Medicare Supplemental Insurance, also known as Medigap, helps seniors cover health care costs not included in traditional Medicare plans. Changing Medigap plans after enrollment in Medicare Part B typically requires a physical exam and can result in rejection for pre-existing conditions. In most states, participants can only switch Medigap coverage during a six-month window after enrolling in Part B, with no opportunity for changes without medical underwriting. However, nine states offer a birthday rule, allowing participants to shop for less expensive plans once a year.
Medigap insurance, provided by private insurers, fills the gaps in Medicare coverage by paying for deductibles, coinsurance, and copayments. Each state has its own regulations regarding Medigap plans, offering 10 different standard plan types. To purchase Medigap insurance, participants must be enrolled in both Medicare Part A and Part B, excluding those enrolled in a Medicare Advantage plan. The birthday rule for Medigap insurance allows for yearly changes in coverage without the need for a physical exam or risk of rejection for pre-existing conditions, known as a right of “guaranteed issue.”
As of August 2024, nine states, including California, Oregon, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, and Oklahoma, allow participants to change their Medigap coverage during a specified period around their birthdays. Each state sets its own rules for the birthday rule, including the length of the window and limitations on switching to plans of equal or lesser value. For example, in California, participants have 60 days after their birthday to change their Medigap plan to a lesser or equal one. Participants in states with a birthday rule can save money by shopping for cheaper plans each year.
State-specific rules for the Medigap birthday rule vary, with some states allowing 30-day windows before and after a participant’s birthday, while others offer up to 63 days for changes in coverage. Participants must adhere to limitations on switching to plans of lesser or equal value, which may involve changing insurers or selecting different plan types within the same issuer. Four additional states considered legislation for a birthday rule in 2024 but have not enacted any laws yet. Understanding the rules in your state can help you make informed decisions about your Medigap coverage and potentially save money on healthcare costs.
