Navigating Medicare can already be complicated, but some states add their own unique regulations to the mix. One such regulation is the Medigap Birthday Rule. This rule, adopted in states like California, Illinois, Idaho, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon, provides significant advantages to residents in those areas.
So, what exactly does the Birthday Rule allow? Let’s break it down and examine how Medigap policies affect Medicare beneficiaries in Arizona and across the rest of the nation.
Switching Medigap Plans
Many people assume that once they’ve enrolled in a Medicare plan, they’re stuck with it indefinitely. However, this isn’t entirely true – though there are specific rules when it comes to switching Medigap plans.
Medigap plans, also called Medicare Supplement plans, are one of the two ways Medicare beneficiaries can enhance their Original Medicare (Parts A and B) coverage. These plans are identified by alphabet letters, with Plans F, G, and N often being the most popular options.
To enroll in a Medigap plan, you must already have Medicare Part A and Part B. Your initial enrollment period for a Medigap plan lasts six months, beginning the month your Part B coverage starts. During this window, you can select any Medigap plan without worrying about your current or past health conditions, and no medical diagnosis will cause your premiums to increase. After this open enrollment period, different rules apply.
Even if you enroll in a Medigap plan during your initial window, you still have the option to switch plans at any time of the year, regardless of your location. However, in most states, you’ll need to meet medical underwriting requirements to qualify. This means the insurance company will evaluate your health by asking simple yes-or-no questions and requesting a list of prescriptions you’ve taken in the last two years.
Once your application is submitted, it goes to the insurance carrier’s underwriting team for review. They’ll assess your health history, and in many cases, they’ll conduct a phone interview with you. Fortunately, you won’t need to visit a doctor or undergo a physical exam. The review process typically takes one to two weeks before a decision is made.
The good news is that if you don’t pass the underwriting process, your current policy remains unaffected. It won’t be canceled, and your premium won’t increase because you attempted to make a change. However, this does mean you may need to stick with your existing plan for the foreseeable future.
That said, there may be other options to lower your premiums or adjust your plan. If your premiums have become unaffordable, it’s worth discussing Medicare Advantage with your advisor. While there are pros and cons to consider, Medicare Advantage plans can often provide significant savings, particularly on monthly premiums.
States with the Medigap Birthday Rule
Now that you’re familiar with the rules surrounding Medigap, let’s explore a valuable exception to the rules. If you live in one of the nine states mentioned earlier, you have a special opportunity to switch your Medigap plan each year around your birthday.
Here’s how the Medigap Birthday Rule works in each of these states.
California: Residents have a 60-day window starting on the first day of their birthday month to switch to a Medigap plan with the same or lesser benefits. This can be done either within the same insurance company or by moving to a new carrier. For instance, you could switch from Plan F with one company to Plan G with another. Keep in mind that there are restrictions—only beneficiaries who enrolled in Medicare before 2020 are eligible for Plan F or Plan C.
Idaho: You have 63 days after your birthday to change to a Medigap plan offering equal or lesser benefits. You can stay with your current carrier or choose a new one.
Illinois: Beneficiaries have 45 days from their birthday to switch to a plan with the same or lesser benefits. However, this rule only applies within the same insurance company; switching carriers requires passing medical underwriting. Additionally, the rule is limited to those between the ages of 65 and 75.
Kentucky: Residents can change to a Medigap plan of equal benefits with any carrier during a 60-day window following their birthday.
Louisiana: Residents have 63 days following their birthday to switch to a Medigap plan with equal or lesser benefits, but only with their current insurance company.
Maryland: Residents have a 30-day window starting on their birthday to change to a Medigap plan of equal or lesser benefits without medical underwriting.
Nevada: You have 60 days from the first day of your birthday month to switch to a Medigap plan offering the same or lesser benefits. You may also move to a different insurance carrier during this time.
Oklahoma: Policyholders have a 60-day period starting on their birthday to change to a Medigap plan of equal or lesser benefits with any carrier.
Oregon: During your birthday month, you can change to a Medigap plan with equal or lesser benefits. This change can be made with your current insurer or by switching to a new company.
It’s important to note that each state’s rules may have specific nuances, and the availability of the Birthday Rule can change. Beneficiaries should consult with a knowledgeable Medicare advisor to understand the current regulations in their state and to explore their options during the Birthday Rule period.
We hope this clears up any confusion about when you can switch your Medigap plan. If you have questions about Medicare or are considering exploring new coverage options, reach out to Carolina Senior Benefits today. Now is a great time to see if you can save on Medicare costs in 2025!
