Enrolling in a Medicare Supplement requires medical underwriting unless you’re in a guaranteed issue situation or open enrollment. There are 7 guaranteed issue situations, and open enrollment is when you start your Medicare Part B.
Some states have additional rules that allow you to change your Medigap plans annually. The Medicare Birthday Rule is one of those state-specific rules that give you this option.
States with Medigap Birthday Rules
Five states have birthday rules. Before 2022, only California and Oregon had birthday rules. In 2022, this changes with 3 additional states adding birthday rules. The states with birthday rules in 2022 are California, Idaho, Illinois, Nevada, and Oregon.
The five states with birthday rules have slightly different regulations for use. The birthday rule will allow you to change Medigap plans without medical underwriting. Please see below for the explanation of the birthday rules. There is also information for Medicare Supplements by state available.
California’s birthday rule applies to residents already enrolled in a Medicare Supplement plan. You can enroll in another Medigap plan in California with equal or fewer benefits than your current plan. You can initiate this change 30 days before your birthday, and the rule continues through 60 days after your birthday.
Oregon’s birthday rule applies to Oregonians currently enrolled in a Medicare Supplement plan. This allows for changing to another Medigap plan of equal or lesser value than the current plan. The Oregon birthday rule begins on the birthday and ends 30 days after, and the total is 31 days to make the change.
Idaho’s birthday rule allows residents of Idaho with a Medicare Supplement plan to change any Medigap plan of equal or lesser value. The Idaho birthday rule will enable you to make this change within 63 days of your birthday. This new Idaho birthday rule goes into effect on March 1, 2022
If you live in Illinois and are between the ages of 65 and 75, you can enroll in another Medigap plan with their current Medigap company that has equal or lesser benefits. You have 45 days from your birthday to make this change.
Residents of Nevada that are currently on a Medicare Supplement plan can change to another Medigap plan from any carrier within 60 days of the first day of their birth month. The new plan must have equal or lesser benefits than their current plan.
Using your birthday rule
To use your birthday rule, you must meet the following requirements:
- Reside in a state that offers a birthday rule
- Be currently enrolled in a Medicare Supplement plan
You can enroll in another Medigap plan when you are approaching your birthday. In nearly every state with a birthday rule, you can:
- Enroll in a Medicare Supplement with equal or lesser benefits
- Change to another carrier
See your state above to see what your state allows you to do. Remember, the birthday rule is a state-specific rule that allows you to change Medigap plans without medical underwriting. But even if you don’t reside in a state with the birthday rule, Medicare has information on when you’re allowed to purchase additional insurance.
What is the birthday rule in Medicare?
The birthday rule is a Medicare Supplement state-specific rule that allows you to change Medigap plans without medical underwriting.
Can I use the birthday rule if enrolled in a Medicare Advantage plan?
No, you must be currently enrolled in a Medicare Supplement plan to utilize your birthday rule.
Can I use the birthday rule if I only have Original Medicare?
No. You must be actively enrolled in a Medigap Plan.
If I live in 2 states, one with a birthday rule and the other doesn’t, can I use the birthday rule to change my plans?
The state you listed on Medicare as your homestead state is the state you’d enroll in. If the state you have on file with Medicare has the birthday rule, you can enroll utilizing the state-specific rule.
How do I update my resident state to a state with a birthday rule?
Your homestead state is defined as the state you live in for six months and one day. If this applies to you in a state with a birthday rule, simply call Medicare and Social Security to update your home address to that state,
Can I use the birthday rule to enroll in a Medicare Advantage plan?
No. The birthday rules are specific to Medicare Supplement plans.
If I use my birthday rule to change my Medicare Supplement, can I change my Part D plan with it?
No. The birthday rule is only used with Medigap plans, and the Part D plans have different enrollment periods.
How many states have a birthday rule?
Five. California, Oregon, Nevada, Illinois, and Idaho have birthday rules. Please see the specific state rules for details. Not all birthday rules work the same.
Can you change your Medigap plan on your birthday?
Yes. In fact, you can change from one Medigap to another at any time if you can pass the underwriting. However, five states have a birthday rule allowing you to make changes every year without needing medical underwriting.
If I move to a state with a birthday rule, will it apply to me?
Yes. The birthday rule will apply to residents in the state that has a birthday rule in effect. Once you become a state resident, you’ll be eligible to use the birthday rule.
Are there any other states that allow you to change without Medical underwriting?
Yes. The states listed above all have the annual birthday rule. The states below all have state-specific regulations that allow you to change your Medigap without underwriting.
Washington, Missouri, New York, and Connecticut all have state-specific rules you could qualify for if you’re a resident.
Getting Help Using Your Birthday Rule
Do you have a birthday coming up, and feel like help is needed navigating the birthday rules for your state? We have experienced licensed insurance agents that specialize in Medicare who can assist.
Give us a call or fill out the online request form. We can review your options and help you determine if using your birthday rule is right for you.