Medicare Birthday Rule: How State Rules Affect Medigap Plan Changes

Medicare beneficiaries often review their health and prescription drug coverage during the annual fall open enrollment period. However, this period of flexibility does not extend to Medicare Supplement Insurance, also known as Medigap. Under federal law, you are granted only one six-month Medigap open enrollment period in your lifetime, which begins when you are 65 or older and enrolled in Medicare Part B. During this window, insurance companies cannot use medical underwriting to deny you a policy or charge higher premiums based on your health history.

Once this initial period concludes, changing your Medigap plan can become difficult. In most states, insurers are permitted to use medical underwriting for new applications, potentially leading to higher costs or application denial for individuals with pre-existing conditions. This can leave many policyholders feeling locked into a plan, even if their needs or budget change over time.

Fortunately, some states have introduced consumer protections to address this issue. One of the most significant is the "Medicare birthday rule," which provides an annual opportunity for Medigap enrollees to switch plans. Understanding this rule is essential for managing your healthcare costs effectively.

What is the Medicare birthday rule?

The Medicare birthday rule is a state-level regulation that gives current Medigap policyholders a special enrollment window each year, typically centered around their birthday. During this time, you can switch to a different Medigap plan without undergoing medical underwriting. This means an insurance company cannot reject your application or charge you more due to your health status.

Primary benefit of the Medicare birthday rule

The primary benefit of the Medicare birthday rule is the freedom to seek a more suitable or affordable plan. As insurance premiums can increase over time, this rule allows you to compare offerings from different carriers and potentially lower your monthly costs without sacrificing coverage. It restores a degree of flexibility that is otherwise absent for Medigap policyholders after their initial enrollment period.

What states have the Medicare birthday rule?

As of late 2025, several states have enacted the Medicare birthday rule provision. Although the specifics vary, it is important to note that this is not a federal mandate and regulations are subject to change based on state legislation.

The states with Medicare birthday rules generally allow you to switch to a plan with equal or lesser benefits than your current one. Some states also permit you to change insurance carriers, while others restrict you to plans offered by your existing insurer. The adoption of birthday rules is a growing trend, providing valuable protection for Medicare beneficiaries.

States with Medicare birthday rule provisions

• California: Enrollees have a 60-day window starting on their birth month to switch to a plan with equal or lesser benefits from any carrier.
• Delaware: Effective January 1, 2026, policyholders can switch to another plan with the same or lesser benefits. The window begins 30 days before the birthday and lasts for at least 30 days after.
• Idaho: A 63-day window from your birthday allows you to switch to a plan with equal or lesser benefits from any carrier.
• Illinois: Individuals aged 65-75 have 45 days from their birthday to switch to a plan with equal or lesser benefits from their current insurer or an affiliate.
• Indiana: Effective January 1, 2026, a birthday rule permits enrollees to switch to the same plan type offered by a different insurer.
• Kentucky: A 60-day window following an enrollee's birthday allows a switch to the same Medigap plan offered by a different insurer.
• Louisiana: Enrollees have 63 days from their birthday to select a different plan with equal or lesser benefits from their current carrier or an affiliate.
• Maryland: A 30-day window following your birthday allows you to switch to a plan with equal or lesser benefits.
• Nevada: A 60-day window starting on the first day of your birth month allows a change to a plan with equal or lesser benefits from any carrier.
• Oklahoma: Enrollees have a 60-day window from their birthday to switch to a plan with equal or lesser benefits.
• Oregon: A 30-day window starting on your birth month provides an opportunity to switch to a plan with equal or lesser benefits from any carrier.
• Utah: A 60-day annual window allows enrollees to switch to a plan of equal or lesser benefits, but only with their current insurer.
• Virginia: Effective July 2025, a birthday rule allows enrollees to switch to the same Medigap plan offered by a different insurer.
• Wyoming: Enrollees can switch to any available Medigap plan with the same or lesser benefits during a 63-day window that begins on their birthday.

Several other states, including Nebraska, Iowa, and Michigan, have considered or are considering similar legislation. This reflects a growing recognition of the need for greater flexibility in the Medigap market.

The importance of annual Medigap plan reviews

Even if you are satisfied with your current Medigap plan, an annual review is a prudent financial practice, especially if you reside in a state with a birthday rule. Premiums can change, and a competitor may offer the same coverage at a more competitive rate. The birthday rule provides a risk-free opportunity to explore these options without fear of being denied coverage.

Navigating the complexities of Medigap plans and state-specific regulations can be challenging. Each state's birthday rule has unique conditions regarding timing, plan eligibility, and carrier options. Misunderstanding these rules could lead to a missed opportunity or an unintended gap in coverage.

How Risk Strategies supports Medicare beneficiaries

Our team has the knowledge to help you understand the specific Medigap regulations in your state, including the nuances of any applicable birthday rule. We can help you:

• Assess your current Medigap plan coverage: We will review your existing Medigap policy to ensure it still aligns with your healthcare needs and financial objectives.
• Compare your Medigap plan options: We can provide a comprehensive comparison of available plans during your birthday rule window, helping you identify potential savings or more suitable coverage.
• Navigate the application process: Our specialists can guide you through the process of switching plans, ensuring a seamless transition and continuous coverage.

Your birthday may offer more than just a celebration — it could be your annual opportunity to optimize your Medicare Supplement coverage. By staying informed and working with a trusted advisor, you can ensure your Medigap plan continues to serve you well for years to come.

For further information on Medicare guidelines, please contact a Risk Strategies Medicare representative.