For those with Medigap (Medicare Supplement) plans, you may be wondering what your options are for switching carriers or coverage over time as your healthcare needs change. Unlike Part D and Medicare Advantage that have an Annual Enrollment Period (Oct. 15-Dec. 7), Medigap beneficiaries can make changes to their plans at any time of year but those changes will require underwriting, unless you meet certain criteria. Underwriting means that an insurer needs to evaluate your health history before offering you a plan and can deny coverage or charge more in costs to cover you based on your health history or pre-existing conditions. But there are some exceptions to this.
What is the birthday rule?
Some states have passed laws to open up enrollment periods without underwriting (called guaranteed issue rights) around beneficiaries’ birthdays to help them get the coverage they need. These are called “birthday rules.” Note that they only apply to those who already have a Medigap plan.
What states have Medigap birthday rules?
As of this writing, eight states have Medigap birthday rules. These birthday rules allow Medigap beneficiaries to change or switch Medigap plans to the same level or lower level of benefits without underwriting. Any additional coverage will require underwriting. Note that these special enrollment periods vary in length and either start on your birthday or start the first day of your birth month. Further, you can only change providers in some states during this period.. Otherwise you must stay with your insurer.
- California: Starting the first day of your birth month, you have 60 days to change to another Medigap plan. You can also change insurance carriers.
- Idaho: Starting on your birthday, you have 63 days to change to another Medigap plan. You can also change insurance carriers.
- Illinois: Starting on your birthday, you have 45 days to change to another Medigap plan. This only applies to plans with your current insurance carrier or an affiliate of your current insurer. Further, to qualify for this birthday rule, you must be 65-75 years old.
- Kentucky: You can switch to another insurer’s Medigap policy if it offers the same benefits as the plan you already have within 60 days of your birthday.
- Louisiana: Starting on your birthday, you have 63 days to choose another Medigap plan. This only applies to plans with your current insurer or its affiliates.
- Maryland: Starting on your birthday, you have 30 days to switch to another Medigap plan.
- Nevada: 60 days from the first day of your birth month, you can change to another Medigap plan. You can also change insurance carriers.
- Oregon: From the first day of your birth month, you have 30 days to change to another Medigap plan. You can also change insurance carriers.
If you live in one of these states, you can plan ahead for any changes to your Medigap plan. If you have not enrolled in a Medigap plan and you’re considering it, please know that your Medigap initial enrollment period begins as soon as you enroll in Original Medicare (specifically Part B) and you are 65 years old. Learn more about Medicare Supplement here.
