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Medigap Birthday Rule

Medigap-birthday-ruleWhat is the Medigap “Birthday Rule” and how does it apply to consumers? If you already have Medicare Supplement (Medigap) insurance, you have 30 days of “open enrollment” following your birthday each year.

What states offer the special rule?

  • California
  • Oregon
  • Illinois
  • Nevada
  • Idaho

How do consumers benefit?  During this special time period, when you can buy a new Medigap policy without a medical screening or a new waiting period.

The Birthday Rule (a nickname for this special provision) ONLY applies to individuals who reside in certain states.  However, more states are adding this provision starting in 2022.

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What You Should Know About The Birthday Rule

The rule applies only to those with Medicare Supplement (Medigap) coverage.

If you have Medicare Advantage coverage, the rule does not apply.

The rule provides an open enrollment period each year typically starting on your date of birth.

Each state’s birthday rules differ.  Some states allow policyholders to change to another plan or carrier.  Others only allow plan changes within the same insurer.

In 2022, Illinois, Nevada and Idaho started offering this benefit.  Previously only California and Oregon had the rule.

What does ‘lesser’ generally mean.  An example would be individuals with Medigap Plan F  (no longer offered to new Medicare enrollees).  Those with Plan F could generally switch to Medigap plan G.  That is because Plan G offers less benefits than Plan F (G doesn’t cover the Part B deductible).  The reverse (from G to F) is not possible using the birthday rule.

California Medigap Birthday Rule

In California the rule applies to all residents who already have a Medicare Supplement (Medigap) policy.  The opportunity to change begins 30 days before the policyholder’s birthday and ends 60 days following. During this time, policyholders can change to any plan of equal or lesser benefit with the carrier of their choice.  You are not be required to answer health questions — a significant benefit for those with health issues.

Oregon Medigap

In Oregon the rule allows policyholders to change to any carrier or plan of equal or lesser benefit with no health underwriting.  The opportunity to take advantage of the special rule begins 30 days before the policyholder’s date of birth.  It ends 30 days following the birthday. This permits Oregon policyholders 61 days to take advantage of the rule.

Illinois Medigap

In Illinois those with a Medicare Supplement (Medigap) policy who are between the age of 65 and 75 have the chance to enroll in any plan of their choice from their current carrier.  The new plan’s benefit level must not exceed that of their current plan. The rule provides the special open enrollment window beginning on the date of birth and lasts for 45 days.

Nevada Medigap

In Nevada one can change their Medigap carrier or plan to one that offers an equal or lesser benefit.  This opportunity begins on the first day of the beneficiary’s birth month and lasts 61 days.

Idaho Medigap

In Idaho one can enroll in another Medigap plan of equal or lesser benefit.  Unlike some states (that require the same insurance carrier) in Idaho the plan may be with any carrier. The opportunity begins on the policyholder’s birthday and lasts for 63 days.

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