Medigap under 65 in Washington: disability, ESRD and WSHIP

Options for Washington residents on Medicare before 65 because of disability or ALS: the limited Medigap market, WSHIP, Medicare Advantage, and what changes at 65.

About one in seven people on Medicare is under 65, qualifying through Social Security disability, ALS, or end-stage renal disease. Federal law does not require insurers to sell Medigap to them, and Washington is one of the states that also does not require it.

What the market looks like

Very few insurers in Washington offer Medigap to under-65 enrollees, and the plans that exist usually cost more than the same plan for a 65-year-old. That leaves many people choosing between three routes.

Route 1: WSHIP's Medicare Supplement plan

The Washington State Health Insurance Pool (WSHIP) offers a Medicare supplement plan for people who cannot get Medigap because of their health and who do not have a reasonable choice of Medicare Advantage plans where they live. In counties considered to have a reasonable choice, people may still qualify if their providers are not in-network with an available Medicare Advantage plan. Check WSHIP's current eligibility rules and premiums.

Route 2: Medicare Advantage

Medicare Advantage plans must accept anyone with Parts A and B in their service area, including under-65 enrollees. They cap in-network out-of-pocket costs each year, but use networks and prior authorization. Compare carefully if you see specialists frequently.

Route 3: Original Medicare alone

Possible, but risky because Part B's 20% coinsurance has no cap; see the 20% with no cap.

The second chance at 65

When an under-65 enrollee turns 65, they get a fresh six-month Medigap open enrollment period. During it, insurers must sell any Medigap plan at standard rates regardless of health. Mark that date: it is often the moment to move to a better-priced plan.

Help with costs

People on disability often qualify for Medicare Savings Programs or Extra Help with drug costs. A SHIBA counsellor can screen eligibility for free.

Questions people ask

Must insurers sell Medigap to people under 65 in Washington?

No. Washington does not require it, so options are limited.

What is WSHIP?

Washington's high-risk pool, which offers a Medicare supplement plan to some people who cannot get Medigap.

What happens at 65?

You get a new six-month Medigap open enrollment period with guaranteed issue.

Can under-65 people join Medicare Advantage?

Yes, plans must accept anyone with Parts A and B in their area.

Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.