Birthday Rule (Medigap)
In some states, the birthday rule gives Medigap policyholders a yearly window around their birthday to switch to an equal or lesser plan without medical underwriting. The exact rules and timing vary by state.
Understanding Birthday Rule (Medigap)
The Medigap birthday rule is a state-level consumer protection that gives Medicare Supplement policyholders an annual window around their birthday to switch to an equal or lesser Medigap plan without going through medical underwriting. That means the insurer cannot deny you or raise your premium based on your health. The exact timing and rules vary by state.
For beneficiaries, the birthday rule is valuable because, outside of guaranteed-issue situations, switching Medigap plans normally requires passing health questions. In birthday-rule states, you get a yearly chance to shop for a lower premium on the same or lesser coverage — useful as your existing plan's rates rise with age.
For example, in California the window is 60 days starting on your birthday; if you have Plan G with one insurer, you can move to another company's Plan G (or a lesser plan) at a better rate without health questions. States like Oregon and Idaho have their own versions.
Have questions about the birthday rule? Get a free Medicare review and we will tell you whether your state offers this option and how to use it.
Related Terms
Medigap
Medigap (Medicare Supplement Insurance) is private health insurance that helps pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
Guaranteed Issue Rights
Guaranteed issue rights are situations where an insurer must sell you a Medigap policy without medical underwriting — it cannot deny you or charge more for health reasons. These rights apply during your Medigap open enrollment window and certain special circumstances.
Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period runs January 1 to March 31. People already in a Medicare Advantage plan can make one change — switch plans or return to Original Medicare with a Part D plan.
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