The Medigap Birthday Rule Applies to Certain States

When is Medigap Open Enrollment?

medigap birthday ruleFor the first six months after enrolling in Medicare Part B, you have an Open Enrollment Period. When a person turns 65 and enrolls in Medicare Part B, they become eligible for Medigap plans and are guaranteed to be accepted. Enrolling in Medigap during this Open Enrollment Period guarantees acceptance, making it the best time to do so.

Some states allow for annual opportunities to enroll during an annual open enrollment period. These states may have a special Medicare birthday rule or other special open enrollment opportunities. We will cover these in detail.

The Open Enrollment Period for Medicare Supplements should not be confused with the commonly mislabeled “open enrollment” for Medicare that takes place every fall. Surprisingly, even the Centers for Medicare and Medicaid Services (CMS) inaccurately labels the fall period as “open enrollment.” It is named as the Annual Election Period, or AEP. Incorrectly labeling AEP as “open enrollment” is the primary cause of confusion each year among Medicare beneficiaries. CMS itself could easily rectify this, but they choose not to.

Who Qualifies For Medigap Open Enrollment?

Each year, Medicare Advantage enrollees can review and modify their coverage. Medicare Advantage and Medicare Part D have an enrollment period every year. The Annual Election Period we referenced above (Oct 15-Dec 7 each year) gives enrollees of those plans a chance to change companies and coverage each year. Medigap only has one guaranteed Open Enrollment period during your lifetime.

Outside of that period, you will need to qualify medically to be accepted into a Medicare Supplement plan. In some states, Medigap enrollees can now switch plans each year around their birthday without underwriting.

Medigap special enrollment may be available for certain enrollees.

If you have guaranteed issue rights, you could be eligible for a special Medigap enrollment period. During this time, insurance companies are prohibited from charging you more based on your medical conditions, imposing waiting periods, or denying coverage.

The Centers for Medicare and Medicaid has established a list of seven situations that grant you a guaranteed issue right to sign up for or switch Medigap plans without undergoing medical underwriting. While this list is somewhat restricted, there may be additional options available to you depending on your state of residence.

Starting in 2023, twelve states offer guaranteed issue rights that surpass those mandated by the federal government. This includes opportunities for annual enrollment or plan changes. In fact, more than half of all states exceed the federal requirements by providing guaranteed-issue Medigap plans to beneficiaries under the age of 65.

Annual Guaranteed Issue and Open Enrollment By State

But there are some states that have annual guaranteed-issue opportunities to enroll in Medigap or at least switch to a different plan:

  • In New York and Connecticut, Medigap plans do not require medical underwriting, regardless of the enrollment timing.
  • Every year in Massachusetts, there is a guaranteed-issue Medigap open enrollment period from February 1 to March 31. During this time, individuals have the opportunity to secure coverage without being subject to medical underwriting.
  • In Maine, Medigap insurers are required to allocate a specific month annually wherein Plan A is guaranteed to be issued, irrespective of the applicant’s medical history.
  • In Missouri, people can easily switch their Medigap insurance between companies during a certain time period.. You can only enroll in the same lettered plan, like Plan G to Plan G. You can switch during the 30 days before or after your plan’s purchase anniversary for guaranteed coverage..
  • Seven states, including California, Idaho, Illinois, Kentucky, Louisiana, Nevada, and Louisiana, have implemented a Medigap birthday rule for Medicare Supplement enrollees. These rules provide a time-limited window around their birthday each year, This allows them to easily switch to another Medigap plan with the same or reduced benefits without the need for medical underwriting. Illinois and Louisiana, limits a change to a plan offered by the existing Medigap insurance company. Starting in 2024, Kentucky will also adopt similar rules. However, plan changes will be limited to the enrollee’s same lettered plan, offered by a different insurer.
  • Washington and Oklahoma Medigap enrollees have the flexibility to switch to another plan at any time, provided they have maintained coverage for at least 90 days. In Washington, individuals with Medigap Plan A are limited to switching only to another Plan A. However, those with Medigap Plans B through N have the freedom to switch to any Plan B through N. In Oklahoma, enrollees have the option to switch to any plan that offers equal or lesser benefits.

What Is The Medigap “Birthday Rule?”

The Medicare Supplement birthday rule provides an annual safeguard for Medicare beneficiaries in select states. During a specific timeframe around your birthday, you have the opportunity to purchase a Medigap policy without the need for underwriting or a waiting period.

The time frames in which the birthday rule applies may vary from state to state. There may also be limitations on the insurance companies you can choose, which can impact your coverage. Additionally, your state may have age requirements that affect when the Medicare Supplement birthday rule applies to your benefits.

Among the twelve states mentioned, the Medicare Supplement “birthday rule” is implemented in seven.. This period varies by state. To be eligible for a plan change under the “birthday rule ” you must already be enrolled in a Medigap plan.

Which States Offer a Medigap Birthday Rule?

  • California: Starting on the first day of your birth month, you have 60 days to change your Medigap plan with no underwriting requirements. You must switch to a Medigap plan that offers the same level or lower benefits. However, you may also change insurance carriers.
  • Idaho: Medigap policyholders will be eligible to enroll in any plan of equal or lesser benefit. Additionally, you may switch to any insurance company. This rule lasts 63 days, beginning on the policyholder’s birthday..
  • Illinois: The birthday rule exclusively pertains to beneficiaries aged 65 to 75. This open enrollment period commences on your date of birth and extends for 45 days. Within this timeframe, you have the opportunity to enroll in a plan offered by your existing carrier. However, the benefit level of your new plan must be the same, or be lower than, that of your current plan.
  • Kentucky (effective starting in 2024): Individuals enrolled in Medigap can conveniently switch to another insurer’s Medigap policy within 60 days of their birthday, maintaining the same benefits as their existing plan.
  • Louisiana: You have a window of 63 days following your birthday to switch to a Medigap plan with equal or lesser benefits. This option applies solely to plans offered by your present insurance carrier. Notably, legislation being deliberated in 2023 may broaden the scope to encompass affiliates of your current insurer.
  • Nevada: You have a 60-day window, starting from the first day of your birth month, to switch to another Medigap plan that offers the same or lower level of benefits. During this timeframe, you also have the flexibility to change insurance companies.
  • Oregon: You are eligible to switch to another Medigap plan, with the same or lower level of benefits, during the 30-day period starting from the first day of your birth month. Additionally, you have the option to change insurance carriers.

Living in one of these states? You might benefit from these birthday regulations if you know how to use them..

Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their Medicare insurance and financial needs since 1996.

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