Medicare by State – 50-State Comparison Guide (2026)

Medicare by state varies significantly across the United States. While Medicare is a federal program, Medigap (Medicare Supplement) insurance is regulated at the state level, meaning available plans, pricing methods, guaranteed issue rights, birthday rule protections, and consumer protections differ from state to state. Medicare Advantage availability and penetration rates also vary dramatically by county and state. Every state operates a SHIP (State Health Insurance Assistance Program) that provides free, unbiased Medicare counseling. This comprehensive 50-state guide compares the key Medicare features in every state so you can understand your options.

Click any state name below to read its detailed Medicare guide with SHIP contacts, Medigap plans, birthday rule details, and Medicare Advantage options.

All 50 States – Medicare Comparison

The table below shows each state’s SHIP program, birthday rule availability, Medigap pricing method, Medicare Advantage penetration rate, and notable features. Click any state name to read the full guide.

Understanding How Medicare Differs by State

Medicare Parts A and B (Original Medicare) are identical in every state because they are administered by the federal government. However, the supplemental coverage options available to you depend heavily on your state. Medigap plans are standardized by letter (Plan A through N), meaning Plan G from one carrier covers the same benefits as Plan G from another. But the premiums for those plans vary by state because each state sets its own pricing rules. Community-rated states like New York and Connecticut charge everyone the same premium regardless of age. Attained-age states increase premiums as you get older, which means your costs rise over time.

Medicare Advantage availability depends on where you live. States like Florida, Minnesota, and New York have penetration rates above 48%, with dozens of plan options per county. Rural states like Alaska, Wyoming, and Vermont have far fewer MA choices, making Original Medicare with a Medigap supplement the more practical option for many beneficiaries.

The Birthday Rule Advantage

14 states currently offer a Medigap birthday rule: California, Connecticut, Illinois, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, Washington. In these states, you can switch Medigap plans during your birthday month without medical underwriting, regardless of health conditions. This annual switching window is one of the most valuable consumer protections in Medicare because it lets you shop for lower premiums every year without risk of denial. If you live in a birthday rule state, compare rates annually.

Compare Medicare Plans in Your State

Ready to explore your Medicare options? Use the official Medicare Plan Finder or contact your local SHIP counselor for free, unbiased help.

Official Sources

• Medicare.gov: medicare.gov – Official Medicare information
• CMS.gov: cms.gov – Medicare data, enrollment statistics
• NAIC: naic.org – Medigap shopping guide, state regulations
• KFF.org: kff.org – Kaiser Family Foundation Medicare research

State data compiled from CMS enrollment reports, state Department of Insurance publications, and NAIC model laws. Medicare Advantage penetration rates and Medigap premiums are approximate and subject to change. Click any state name above for your complete state guide. Last reviewed April 2026.

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• Medicare Enrollment Guides
• Helping Parents With Medicare
• Medicare Costs and Premiums