Birthdays Are Sweeter with Medicare’s Birthday Rule
If you’re enrolled in a Medicare supplement plan, live in a number of special states, and will soon be blowing out a few birthday candles, Medicare has a special gift just for you. Known as the “Birthday Rule,” this Medicare provision gives California, Idaho, Illinois, Maryland, Oregon, Nevada, Louisiana, Oklahoma, Kentucky, Utah, Virginia, Indiana, and Wyoming residents the option of changing their Medicare supplement plan with no medical underwriting.
How Does the Medigap Birthday Rule Work?
The Medigap Birthday Rule is a provision that allows individuals who already have a Medicare Supplement insurance plan (also known as Medigap) to switch to a different Medigap policy during a specific period around their birthday without being subject to medical underwriting.
Under this rule, Medicare beneficiaries have a one-time opportunity each year to switch to a Medigap policy that offers the same or fewer benefits as their current policy.
During this period, insurance companies that offer Medigap policies cannot deny coverage or charge higher premiums based on pre-existing health conditions. However, if you want to switch to a policy with more benefits, you may be subject to medical underwriting and could be denied coverage or charged higher premiums based on your health status.
It's important to note that the Medigap Birthday Rule applies only to individuals who already have a Medigap policy and want to switch to a different one. You may not be eligible for this rule if you don't currently have a Medigap policy.
In Which States Can I Use The Birthday Rule?
In certain states across the United States, a "birthday rule" exists that allows individuals to change their Medigap plans without undergoing medical underwriting. This rule was previously only applicable in California and Oregon but has since been adopted by many additional states in 20225. It is important to note that each state has its own set of regulations regarding using the birthday rule.
To qualify for the birthday rule, you must be enrolled in a Medicare Supplement plan and reside in a state that offers this option. Using this rule, you can transfer to another Medigap plan that offers equal or fewer benefits and switch carriers without undergoing medical underwriting. The regulations for using the birthday rule vary across states; therefore, it is recommended that you check with your state to determine what your options are.
How Birthday Rule Differs By States
Here are specific time frames for using Birthday Rule by State:
California: You have 60 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers during this time. This is an updated birthday rule that took effect on January 1, 2020. Prior to that the special enrollment period was only 30 days long.
Idaho: You have 63 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule starts on March 1, 2022.
Illinois: You have 45 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. This only applies to plans with your current insurance carrier pr an affiliate of your current insurer (the addition of affiliate insurers was due to legislation that Illinois enacted in 2024). To qualify for this birthday rule, you must be 65 to 75 years old. This birthday rule took effect on January 1, 2022.
Maryland: You have 30 days from your birthday to switch to another Medigap plan with equal or lesser benefits than your current Medigap plan. This birthday rule took effect on July 1, 2023.
Oregon: You have 30 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule took effect on January 1, 2013.
Nevada: You have 60 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule took effect on January 1, 2022.
Louisiana: You have 63 days from the date of your birthday to select a different Medigap plan with equal or lesser benefits. This only applies to plans with your current insurance carrier (or affiliates of your current insurer, under legislation that was enacted in 2023).
Oklahoma: You have 60 days from the date of your birthday to select a different Medigap plan with equal or lesser benefits. Oklahoma’s birthday rule is considered the minimum acceptable compliance with the state’s requirement that Medigap enrollees be allowed to switch to a plan with equal or lesser benefits as long as they haven’t had a gap in coverage of more than 90 days.
Kentucky: Legislation enacted in 2023 allows a Medigap enrollee to switch to another insurer’s Medigap policy (same benefits as the plan they already have) within 60 days of their birthday. This birthday rule took effect on January 1, 2024.
Utah: (Effective May 7, 2025) Legislation enacted in Utah in 2025 gives enrollees a 60-day annual window to switch to a plan of equal or lesser benefits without medical underwriting, but only if the plan is offered by the enrollee’s current insurer. So this does not give enrollees guaranteed issue access to policies offered by a different insurance company.
Virginia: (Effective July 1, 20255) Legislation enacted in 2025 creates a birthday rule enrollment window that allows Medigap enrollees to switch to any other insurer’s version of the policy they already have (so for example, if they have plan G, they could switch to Plan G offered by a different insurer), without medical underwriting. Earlier versions of the legislation would have also allowed people to downgrade to a plan with fewer benefits, but that was not part of the final legislation.
Indiana: (Effective Jan. 1, 2026) Legislation enacted in Indiana in April 2025 creates a birthday rule enrollment window, starting in Jan. 2026, that will allow Medigap enrollees to switch to any other insurer’s version of the policy they already have.
Wyoming: (Effective June 4, 2025) The state of Wyoming implemented an Annual 64-day Birthday Enrollment Period that allows Wyoming residents to replace their current Medicare Supplement plan with a Medicare Supplement plan of comparable or lesser benefits offered by any insurer. If the individual qualifies for the Annual 64-day Birthday Enrollment Period, the individual will not be underwritten.
Are the other times when can I switch my Medigap policy?
In addition to the Medigap Open Enrollment Period (OEP), which lasts for six months and begins on the first day of the month when you turn 65 and enroll in Medicare Part B, there are a few other times when you may be able to change your Medigap policy. These include
Guaranteed Issue Period (GIP): If you lose your existing coverage due to certain circumstances, such as losing employer-based health coverage, moving out of your Medicare Advantage plan's service area, or the insurance company selling the policy goes bankrupt, you may have a GIP to enroll in a new Medigap policy. During this period, you can enroll in any Medigap plan available in your state without being subject to medical underwriting.
Trial Right Period: If you enrolled in a Medicare Advantage plan when you turned 65 and enrolled in it for less than 12 months, you may be able to switch to a Medigap policy without medical underwriting during a Trial Right Period when you return to Original Medicare.
If you are still working at age 65: The initial enrollment period for Medigap is tied to the signup date for Medicare Part B. If you continue working at age 65 and have alternative coverage, you may delay Medicare Part B enrollment without penalty. This will also postpone the initial Medigap enrollment period, allowing you to receive guaranteed issue protections after you retire and require new coverage. However, delaying Part B enrollment necessitates qualifying for a Medicare special enrollment period due to having medical and prescription coverage from an employer or union that is at least equal to Medicare, with a minimum of 20 employees. You will not be eligible if you have a smaller group or an individual plan.
It's important to note that changing your Medigap policy outside of these periods may result in you being subject to medical underwriting. The insurance company can deny coverage or charge higher premiums based on your health status. In other words, you can switch carriers or enroll in Medigap policy anytime you want but it may be subject to medical underwriting, and you are at risk that your application will be denied. So, the best way, if you don’t live in a state with Birthday Rule, is to purchase a Medigap policy during your Initial Enrollment Period.