What Is the Medicare Birthday Rule?

Medicare beneficiaries who have Medicare Supplement Insurance, or Medigap, can switch Medigap plans around the time of their birthday without facing medical underwriting practices that can be used to charge higher rates or deny approval of a policy, but only if they live in one of the nine states that has a Medicare Birthday Rule.

State laws providing this type of enrollment opportunity called the “birthday rule” are different from state to state, and only nine states currently have a Medicare Birthday Rule.

Medicare Birthday Rule vs. Medigap Open Enrollment 

The Medicare Birthday Rule allows what are called “guaranteed issue rights” that beneficiaries typically only have during their Medigap Open Enrollment Period or if they have qualifying life events. 

When you first become enrolled in Part A and Part B and are at least 65 years old, you will begin a six-month Medigap Open Enrollment Period. During this period, you can sign up for a Medicare Supplement Insurance plan with guaranteed issue rights.

If you have guaranteed issue rights, insurance companies are not allowed to use medical underwriting to charge you a higher plan premium or deny you coverage because of your health status.

Once your six-month Medigap Open Enrollment period is over however, you typically no longer have guaranteed issue rights. And while you are technically free to sign up for or switch Medigap plans at any time, doing so after your Medigap Open Enrollment Period means insurance carriers reserve the right to charge you a higher rate due to any pre-existing conditions or other health concerns. They may even deny you coverage entirely.

There are a few special circumstances that may qualify you for a Special Enrollment Period with guaranteed issue rights.

What Is the Medicare Birthday Rule?

The birthday rule grants a brief Medigap plan enrollment period to current Medigap beneficiaries around the time of their birthday.

Medicare Supplement plan beneficiaries have guaranteed issue rights and can switch to a different Medigap plan with no medical underwriting if they live in a state that recognizes the Medicare Birthday Rule. 

It’s important to note that the birthday rule only applies to current Medigap plan members who are looking to switch to a different plan. It does not apply to those not already enrolled in Medigap who are wanting to join a plan.

As of October 2023, there are nine states that have adopted a Medicare Birthday rule. The eligibility requirements and other terms of each state Medicare Birthday Rule can vary. Different state birthday rules can vary based on the length of the enrollment period, the plans you may be allowed to enroll in and more. 

Which States Have the Medicare Birthday Rule?  

The nine states with a Medicare birthday rule include:

• California
• Idaho
• Illinois
• Kentucky
• Louisiana
• Maryland
• Nevada
• Oklahoma
• Oregon

Only California and Oregon had a birthday rule prior to 2022. Six additional states since adopted a birthday rule, and the Kentucky Medicare birthday rule takes effect in 2024.

A bill in Iowa would grant guaranteed issue rights to Medigap beneficiaries every year during the month of March.

What Is the Medicare Birthday Rule in California? 

Current Medigap members in California have 60 days from the first day of their birthday month to switch to a different Medigap plan with the same level of benefits or a lower level of benefits than their current plan. The new plan may be with a different insurance company or the same company as their current plan. 

What Is the Medicare Birthday Rule in Idaho? 

Medigap beneficiaries in Idaho have 63 days after their birthday to change to a different plan with benefits of an equal or lower level. The new plan may be with a different insurance carrier.

What Is the Medicare Birthday Rule in Illinois? 

Medigap plan members in Illinois who are between the ages of 65 and 75 have 45 days from their birthday to switch to a plan with the same insurance company that has a level of benefits equal to or less than that of their current plan. 

What Is the Medicare Birthday Rule in Kentucky? 

The Kentucky Medicare birthday rule, which goes into effect in 2024, allows those with a Medigap plan to switch to a plan with the same level of benefits through a different insurance carrier within 60 days of their birthday. 

What Is the Medicare Birthday Rule in Louisiana? 

If you have a Medigap plan in Louisiana, you may switch to a different plan with equal or lesser benefits offered by the same insurance carrier within 63 days of your birthday. 

What Is the Medicare Birthday Rule in Maryland? 

The Maryland Medicare birthday rule begins on a beneficiary’s birthday and lasts for 30 days. During this time, Medigap plan members may switch to a plan of equal or lesser benefits through their current insurance carrier or a different one. 

What Is the Medicare Birthday Rule in Nevada? 

Medigap beneficiaries in Nevada have 60 days from the first day of their birthday month to switch to a plan with the same level or a lower level of benefits than their current plan. The new plan may be with their current insurance company or a different one.

What Is the Medicare Birthday Rule in Oklahoma? 

Oklahoma allows Medigap beneficiaries to switch to a different plan of equal or lesser benefits than their current plan and the new plan can be offered by a different insurance carrier or their current carrier. Beneficiaries have 60 days from their birthday to make the switch.

What Is the Medicare Birthday Rule in Oregon? 

The Oregon Medicare birthday rule gives Medigap plan members 30 days from the first day of their birthday month to switch to a plan of equal or lesser benefits from any insurance carrier including their current one.

How to Switch Medigap Plans During a Birthday Rule Enrollment Period

If you live in a state with a birthday rule and are currently enrolled in a Medicare Supplement Insurance plan, contact a licensed insurance agent today. They can help you review your additional plan options, compare costs and benefits to your current plan and switch plans if you’re eligible.