Can you get a Medicare Supplement (Medigap) plan under 65 in Texas?

Yes. For Medicare Supplement plans delivered, issued, or renewed on or after September 1, 2025, Texas HB 2516 (the Chris Larkin ALS Act) requires every Medigap carrier that sells to people 65 and older to offer the same coverage to Texans under 65 who qualify for Medicare because of ESRD (end-stage renal disease) or ALS. You get a 6-month guaranteed-issue window that starts on your Part B effective date — no medical underwriting during that window.

Does the Texas "Medigap birthday rule" exist?

No. Despite what many national guides still say, Texas does not have a Medigap birthday or anniversary rule. Some sites confuse this with TX Insurance Code §1652.101, which is actually the loss-ratio standards section. The real, current Texas advantage for under-65 beneficiaries is HB 2516 — a guaranteed-issue protection most national agencies have not updated their content to reflect.

I have ESRD (kidney failure) in Texas — can I buy Medigap before 65?

Yes. Under HB 2516, ESRD is one of the qualifying conditions. Any Medigap plan a carrier offers to 65-and-older Texans must also be offered to you, guaranteed-issue, during the 6-month window from your Part B effective date. This is a meaningful change — historically, under-65 ESRD beneficiaries in most states could be declined or medically underwritten.

What if I miss my 6-month under-65 Medigap window in Texas?

You get a second 6-month guaranteed-issue Medigap Open Enrollment Period when you turn 65 and are enrolled in Part B — so a missed under-65 window is not your last chance. Texas has also long offered Plan A to disabled enrollees under 65 without medical underwriting. Outside these windows, carriers may medically underwrite, so timing matters. We can map your exact windows on a short call.

Updated 2026-05-31 · Texas Medicare brief

Texas Medigap under 65 — the HB 2516 / Chris Larkin ALS Act

Quick answer: For Medicare Supplement plans issued or renewed on or after September 1, 2025, Texas HB 2516 (the Chris Larkin ALS Act) requires every Medigap carrier that sells to people 65+ to offer the same coverage to under-65 Texans on Medicare due to ESRD or ALS — a 6-month guaranteed-issue window from your Part B effective date, no underwriting. Texas has no Medigap "birthday rule." Not connected with or endorsed by the United States government or the federal Medicare program.

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What HB 2516 actually changed

Before HB 2516, Texans who qualified for Medicare before age 65 because of end-stage renal disease (ESRD) or ALS had very limited access to Medicare Supplement (Medigap) coverage. Most carriers could decline them or medically underwrite. HB 2516, passed by the 89th Texas Legislature and codified as new Texas Insurance Code §§1652.059–1652.060, closed that gap for plans delivered, issued, or renewed on or after September 1, 2025.

Per the official HB 2516 bill analysis, the law "requires an entity that offers coverage under a Medicare supplement benefit plan to individuals 65 years of age or older to offer the same coverage to individuals younger than 65 years of age." In plain terms: any Medigap plan a carrier sells to seniors in Texas must also be offered to qualifying under-65 beneficiaries — on a guaranteed-issue basis during the enrollment window.

Who qualifies

HB 2516's guaranteed-issue right (Tex. Ins. Code §1652.059) applies to under-65 Texans who are enrolled in Medicare by reason of ESRD or ALS specifically:

ESRD (end-stage renal disease). Medicare eligibility tied to dialysis or transplant.
ALS (Lou Gehrig's disease). Medicare begins the month SSDI starts — no 24-month wait.

Note: HB 2516's prospective guaranteed-issue protection does not extend to general Social Security Disability Insurance (SSDI) eligibility on its own. Texas does, however, separately require carriers to offer Plan A to under-65 disabled enrollees, and everyone gets a fresh 6-month Medigap Open Enrollment Period at 65 — see below.

Your 6-month guaranteed-issue window

The protected enrollment window runs 6 months from your Part B effective date. During that window, carriers cannot use medical underwriting, cannot charge you more for health history, and cannot decline you for a plan they otherwise sell to seniors. Miss it and you are not out of options — Texans get a second 6-month Medigap Open Enrollment Period at 65, and Texas has long offered Plan A to disabled under-65 enrollees without underwriting. But the cleanest, widest access is inside the HB 2516 window, so timing your application matters.

Why most agencies' content is wrong about Texas

A lot of national sites claim Texas has a Medigap "birthday rule" or "anniversary rule." It does not. That confusion often traces back to TX Insurance Code §1652.101, which is the loss-ratio standards section ("a Medicare supplement benefit plan must return to a plan holder benefits that are reasonable in relation to the premium charged") — nothing to do with a switching window. Texas is not on the standard birthday-rule states list. The real, current Texas differentiator is HB 2516, and most agencies still haven't updated for it.

Medigap vs. Medicare Advantage when you're under 65

Medicare Advantage is always available to under-65 beneficiaries during their Initial Coverage Election Period, but MA plans have local networks and annual changes. Medigap pairs with Original Medicare, travels anywhere Medicare is accepted, and locks in predictable out-of-pocket costs — which matters a lot for ESRD and ALS patients who see specialists and may travel for care. We compare both, side by side, at no cost.

→ Texas Medicare Supplement (Medigap) overview · Texas Medicare Advantage by county

Under 65 and on Medicare in Texas?

Don't let your HB 2516 window close. Pick a time — Matt will confirm your Part B date, identify your guaranteed-issue deadline, and compare every Medigap plan you're entitled to. No fee, no pressure.

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Sources: HB 2516 bill analysis, capitol.texas.gov (89R, 2025) · Texas Insurance Code §§1652.059–1652.060 and §1652.101 (statutes.capitol.texas.gov) · healthinsurance.org, "The 'birthday rule': a gift to Medigap enrollees?" · CMS Medicare eligibility rules for disability/ALS/ESRD. Giron Agency LLC is a licensed Texas insurance agency. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or the Texas HICAP SHIP program (1-800-252-9240) for all of your options.