Five States Now Offer Seniors A Special Medigap Birthday Rule Benefit

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Contributor, Benzinga
November 4, 2022

Medicare offers several opportunities for the 26 million Medicare Advantage plan participants to freely switch their coverage.  Not so for many of the 14 million with Medicare Supplement plans.

There is, however, good news for Medigap policyholders in 2022.  Three more states now allow an annual opportunity for residents to switch plans around their birthday.  This brings the total to 5 states with special Medicare birthday rules.

Medicare’s Open Enrollment seasons provide Advantage plan participants with opportunities to compare their current coverage.  If one finds better plan benefits or costs, switching is relatively easy.  That’s why the television airwaves are particularly filled with commercials encouraging consumers to call.

Individuals who selected Medicare Supplement coverage, often commonly called Medigap, do not share similar opportunities.  In most cases, there is no right under federal law to freely switch Medigap policies, unless one of these applies:

Your Rights To Switch Medigap Plans

You can always change your Medigap plan.   But if you do decide to change plans, you can face some restrictions that didn’t apply when you originally signed up.  Typically, people sign-up for Medicare Supplement during the Special Enrollment Period when one first becomes eligible for Medicare.  During this time the insurance company must issue you a policy.  More important, they cannot charge you more based on your age or health condition.

After the guaranteed issue period ends, an insurance company can deny you coverage.  Or, it can charge you more based on your current health.  The Birthday Rule makes getting the best Medicare Supplement insurance coverage easier for millions.

California and Oregon, The Original Medigap Birthday Rule States

Prior to this year, only two states provided Medigap plan participants with a special opportunity, commonly called the Birthday Rule.   The rule allows policyholders an open enrollment period each year surrounding their date of birth.

In California, the rule applies to all residents with a Medigap policy.  Starting 30 days before your birthday you can change to any other Medigap plan of equal or lesser benefits with the insurance company of your choice.   No health underwriting questions need be answered during this special open enrollment.  As of January 1, 2020 the opportunity has been extended to 60 days.

 Oregon has similar rules allowing policy owners to switch to any carrier or plan of equal or lesser benefits.  The opportunity starts on your date of birth and ends after 30 days.

Three New States Add Birthday Rules in 2022

In Illinois, the largest of the new states adding the benefit, residents with Medigap plan coverage who are between ages 65 and 75 have the opportunity to enroll in an plan of equal or lesser benefits.  For example, someone with Plan F coverage can switch to Medigap Plan G which has similar benefits but does not cover the annual Medicare deductible amount.

The Birthday Rule open enrollment window in Illinois begins on the date or birth and lasts for 45 days.  Switching insurance carriers is not currently permitted.

Nevada residents also now have a Birthday Rule that allows roughly 60 days to change plans.  The opportunity begins on the first day of the birth month.  And, again, changing is possible so long as one selects a plan of equal or lesser benefits.

The third state to add the new rule in 2022 is Idaho.  State residents have 63 days to switch to any plan of equal or lesser benefits.

Who Should Consider Switching Medicare Supplement Plans

Typically, Medicare insurance experts suggest that cost, or saving money, is the primary reason to consider switching.  The 2022 Medicare Supplement Insurance Price Index found a wide spread in rates available in every of the top-10 U.S. markets.

 For example, in Chicago a 65-year-old man could purchase Plan G coverage for as little as $130-per-month.   The highest rate for Plan G coverage for a 65-year-old male is $270.35.   In Phoenix identical Plan G coverage for a 65-year-old woman ranged from a monthly low of $115.52 to $345.56.

Insurance companies have the right to review plan premium amounts annually for both new and existing policyholders.  The Birthday Rule can be extremely beneficial for those who face a rate increase in their yearly premium.

Comparing To Find The Best Medicare Supplement Plans

Finding the best Medicare Supplement insurance plan and pricing can be a daunting task.  Depending on where you live, there might be as few as 5 different plans to compare. But, in many areas, there are 20 or more plans available.

Switching plans can be even more difficult.  That’s when connecting with a knowledgeable specialist can be a smart move.   The American Association for Medicare Supplement Insurance makes available an online directory listing local Medicare insurance agents.  Directory access is both free and private.

Taking advantage of the Medicare Birthday Rule can save you hundreds of dollars a year.  Perhaps even more.  It might just be the best present you give yourself this year.


What is the birthday rule for Medigap?


The birthday rule for Medigap says that you have 30 days of open enrollment each year following your birthday.


What states have the Medigap Birthday Rule?


The states that have the Medigap birthday rule are California, Idaho, Illinois, Oregon, and Nevada.


Can Medigap deny pre-exisitng conditions?


Medicap can deny you coverage for pre-existing conditions in the first six months of the policy.

Jesse Slome

About Jesse Slome

Medicare Expert – Director Long Term Care Insurance Association, Medicare Supplement Insurance & Critical Illness Insurance Association