If you are one of the millions of seniors signing up for Medicare for the first time, you may have some questions. As you may already know, supplement insurance or Medigap plans are policies you purchase from private insurance companies to cover medical expenses that Medicare does not cover.
When you turn 65 and begin receiving Medicare Part B, there’s an open enrollment period during which you can purchase a Medigap policy from any insurance company offering Medigap coverage in the state in which you live. Once the window to open a Medigap plan closes, you must go through medical underwriting to switch policies.
However, many states have recently adopted a Medigap birthday rule. The Medigap birthday rule allows those on Medicare the right to switch policies without needing a medical evaluation or documented health information to qualify. There are many advantages to having the Medigap birthday rule. One of the greatest benefits of the Medigap birthday rule is the fact that you can switch to a plan with a lower premium that still provides the same coverage as the plan you already have without health underwriting.
The price of plans tends to go up on a regular basis, so you can expect to see a change in premiums on occasion. Despite this, you may be able to find a similar plan at a lower cost. However, there’s just one catch. The Medigap birthday rule is only available in a handful of states. California, Oregon, Illinois, Idaho, Washington, and Nevada all have birthday rules. Up until 2022, only two US states had Medigap birthday rules. California and Oregon were the first two states to adopt a birthday rule.
California
The Medigap birthday rule in California applies only to those who already have a Medicare supplement insurance plan. If you are already enrolled in a Medigap plan in California, you can enroll in a plan that has “equal or fewer benefits” than the plan you already have. You can sign up to switch plans 30 days prior to your next birthday. This rule applies for up to 60 days after your birthday has passed.
When you use the California Medigap birthday rule, you are guaranteed to be accepted. If you choose not to use the Medigap birthday rule in California, you will need to go through the medical underwriting process to switch to a different plan. If you choose to switch plans without using the Medigap birthday rule, you run the risk of having your application denied if you have a preexisting medical condition.
According to experts, you can be charged more for a Medigap policy or potentially turned down for one. Although the birthday rule has existed for several years in California, Senate Bill 407 extended the time during which you could switch plans. The time gap between Medigap policies changed from 30 to 60 days after an individual’s birthday.
Oregon
Oregon’s Medigap birthday rule is slightly different. According to experts, Oregon’s Medigap birthday rule lasts for 60 days. The rule itself begins 30 days before your birthday and ends 30 days after your birthday. You can replace your policy at any time during this 60-day enrollment window. However, bear in mind that the policy you choose must have equal or fewer benefits than your previous policy.
You cannot switch to a different policy after 60 days have passed without health underwriting.
Idaho
Idaho and several other states adopted the Medigap birthday rule after California and Oregon. In Idaho, open enrollment lasts 63 days. You can switch to a new policy at any time during this time period, but you must switch to a plan whose benefits are equal to or less than the plan you previously had. Your new coverage will not go into effect until your birthday is over or until 60 days have passed after you applied for new coverage. Your new coverage will start on the first day of the month, 63 days after your birthday.
However, don’t cancel your existing policy until after the changes have taken effect, and you are on your new Medigap policy. You may be required to pay two premiums in one month, as you make the transition from your old policy to a new one. However, this is only temporary. Once you have settled into your new policy, you will be back to paying only one premium per month. You may want to take into consideration your annual deductible before you switch policies.
Louisiana
Louisiana’s Medigap birthday rule was introduced in 2022. Like Idaho, Louisiana’s Medigap birthday rule lasts 63 days and begins 30 days before your birthday. If you are switching during this period, you must select a plan that is equal to or has fewer benefits than your old plan. You are required to select a plan offered by the same insurance company you have been using for your Medigap plan. Your new coverage cannot go into effect before your birthday or more than 60 days after you apply for new coverage.
Illinois
Illinois is yet another state that has a Medigap birthday rule. In Illinois, open enrollment lasts 60 days and begins on your birthday. You can replace your Medigap policy during this timeframe. Like other states, your new policy must be equal to or has fewer benefits than your previous policy. To make a change in policy in the state of Illinois, you must be between the ages of 65 and 75. You must switch to a different plan offered by your existing insurance policy.
The Illinois Medigap birthday rule has many options for seniors in Illinois. However, only one provider guarantees coverage to seniors in this state. If you want guaranteed acceptance in Illinois, it may be wise to apply for a Medigap Secure plan. Under Medigap Secure, you can get a plan that lowers your costs. Under Illinois’s birthday rule, you cannot be denied coverage, and you will not be charged more during the open enrollment period.
Missouri
Missouri’s Medigap birthday rule is slightly different than many others. In Missouri, you can end your existing Medigap policy, and you can get the same policy from another company. However, you must make this switch within 30 days of your yearly “policy anniversary,” according to experts. You can switch as early as 30 days before your birthday and 30 days after your birthday.
The Missouri birthday rule lets you end your existing Medigap policy and get the exact same plan from another company. However, this must be done within 30 days. A large majority of Missouri’s population is made up of Medicare beneficiaries. Missouri is one of a select few states that created laws to protect those on Medicare and individuals with Medigap policies.
What happens if you don’t have a Medigap policy in Missouri but want to get one? Experts assert that if you want to enroll in a plan outside of your enrollment window, you will need to go through medical underwriting. This means that insurance companies will examine your medical history. These companies will look at your medical diagnoses, hospitalizations, prescriptions you take, and other factors related to your health. Based on that information, an insurance provider will decide whether they want to deny or approve your coverage.
Nevada
Nevada is yet another state that has Medigap birthday plan rules. Nevada’s open enrollment spans 60 days from your date of application. Nevada’s open enrollment period starts on the “first day of your birthday month,” according to experts. You can switch to a different policy at any time during this window, if the new policy is equal to or has fewer benefits than the one you had previously.
Washington
In Washington, new coverage cannot go into effect before your birthday or 60 days beyond your date of application. Washington’s open enrollment is unique in the sense that it is not linked to your birthday. You have the ability to switch at any time of the year. However, the plan you switch to must be like the one you already have. You can switch ant any time of the year without providing medical information or needing underwriting.
If you are on plans B- N, you have the ability to switch to one of those plans, whether benefits are higher or lower than the plan you already have. Regardless of the state in which you live, it helps to have options when it comes to Medigap plans. States with birthday rules offer more flexibility. This may be an incentive for some people to relocate to states with Medigap birthday rules.
4 Sources
MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.
https://www.medicare.org/articles/what-is-californias-medigap-birthday-rule/
https://www.medicare-idaho.com/birthday_rule_ID.html
https://insurance.mo.gov/seniors/documents/2019MedigapBook.pdf