Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket healthcare costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own. According to Medicare's plan finder tool, there are 38 insurers that offer Medigap plans in Alabama as of 2023.[efn_note]Find a Medicare plan. Medicare.gov. Accessed June 28, 2023.[/efn_note] Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans, and insurers can't use medical underwriting to determine eligibility or premiums. Federal rules do not, however, guarantee access to a Medigap plan if you're under 65 and eligible for Medicare as a result of a disability. The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but Alabama is not among them. In Alabama, Medicare beneficiaries who are under 65 can apply for a Medigap plan, but coverage is not guaranteed issue and insurers can use medical underwriting to determine whether to issue a policy and at what price. There are two insurers in Alabama that offer Medigap plans to enrollees who are under age 65.[efn_note]Find a Medicare plan. Medicare.gov. Accessed June 28, 2023.[/efn_note] They offer just a few plan options, with premiums are substantially higher than premiums for similar plans for a person who is 65. A person who has Medicare prior to age 65 as a result of a disability does qualify for an open enrollment period, upon turning age 65, during which they can select any Medigap plan, guaranteed-issue, from any insurer offering plans in their area. People under age 65 who are eligible for Medicare also have the option of enrolling, with standard premiums, in a Medicare Advantage plan. This now includes people with end-stage renal disease, who were ineligible to join most Medicare Advantage plans prior to 2021.