A Medigap birthday rule allows policyholders in specific states an open enrollment period each year surrounding their date of birth. Each state’s birthday rules differ. However, not every state offers this enrollment opportunity. Below we will review the five states with a Medigap birthday rule.
States with a Medigap Birthday Rule
Prior to 2022, only two states provided Medigap beneficiaries with a birthday rule. Oregon and California were the first. Now, three additional states are implementing birthday rules. These states are Idaho, Illinois, and Nevada.
In each of the five states, rules and regulations surrounding the birthday rules are different. Thus, some states allow policyholders to change to another plan or carrier, while others only allow changes within the same insurer.
Below we will discuss how each state utilizes the birthday rule. In addition, we will review how residents can benefit in their state.
California and Oregon
As the originators of the birthday rule, California and Oregon continue to allow residential policyholders to utilize this guaranteed issue right annually.
- California: The birthday rule in California applies to all residents who already have a Medigap policy. Most importantly, the rule starts 30 days before their 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. Beneficiaries will not be required to answer underwriting health questions.
- Oregon: Like California, Oregon allows policyholders to change to any carrier or plan of equal or lesser benefit with no health underwriting. The rule begins on your date of birth and ends 30 days following. This gives residents a 31-day period to make changes to their plan.
States Adding a Birthday Rule in 2022
Joining California and Oregon are Idaho, Illinois, and Nevada. In 2022, a total of five states will allow their residents an annual birthday rule to review Medigap coverage.
- Idaho: Medigap policyholders will be eligible to enroll in any plan of equal or lesser benefit. Additionally, the plan may be with any carrier. This rule lasts 63 days beginning on the policyholder’s birthday.
- Illinois: Beneficiaries between the age of 65 and 75 will 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. This is open enrollment window opens on their date of birth and lasts 45 days.
- Nevada: Beneficiaries can change their Medigap plan during a period of at least 61 days. This window opens on the first day of the beneficiary’s birth month. During this time, policyholders can change their Medigap carrier or plan if it is an equal or lesser benefit to their current plan.
How Do I Utilize My State’s Birthday Rule?
Firstly, only those who currently have a Medigap plan can use the birthday rule. In short, birthday rules offer a chance to make changes to your Medicare Supplement coverage without answering underwriting health questions. Thus, the rules open up plan options for those who would not otherwise pass the underwriting process due to pre-existing conditions.
If you reside in one of the five states with a birthday rule, the first step is understanding the stipulations in your specific state. However, if you are on a Medicare Advantage plan, this is not an opportunity for you to change to Original Medicare and add a Medicare Supplement.
If you have a Medigap policy and reside in any state with a birthday rule, fill out our online rate comparison form to find the best premium rate for a policy near you.
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