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.
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.
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.
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.
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.
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.
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:
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.
Brenda Shearer was part of the Risk Strategies acquisition of Benefits Network Insurance in December 2018. She served as the Director of Wholesale, dedicated to providing day-to-day employee benefit account management for customers and brokers, as well as the management of the staff.
Brenda has extensive training and knowledge of all major carriers in the marketplace, including individual, senior, small and large group products. She has also worked closely with large accounts and PEO’s.
Risk Strategies is not affiliated with or endorsed by the Government or Federal Medicare Program.