

Usually, birthday rules protect people who already have Medigap. For a client leaving MA, investigate the separate federal or state entry right.

The birthday, the AEP election, and the Medigap entitlement should each be documented under the applicable rule.

Related agent resources

Use the 2027 Medicare Advantage county guide to organize the broader annual review, then verify each client’s actual plan notices and Medigap rights.

When a Medigap review also includes Part D or MA discussion, check the applicable Scope of Appointment requirements before the plan-specific discussion. See Does a Medicare Supplement Appointment Require an SOA? Keep enrollment-right documentation alongside the client’s appointment and coverage records.

After confirming the enrollment path, Informed + Choice Medicare quoting tools can help agents compare available Medicare Supplement rates and review Part D options. Review current availability and start an Essentials trial for the workflow that fits your agency. Essentials is $29.99/month after a 30-day free trial. Card required at checkout; one trial per NPN.

Sources

• CMS CY 2027 Part C and D enrollment and disenrollment guidance
• New Mexico SB 21, final version
• CMS Medigap guaranteed-issue frequently asked questions
• CMS 2027 Medigap high-deductible options
• 42 U.S.C. 1395ss — Medicare supplemental policies
• Medicare & You
• Get ready to buy a Medigap policy
• Delaware Code Title 18, Chapter 34 — Medicare supplement insurance
• Choosing a Medigap Policy: 2026 official guide
• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation
• CHRISTUS 2027 Medicare Advantage nonrenewal guidance
• Learn how Medigap works
• California Medicare supplement consumer information
• Delaware Medicare Supplement birthday rule fact sheet
• Idaho Medicare Supplement law and rule changes
• Illinois Public Act 103-0747
• Indiana SHIP HEA-1226 birthday-rule fact sheet
• Kentucky Administrative Regulation 806 KAR 17:570
• Louisiana Revised Statutes 22:1112
• Maryland Medicare Supplement FAQs
• Nevada Revised Statutes Chapter 687B
• Oklahoma Medicare Supplement open enrollment FAQs
• Oregon Medigap birthday rule matrix
• Utah Insurance Department Bulletin 2025-5
• Virginia Medigap birthday rule
• West Virginia HB 4869, enrolled
• Wyoming DOI Medicare supplement rule resource
• Minnesota administrative bulletin 2026-3
• Rhode Island OHIC Bulletin 2026-02
• Maryland new Medicare supplement enrollment rights
• New York information for Medicare beneficiaries
• Can I change my Medigap policy?
• When can I buy Medigap?