He Answered Yes to One Question About Sleep Apnea. At 73, Every Medigap Insurer He Called Said No.
A single yes on a health questionnaire cost an Ohio retiree something he never expected to lose: the ability to shop for a cheaper Medicare supplement. What he did not know about Medigap could fill a hospital bill.
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A 73-year-old Ohio retiree decides his Medigap Plan F premium has climbed too far. He calls several insurers hoping to switch to a cheaper Plan G. Then the medical questions begin. He discloses treatment for sleep apnea, and every carrier he approaches declines his application. He still has his Plan F. What he has lost is the easy ability to shop around.
That surprises most people. Medigap plans are standardized and heavily regulated, which creates an expectation of flexibility. But the federal protection against medical underwriting is concentrated almost entirely in one six-month window. Once it closes, changing carriers can become much harder, and Ohio offers no state-level safety valve to compensate.
The Six-Month Window Does Not Come Back Every Fall
A person’s federal Medigap open enrollment period begins the first month he is 65 or older and enrolled in Medicare Part B. It lasts six months. During that window, an insurer cannot deny a Medigap application because of pre-existing health problems, and it cannot charge more because of them. Afterward, federal law generally does not guarantee the right to switch policies unless a specific guaranteed issue protection applies. Insurers may then use medical underwriting, and one carrier’s standards can differ significantly from another’s.
Sleep apnea is a useful example of how uneven underwriting can be. Whether it affects an application depends on the treatment type, the severity of the condition, and the individual company’s internal guidelines. It should not be assumed to be an automatic nationwide rejection, because it is not. What the Ohio retiree ran into was a particular combination of age, health history, and carrier standards that happened to produce a wall of denials. Another trap on the same topic is the calendar. Medicare’s October 15 through December 7 annual enrollment period covers Medicare Advantage and prescription drug plans. It does not open a fresh Medigap enrollment window every year, a distinction that catches many beneficiaries off guard.
State Law Can Reopen Some Doors, But Not in Ohio
Federal law is only the floor. A growing number of states have enacted protections that go beyond federal Medigap rules. Connecticut, Maine, New York and Vermont offer broad access without medical underwriting on a year-round or near-year-round basis. Massachusetts has its own separate regulatory framework with similar effect.
Beyond those states, birthday-based switching rights have expanded sharply. As of 2026, 16 states have adopted some version of a Medigap birthday rule, more than ever before. The list includes California, Idaho, Illinois, Louisiana, Nevada, Oklahoma and Oregon, which the federal framework does not cover, along with newer additions such as Delaware, Indiana, Virginia, West Virginia and Wyoming, which joined in 2024, 2025 and 2026. Missouri uses a policy anniversary date rather than a birthday. The details vary considerably: window lengths range from 30 to 63 days, some states restrict switching to the same carrier, and most limit changes to a plan with equal or lesser benefits.
Ohio is not among any of these states. A state bill that would have created a birthday rule for Ohio Medigap enrollees died at the end of the 2024 legislative session and had not been reintroduced as of mid-2026. For the Ohio retiree in this story, the state map offers no relief. The timing and plans available are governed entirely by federal rules, which in his case have run out.
Walking Away From Medigap Has Its Own Price
The temptation is to drop an expensive supplement and rely on Original Medicare alone. That creates a different risk. In 2026, the standard Part B premium is $202.90 a month and the annual deductible is $283. After that deductible, beneficiaries remain responsible for 20% of Medicare-approved Part B charges, with no annual out-of-pocket ceiling under Original Medicare itself.
Part A carries a $1,736 inpatient hospital deductible per benefit period in 2026, up $60 from 2025. Hospital days 61 through 90 cost $434 per day in coinsurance, while skilled nursing facility care runs $217 per day from days 21 through 100. Critically, the Part A deductible applies per benefit period, not per year, so a beneficiary with multiple hospitalizations could face it more than once in a single calendar year. Plan G covers many of those gaps, though it does not cover the Part B deductible. An expensive Medigap premium can still be buying protection that would be very difficult to replace once health circumstances change.
Protect the Policy Before Shopping for Another
Someone already outside the six-month window still has options, but the sequence matters.
- Apply for and secure any replacement Medigap policy before canceling the existing one. Medicare specifically advises keeping the old coverage until the new policy is in place and the free-look period has passed.
- Check for federal guaranteed issue rights and any additional state protections before accepting an underwriting denial as final.
- If considering Medicare Advantage instead, remember that certain “trial rights” can protect a return to Medigap, but they apply only in specific circumstances, including some first-time moves into Medicare Advantage.
The Ohio retiree can still keep the Medigap plan he has. What changed is his freedom to shop for another one. At 73, that existing policy is not just coverage. It is coverage he no longer has to qualify for.
Editor’s note: This article was updated to reflect that 16 states now offer Medigap birthday-rule protections as of 2026 (including recent additions such as Delaware, Indiana, Virginia, West Virginia and Wyoming), that Maine and Vermont join Connecticut and New York as states with year-round or near-year-round Medigap access, and that Ohio’s proposed birthday-rule legislation died in December 2024 without passage. The 2026 Medicare Part A deductible of $1,736 per benefit period (up $60 from 2025) and the per-benefit-period nature of that deductible were also clarified.
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Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
