Medigap Birthday Rule
- Learn about the Medigap birthday rule, which lets Medicare Supplement policyholders in California, Oregon, Idaho, Illinois and Nevada reevaluate their plans.
If you are currently enrolled in a Medicare Supplement plan, you may have heard of the Medigap birthday rule. This rule gives some policyholders the ability to adjust their policies and coverage on a more frequent basis, but it's not available to everyone.
Read on to learn more about the Medigap birthday rule and the specific guidelines in each state that offers it.
What Is the Medigap Birthday Rule?
Many Medicare policyholders across the nation don't have the chance to update, customize or adjust their plan or provider without being subjected to a barrage of preliminary screening questions.
However, five states have the Medigap birthday rule, which gives Medicare Supplement policyholders the annual opportunity to make changes to their current Medigap coverage without having to answer the mandatory questions that typically accompany such adjustments.
This adjustment period coincides with a policyholder's birthday — hence the rule's name — and usually lasts for a duration of anywhere from 1 to 3 months. The five states that have the birthday rule are California, Oregon, Idaho, Illinois and Nevada.
How Does the Birthday Rule Differ by State?
Each state has slightly different timelines and requirements for the birthday rule.
California's open adjustment period spans 3 months, beginning 30 days before a policyholder's date of birth and ending 60 days after it.
Oregon allows its policyholders to change or switch from plan to plan, or even provider to provider, with no underwriting at all. However, there's a catch: You can only switch to a new plan of equal or lesser value than your current one. Also, the adjustment period in Oregon is only available for 30 days after your birthday.
Idaho allows policyholders to change from any current plan to a new one of equal or lesser value. The adjustment period lasts for 63 days beginning on the policyholder's birthday.
In Illinois, only Medigap beneficiaries between the ages of 65 and 75 are eligible to change coverage under the birthday rule. Policyholders can enroll in any new plan of equal or lesser value, but it must be from their current provider. The adjustment period starts on the person's birthday and lasts 45 days.
In Nevada, the rule's grace period opens on the first day of your birth month and continues over the following 61 days. Policyholders can switch to any new carrier or plan of equal or lesser value.
Does the Birthday Rule Apply to Original Medicare or Medicare Advantage Plans?
Original Medicare and Medicare Advantage plans do not offer the same birthday rule as Medigap. However, it's still possible to change your coverage if you're not happy with it.
If you change your Original Medicare or Medicare Advantage plan, you typically don't have to go through the health screenings in order to apply for coverage.
Learn more about how the Medigap birthday rule may or may not affect your eligibility. Compare Medicare Supplement plans where you live and get help applying for a plan from a licensed insurance agent.