What States Have the Medigap Birthday Rule?

A Medicare Supplement 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. During this time period, beneficiaries can enroll in Medicare Supplement (Medigap) coverage without the fear of being turned away due to health conditions. Below, we review the six states with a Medigap birthday rule.

What is the Medicare Birthday Rule?

The Medicare Supplement birthday rule is an annual protection that is afforded to Medicare beneficiaries in certain states. It’s an open enrollment period available for a specific timeframe around your birthday where purchasing a Medigap policy without underwriting or a waiting period is possible.

There are six total Medicare Supplement birthday rule states, and while each of these states participates, each also has its own unique parameters surrounding this opportunity. Therefore, it’s important to understand not only who has the Medigap birthday rule but how it’s applied within each.

For the most part, the time frames in which the birthday rule applies to you vary from state to state, but there are also restrictions based on the carriers you can enroll in that can affect your coverage. Furthermore, your state may also have age parameters that can affect when the Medicare Supplement birthday rule applies to your benefits.

What States Have the Birthday Rule?

There are six states that have a Medigap birthday rule, including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states provided Medigap beneficiaries with a birthday rule. Oregon and California were the first.

Now, four additional states are implementing birthday rules for Medicare Supplement policies. These states are Idaho, Illinois, Louisiana, and Nevada.

In each of the four states, rules and regulations surrounding the Medicare Supplement birthday rule are different. Thus, some states allow policyholders to change to another plan or carrier, while others only enable changes within the same insurer.

Below, we discuss how each state utilizes its birthday rule. In addition, we will review how residents can benefit in their state.

California and Oregon Birthday Rule

As the originators of the birthday rule, California and Oregon continue to allow residential policyholders to utilize this annually.

• The California birthday rule 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 in The Golden State can change to any plan of equal or lesser benefit with the carrier of their choice. Beneficiaries do not need to answer underwriting health questions.
• The Oregon birthday rule works similarly to California’s and allows policyholders to change to any carrier or plan of equal or lesser benefit with no health underwriting. The Beaver State’s birthday rule begins on your date of birth and ends 30 days following. This gives residents a 31-day period to make changes to their plans.

More States Added a Birthday Rule in 2022

In 2022, Illinois, Louisiana, and Nevada joined California and Oregon on the list of states with a Medicare Supplement birthday rule. This means there are now six states that 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: The Medicare Supplement birthday rule only applies to beneficiaries between the ages of 65 and 75. During this period, they can enroll in a plan from their current carrier. However, their new plan’s benefit level must not exceed that of their current plan. This open enrollment window opens on their date of birth and lasts 45 days.
• Louisiana: The Medigap birthday rule opens its window 30 days before your birthday and ends 63 days after your birthday. Thus, you get a 93-day window to change your current Medigap plan. You can switch to a policy of equal or lesser benefit through your current carrier during this time.
• Nevada: Beneficiaries can change their Medigap plan for 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. However, the new policy must be of an equal or lesser benefit level to their current plan.

How To Take Advantage of Your State’s Medicare Supplement Birthday Rule

Taking advantage of your state’s Medigap birthday rule is a great way to save money and receive the benefits you need for your healthcare. Only certain states offer this unique period, and navigating your state’s guidelines doesn’t have to be complicated.

In short, Medicare Supplement birthday rules offer a chance to change your Medicare Supplement coverage without answering Medicare Supplement underwriting 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 six states with a Medigap 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 Medicare Supplement birthday rule, give us a call, or fill out our online rate comparison form to find the best premium rate for a policy near you.

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