Medigap plans are private insurance policies that help fill in the gaps in original Medicare Parts A and B. During the initial open enrollment period, which starts when you turn 65 or enroll in Medicare Part B, you can choose any plan from any insurer that offers Medigap plans in your state. After that, changing plans or insurers typically requires medical underwriting. However, Medigap in some states have implemented a “birthday rule” that allows beneficiaries to switch plans or companies without medical underwriting during a specific time period around their birthday. This can be advantageous for those seeking to switch to a lower premium plan that provides the same coverage. The availability and details of the birthday rule vary by state, and this blog lists the states that offer it and explains how it works in each state.
Where is the Birthday Rule Available?
There are six states in the US that have implemented a “birthday rule” for changing Medigap plans without undergoing medical underwriting. Previously, only California and Oregon had this rule, but in 2022, Idaho, Illinois, Nevada and Louisiana also adopted it. Each state has its own regulations regarding the use of the birthday rule.
To take advantage of the birthday rule for Medigap plans, there are certain requirements you must meet. These include being enrolled in a Medicare Supplement plan and residing in a state that offers a birthday rule. The rule allows you to switch to another Medigap plan with equal or fewer benefits and change carriers without undergoing medical underwriting. While the rules vary by state, you can check with your state to see what options are available.
Birthday Rule in California
For California residents already enrolled in a Medicare Supplement plan, the state’s birthday rule allows them to switch to another Medigap plan with equal or fewer benefits. The rule can be initiated 30 days before the individual’s birthday and continues for 60 days after their birthday.
Let’s take a look on a example with Medigap Plan G:
A California resident is currently enrolled in a Plan G Medigap policy, which covers everything that Plan F covers except for the Medicare Part B deductible. They decide that they want to switch to a different Medigap plan with a lower premium. Using the birthday rule, they can switch to any other Medigap plan in California that has equal or lesser benefits than their current Plan G. For example, they could switch to a Plan N policy, which covers everything that Plan G covers except for some small copayments and the Medicare Part B excess charges. The premiums for Plan N are typically lower than those for Plan G, so the individual could save money on their monthly premiums while maintaining the same level of coverage.
Birthday Rule in Oregon
Oregon residents who are currently enrolled in a Medicare Supplement plan also can use the state’s birthday rule to switch to another Medigap plan with equal or lesser value. The rule can be used starting on the individual’s birthday and lasts for 30 days after, giving a total of 31 days to make the change.
Birthday Rule in Idaho
Idaho residents who have a Medicare Supplement plan can use the state’s birthday rule to switch to another Medigap plan of equal or lesser value. The rule allows individuals to make this change within 63 days of their birthday.
Birthday Rule in Illinois
Illinois residents between the ages of 65 and 75 can use the state’s birthday rule to switch to another Medigap plan with their current provider, as long as the new plan has equal or lesser benefits. The rule provides a 45-day window starting from the individual’s birthday to make this change.
Birthday Rule in Nevada
Nevada residents who are enrolled in a Medicare Supplement plan can utilize the state’s birthday rule to switch to another Medigap plan from any carrier within 60 days of the first day of their birth month. However, the new plan must have equal or lesser benefits than their current plan.
Birthday Rule in Louisiana
If you’re a Louisiana resident and currently enrolled in a Medicare Supplement plan, you have a window of 63 days from the date of your birthday to choose a different Medigap plan with equal or lesser benefits. However, this option is only applicable to plans offered by your current insurance carrier. This means that you can’t switch to a Medigap plan offered by a different insurance company under the birthday rule in Louisiana. It’s important to note that the birthday rule allows you to make the switch without undergoing medical underwriting, giving you a chance to explore your options without any additional hassle.
Does Missouri Have a Birthday Rule?
No, the state of Missouri does not have a Birthday Rule. Though, many beneficiaries think it does because it also has a guaranteed issue rule that allows Medicare beneficiaries with Medicare supplement insurance to switch between Medigap policies once a year.
However, Missouri has what is called an “Anniversary rule”. It is different from a Birthday Rule because it applies to a time period of the year when you purchased your policy, not around your birthday.
Another difference is that you need to switch to another carrier 30 days before or after your policy’s annual anniversary date. Secondly, you must switch to a plan from another company with equal benefits. As long as you meet these requirements, you can enroll in a new plan without any medical underwriting.
The availability and details of the birthday rule for switching Medigap plans without medical underwriting varies by state. Currently, six states – California, Oregon, Idaho, Illinois, Nevada, and Louisiana – have implemented the rule. Each state has its own regulations regarding the use of the birthday rule, such as the window of time available to make the switch and the requirement for equal or lesser benefits. Missouri does not have a birthday rule, but it has an anniversary rule that allows beneficiaries to switch to a new plan with equal benefits from another company 30 days before or after their policy’s annual anniversary date. Overall, it’s important to be aware of the rules in your state and take advantage of any opportunities to switch to a lower premium plan with the same coverage.