Enrolling in a Medicare Supplement requires medical underwriting unless you’re in a guaranteed issue situation or open enrollment. There are seven 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 a state-specific rule that gives 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 three 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 60 days after your birthday.


Oregon’s birthday rule applies to Oregonians 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, with 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 your current Medigap company with equal or lesser benefits. You have 45 days from your birthday to make this change.


Residents of Nevada 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 the 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 state-specific, allowing 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 can 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 without, 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, 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. You can change from one Medigap to another anytime if you can pass the underwriting. However, five states have a birthday rule allowing you to make changes yearly 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 with a birthday rule. Once you become a state resident, you can 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 have state-specific regulations allowing 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.

Get help using your birthday rule

Do you have a birthday coming up and feel like help navigating the birthday rules for your state is needed? 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.

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.