Medicare Supplement Under 65 on Disability: NC, SC and TN Rules

If you're under 65 and on Medicare because of a disability, buying a Medicare Supplement (Medigap) depends heavily on where you live. Federal law doesn't guarantee it under 65, so each state sets its own rules. North Carolina, South Carolina and Tennessee take three different approaches. This page explains each one, the deadlines that matter, and what changes at 65. For the full picture, see our guide to Medicare under 65 on disability.

Can I get a Medicare Supplement if I'm under 65?

It depends on your state. Federal law doesn't require companies to sell Medigap to people under 65, and Medicare.gov notes that if you have a disability, you may not be able to buy the policy you want, or any policy, until you turn 65.

A Medicare Supplement works alongside Original Medicare and helps with costs it leaves behind, such as the 20% coinsurance and deductibles. Medigap plans are standardized by letter, so the basic benefits for a given plan letter are the same from one insurer to the next. Premiums, underwriting, discounts and company service can still differ.

How do the rules compare in NC, SC and Tennessee?

North Carolina: Plan A, plus D or G

North Carolina law guarantees under-65 access, but not to every plan, and it lets insurers charge more.

• Which plans: under G.S. 58-54-45, insurers must offer Plan A to people on Medicare because of a disability, and Plan D or G if they sell either to people new to Medicare at 65. If you became eligible for Medicare before 2020, the second plan is C or F instead.
• When: during the 6 months beginning with the first month you enroll in Part B. If your Part B was made retroactive, the 6 months run from Social Security's notice.
• Price: insurers can set rates specific to people with disabilities, so premiums can be higher, but they can't price you based on your health during that window.
• Waiting period: a policy can have a wait of up to 6 months for pre-existing conditions, which is waived if you had creditable coverage, according to North Carolina's SHIIP program.
• Another chance: if a Medicare managed-care plan you're in ends, you have a guaranteed right to buy Plan A, D or G from any insurer within 63 days.

South Carolina: the state pool

In South Carolina, the guaranteed path under 65 is the South Carolina Health Insurance Pool.

The SC Department of Insurance says guaranteed-issue Medigap for people under 65 on Medicare because of a disability is available only through SCHIP. State law requires the pool to offer coverage to people under 65 with Medicare Parts A and B, including Plan A. A private insurer may sell to you if it chooses to, but it doesn't have to. A 2023–2024 bill that would have required Plan A for people under 65 was not enacted. The SC Department of Insurance guide lists the pool's current rates.

Tennessee: the same plans as at 65

Tennessee's rule is the broadest of the three, and it includes people with kidney failure.

• Which plans: since January 1, 2011, any insurer that sells Medigap to people 65 and older must offer the same policies with the same standard benefits to people under 65 on Medicare because of a disability or ESRD.
• When: within 6 months after you enroll in Part B, after Social Security notifies you of retroactive Part B, after employer, individual or Medicare Advantage coverage ends for a reason other than your conduct or nonpayment, or after you're involuntarily disenrolled from Medicaid.
• Health: no one on Medicare because of a disability or ESRD can be denied a Medigap policy because of health status in these windows. Rates for under-65 enrollees can differ.

What if I can't get, or afford, a Supplement under 65?

Look at the other ways to fill the gaps, then plan for 65. Neither Advantage nor a Supplement is automatically the right answer.

• Medicare Advantage is open to you at any age once you have Part A and Part B, charges everyone in a plan the same premium, and has a yearly out-of-pocket limit. See Medicare Advantage under 65 on disability.
• Medicaid or a Medicare Savings Program can pay Medicare premiums and, in some cases, deductibles and coinsurance. See help paying for Medicare and having both Medicare and Medicaid.
• Coverage from current work, if you or your spouse have it, may pay first. Check with that plan before you change anything.

What changes at 65?

You get a full Medigap Open Enrollment Period. During the 6 months starting the first month you're 65 and enrolled in Part B, an insurer can't turn you down or charge you more because of your health, even if you've had Part B for years. That applies in every state. See turning 65 after Medicare on disability.

Mistakes we see people make

• Missing the 6-month window after Part B starts. In North Carolina and Tennessee, that's the guaranteed window under 65.
• Assuming they were turned down for good. At 65, the federal open enrollment period applies regardless of past answers.
• Comparing plans by letter but not by price. Under-65 rates can differ from one insurer to another.
• Leaving Medicare Advantage without a Supplement lined up, when state rules may not guarantee one.

How The Jordan Insurance Agency helps

A licensed agent from The Jordan Insurance Agency will check which Medigap rules apply in your state and your timing, compare a Supplement with Medicare Advantage for your doctors and prescriptions, and plan ahead for your open enrollment at 65. We work by phone, by video, or in person at our office at 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, Monday through Friday, 9 to 5 Eastern, at no cost to you. Call (704) 926-7565 or use the button below to schedule a Medicare review. You can also read more on our Medicare page or browse our Medicare questions answered.

Frequently asked questions

Can I buy Medigap Plan G under 65 in North Carolina?

Possibly. North Carolina requires insurers to offer Plan A, and Plan D or G if they sell those to people new to Medicare at 65, if you apply within 6 months of first enrolling in Part B. Rates for people under 65 can be higher.

Is there a Medicare Supplement for people under 65 in South Carolina?

Yes, through the South Carolina Health Insurance Pool (SCHIP), which is the only guaranteed option under 65. A private insurer may sell to you, but no law requires it.

Does Tennessee require Medigap for people under 65?

Yes. Since 2011, any insurer selling Medigap at 65 must offer the same plans to people under 65 on Medicare because of a disability or ESRD, within 6 months of Part B or certain other events.

Can a Medigap insurer turn me down because of my health under 65?

Not during the guaranteed windows in North Carolina and Tennessee, or through the South Carolina pool. Outside those windows, insurers can generally use health questions until your open enrollment at 65.

What happens to my Medigap options at 65?

You get a 6-month Medigap Open Enrollment Period starting the first month you're 65 and enrolled in Part B. An insurer can't turn you down or charge you more because of your health during it.

Reviewed and approved by Billy Jordan, Jr., licensed agent and President of The Jordan Insurance Agency.

Last reviewed: October 2026