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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.

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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 eight 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?

Birthday Rule Short Graphic

There are eight states that have a Medigap birthday rule, including California, Idaho, Illinois, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. Before 2022, only two states provided Medigap beneficiaries with a birthday rule. Oregon and California were the first. Now, six additional states are implementing birthday rules for Medicare Supplement policies.

In each of the eight 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.

Other States With a Birthday Rule

In recent years, Idaho, Illinois, Louisiana, Nevada, Maryland, and Oklahoma joined California and Oregon on the list of states with a Medicare Supplement birthday rule. This means there are now eight 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.
  • Maryland: The Medicare Supplement birthday rule begins on your birthday and ends 30 days following. Giving residents a 31-day window to enroll in a Medigap plan of equal or lesser value without underwriting health questions.
  • 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.
  • Oklahoma: The Medicare Supplement birthday rule is a 60-day window that starts on your birthday. You can change your Medigap plan or carrier during your 60-day birthday rule window without being subject to medical underwriting. However, you can only switch to another Medigap plan of equal or lesser value to your current plan.

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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 eight 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.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

6 thoughts on "What States Have the Medigap Birthday Rule?"

  1. I moved from California to Colorado. Can I change my Blue Shield of California to a Cigna plan in Colorado during my birthday month?

    1. Hi Marilyn, if you have recently permanently relocated, you will be able to change plans with a Special Enrollment Period. Once of our agents would be able to help with the transition! You can complete our online rate form here!

    1. Hi Kiara, the Louisiana Birthday Rule is a state rule that is set my the Louisiana government. More Information can be found on your states Department of Insurance website.

  2. I moved to Nevada from California and have group retirees medicare PPO Advantage plan. I’m now 68 and would like to switch to a Medd Supp plan in Nevada Can I do so without underwriting?

    1. Patrick, moving out of your Medicare Advantage Plans service area grants you a Special Enrollment Period. This lasts up to two full months after the month you moved to Nevada.

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