The Medigap Birthday Rule: A Unique Opportunity for Medicare Beneficiaries
If you or your clients have a Medicare Supplement plan (Medigap), there’s a little-known rule that can save money and improve coverage and it’s called the Medigap Birthday Rule. This rule is an excellent opportunity for beneficiaries to switch Medigap plans without going through medical underwriting, but it only applies in certain states and during a very specific timeframe. Here’s what you need to know.
What Is the Medigap Birthday Rule
The Medigap Birthday Rule is a state-level regulation that allows Medicare beneficiaries to switch to another Medigap plan with equal or lesser benefits each year around their birthday, without answering health questions or going through medical underwriting.
Normally, after the initial Medigap open enrollment period (which happens when someone first signs up for Medicare Part B), switching Medigap plans could require underwriting; meaning the insurance company can deny coverage or charge more based on health history. The Birthday Rule removes that barrier, making it easier for people to shop for a better premium or a different carrier’s plan.
How the Rule Works
The details of the rule depend on the state you live in, but generally:
- Eligibility: You must already have a Medigap plan in place.
- When You Can Switch: You have a short window each year, usually starting on your birthday (some states give you up to 60 days, others 30).
- What You Can Switch To: You can move to a Medigap plan with the same or lesser benefits; for example, switching from Plan G with one company to Plan G with another, or from Plan F to Plan N.
- No Underwriting: You don’t have to answer health questions, so pre-existing conditions won’t prevent you from switching.
Watch our YouTube video on Medicare Supplement underwriting
States That Offer the Birthday Rule
As of 2025, the Medigap Birthday Rule is available in several states, including:
- California
- Oregon
- Illinois
- Nevada
- Idaho
- Louisiana
- Kentucky (newer version of the rule)
Each state’s version is slightly different, so it’s essential to check the exact length of the switching window and eligibility criteria.
Why the Birthday Rule Matters
For beneficiaries, this rule can mean:
- Lower Premiums: Shop for the same coverage at a better price.
- More Carrier Choices: If you’re unhappy with your current insurer, you can switch without worrying about being declined.
- Guaranteed Access: People with health issues who might otherwise be denied coverage can still change plans.
Tips for Agents
If you’re a Medicare agent, the Medigap Birthday Rule is a perfect client retention opportunity:
- Reach out proactively before a client’s birthday to review their coverage.
- Shop carriers and rates to see if they can save money without losing benefits.
- Build trust by showing clients you’re looking out for their financial well-being.
If you are an agent who wants to join the team at Crowe, click here for online contracting
This annual touchpoint can strengthen your book of business and help you stay top-of-mind with clients.
The Medigap Birthday Rule is a valuable consumer protection that gives beneficiaries a yearly chance to make their coverage more affordable; no health questions asked. If you or your clients live in a state that offers it, don’t miss this opportunity. Mark those birthdays on the calendar and be ready to take advantage of this unique enrollment period.