What Is the Medigap Birthday Rule?

As if Medicare weren’t hard enough to understand, some states have their own rules around certain aspects of the program. One of those rules is called the Medigap birthday rule. California, Illinois, Idaho, Nevada, Oregon, and Louisiana all employ the birthday rule, which will benefit anyone living in those states. 

But what exactly does the birthday rule allow you to do? Let’s explore that, as well as how Medigap rules impact Medicare beneficiaries in Arizona and the rest of the country.

Changing Your Medigap Plan

Many people believe they are locked into their Medicare plans after they enroll. This isn’t necessarily true, but there are some rules around changing your Medigap plan.

A Medigap plan is also known as a Medicare Supplement plan. These are one of two ways people on Medicare can “supplement” their coverage on Original Medicare (Parts A and B). Medigap plans are named after letters of the alphabet. The most popular Medigap plans in Arizona are Plans F, G, and N.

You must have Part A and Part B in place to enroll in a Medigap plan. You have a six-month open enrollment window that begins the month of your Part B effective date. During that time, you can choose any Medigap plan you want. Current and past health conditions will not impact your ability to enroll, and you won’t pay higher premiums because of any medical diagnosis. Outside of that enrollment period, the rules are different.

If you do enroll in a Medigap plan during your open enrollment period, you can still choose to change your plan at any time of the year, no matter where you live. However, in most states, you’ll have to be relatively healthy because you’ll be subject to medical underwriting. This is a process by which your Medicare agent or the insurance company will ask you questions about your health. You’ll answer simple yes or no questions and be asked for a list of any prescriptions you’ve taken in the last two years.

After you submit your application, it is sent to the carrier’s underwriting team. They will review your answers, pull your health history, and in most cases, will call you to perform a phone interview. You will not have to go to the doctor to have a physical. The entire process takes one to two weeks before a decision is made.

The good news is that even if you do not pass underwriting, nothing happens to your current policy. It won’t be canceled because you tried to change your plan, nor will your premium increase. However, there is a good chance you’ll need to keep the plan you’re on for the foreseeable future.

That’s not to say there aren’t other options to reduce your premium or change your plan. If your premiums have gotten too high, you should discuss Medicare Advantage with your advisor. There are pros and cons to this option, but in many cases, it can save you money, especially in premiums.

The Medigap Birthday Rule

Now that you know the Medigap rules, it’s time to break them! If you live in one of the six states we mentioned in the introduction, you have a unique opportunity to change your Medigap plan around your birthday every year.

Let’s look at how the Medigap birthday rule works in each of the six states.

California: You get 60 days beginning on the first day of your birthday month to change your Medigap plan to one with the same or lesser benefits. You can do so within the same insurance company or switch carriers altogether. For example, you could change from Plan F with Company A to Plan G with Company B. In any case, remember that there are some restrictions on which plan you can choose. Only beneficiaries who enrolled in Medicare prior to 2020 are allowed to enroll in Plan F or Plan C.

Idaho: You get 63 days from your birthday to switch to a Medigap plan with the same or lesser benefits. You can do so within your current carrier or change to another company.

Illinois: You get 45 days from your birthday to choose a plan with the same or lesser benefits. However, you can only do so within the same insurance company. If you try to switch carriers, you’ll need to pass underwriting. In addition, you can only take advantage of this rule if you are between 65 and 75 years old.

Oregon: You can change your Medigap plan to another with the same or lesser benefits during your birthday month. You can keep your current carrier to change companies.

Nevada: You get 60 days from the first day of your birthday month to change to a plan with the same or lesser benefits and choose to move to a new insurance carrier.

Louisiana: You get 63 days from your birthday to choose a Medigap plan of equal or lesser benefits. You can only choose a plan from your current insurance company.

We hope that has cleared up some confusion about when you can change your Medigap plan. If you have questions about Medicare or want to shop around for new coverage, call Local Medicare Specialists today!