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What Is the Medigap (Medicare Supplement) Birthday Rule?  Can I Switch Medigap Plans around My Birthday?

Dear Matt,

I have an AARP Medicare Supplement, which is a United Healthcare Medigap Plan G.  My Medicare insurance agent has talked to me about the Medigap Birthday Rule. I might want to switch my Medicare Supplement this year.  I read your book and didn’t see anything in there about a birthday rule for insurance.  What is this?

Thanks,

Andy L.


The Medigap Birthday Rule, or Medicare Supplement Birthday rule only applies if you have a Medigap plan and live in California, Oregon, Illinois, Idaho and Nevada.  The last three states listed only implemented this rule beginning in 2022, and each state’s “rules” differ.

What Is the Medigap Birthday Rule?

If you already have Medicare Supplement (Medigap) insurance policy, you can switch companies and policies (if you want) within thirty days after your birthday, every year.  You can switch without medical underwriting or health screening or any waiting periods.  Each state’s “Birthday Rule” rules are different, and I list those below.

These aren’t the only states that allow changes after you purchased a Medigap plan, and those other states that may allow you to switch your Medigap plan do not call it a “Birthday Rule.”  Yes, it’s confusing.  No, I can’t fix it or tell you why, except to remind people that Medicare Advantage and Medicare Part D benefits are administered and regulated top-down, by CMS, which is the federal government agency that governs Medicare and Medicaid.

Medicare Supplement (Medigap) Enrollment Rules

Medicare Supplements have federal regulations to follow as well, but the states actually govern the licensure, premiums, regulation and a whole lot more for Medicare Supplement insurance companies.  They’re not technically a part of the federal Medicare “system” in that they’re “traditional” insurance products that simply fill in the “gaps” found in Original Medicare Parts A and B.  That’s why Medicare Supplements are also called Medigap plans.  That’s also why there are so many state-based “exceptions” to the “normal” Medigap rules.

Now that’s out of the way, I actually do address this in my book on page 88, but you’re right; I don’t specifically call it the Medigap Birthday Rule.  That’s because at the time of writing, there were only two states that named their exceptions the “Birthday Rule.”  Here’s what the 2021/2022 version of my book says, and it still holds true.

If you’re turning sixty-five or getting Medicare for the first time, it’s extremely important to know there are only certain times you can buy a Medicare Supplement without being asked health questions. If you buy a Medicare Supplement within the first six months of getting Medicare Part B, the insurance company has to accept you. This is called the one-time Medicare Supplement (Medigap) Open Enrollment Period. If you don’t sign up for a Medicare Supplement plan within this timeframe, you will have to answer health questions and could be denied coverage. If you’ve previously been or are very sick (cancer, heart attack, stroke, etc.) before you got Medicare and want to make sure you can get a Medicare Supplement plan with no health questions, it is paramount you don’t miss this window.

Several states have exceptions to this.  In California, you can switch your Medicare Supplement plans between carriers (as long as it’s not an upgrade) every year in the sixty days following your birthday with no medical underwriting. In Oregon, you have thirty days.  In Missouri, you can switch within sixty days of your anniversary date of your initial effective date into a Medicare Supplement plan. Washington, New York, Connecticut, Maine, Minnesota, and Wisconsin also have special rules that may allow you to switch. If you’re in any of these states, I highly suggest you talk to a representative from a Medicare Supplement insurance company or a Medicare insurance agent to help guide you through the process. Planning ahead is key here—don’t wait until the last minute or drop your current coverage without doing your homework or getting help!

So, now that you’ve got taste of all of the states that have their own tweaks to the “normal” Medicare Supplement enrollment rules, let’s review the “Birthday Rule” for the five states that offer this, specifically.

The Medigap Insurance Birthday Rule by State

California Medigap Birthday Rule

If you live in California, you can switch Medicare Supplement plans and Medicare Supplement insurance companies 30 days before your birthday and 60 days after your birthday.  This only applies if you already have a Medicare Supplement plan and doesn’t apply to anyone with a Medicare Advantage plan.  You can’t improve your plan; you can change to any plan of equal or lesser benefit with the carrier of their choice.  That means if you have a Medigap Plan N, you can’t improve your coverage and buy a Medigap Plan G.  You’d have to keep your Medicare Supplement Plan N, or downgrade your coverage to a plan with fewer benefits.  During this switch, you don’t have to go through medical underwriting, which means you won’t have to answer health questions to qualify.

Oregon Medigap Birthday Rule

If you live in Oregon, you can switch Medicare Supplement plans and Medicare Supplement insurance companies 30 days before your birthday and 30 days after your birthday.  You can’t improve your plan; you can change to any plan of equal or lesser benefit with the carrier of their choice.  That means if you have a Medigap Plan N, you can’t improve your coverage and buy a Medigap Plan G.  You’d have to keep your Medicare Supplement Plan N or downgrade your coverage to a plan with fewer benefits.  During this switch, you don’t have to go through medical underwriting, which means you won’t have to answer health questions to qualify.

Illinois Medigap Birthday Rule

If you live in Illinois and are between ages 65 and 75, you can switch Medicare Supplement plans, but not Medicare Supplement insurance companies, up to 45 days after your birthday.   This means you can’t change Medigap insurance companies, only the plan you’re on.  You can’t improve your plan; you can change to any plan of equal or lesser benefit with your current carrier.  That means if you have a Medigap Plan N, you can’t improve your coverage and buy a Medigap Plan G.  You’d have to keep your Medicare Supplement Plan N or downgrade your coverage to a plan with fewer benefits.  During this switch, you don’t have to go through medical underwriting, which means you won’t have to answer health questions to qualify.

Nevada Medigap Birthday Rule

If you live in Nevada, you can switch Medicare Supplement plans and Medicare Supplement insurance companies, starting on the first day of your birthday month, ending after 60 days. You can’t improve your plan; you can change to any plan of equal or lesser benefit with the carrier of their choice.  That means if you have a Medigap Plan N, you can’t improve your coverage and buy a Medigap Plan G.  You’d have to keep your Medicare Supplement Plan N or downgrade your coverage to a plan with fewer benefits.  During this switch, you don’t have to go through medical underwriting, which means you won’t have to answer health questions to qualify.

Idaho Medigap Birthday Rule

If you live in Idaho, you can switch Medicare Supplement plans and Medicare Supplement insurance companies, starting on your birthday, ending 63 days later. You can’t improve your plan; you can change to any plan of equal or lesser benefit with the carrier of their choice.  That means if you have a Medigap Plan N, you can’t improve your coverage and buy a Medigap Plan G.  You’d have to keep your Medicare Supplement Plan N or downgrade your coverage to a plan with fewer benefits.  During this switch, you don’t have to go through medical underwriting, which means you won’t have to answer health questions to qualify.

The new Idaho Medigap rule goes into effect March 1, 2022.

Andy, thanks for the question!

 

I love answering Medicare questions.  Send me yours by clicking here and I’ll pick a few for a future blog post!

 

To your wealth, wisdom, and wellness!

-Matt Feret

 

Related Articles:

When Can I Switch Medicare Supplement Plans?

Do Medicare Supplements Have a MOOP?

Author Bio: Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. He’s also the host of The Matt Feret Show.

He’s held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development and strategy for over 20 years.  Matt holds a BA from Virginia Tech and an MHA from Washington University in St. Louis. 

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