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  • Writer's pictureBrad Gunning

The Medicare Birthday Rule

Updated: May 22, 2019

Medicare Birthday Rule

The federal government regulates private insurance companies with regard to Medicare Supplement programs. That said, some states provide additional Medicare Supplement protections beyond those of the federal government. For example, both Oregon and California have the "birthday rule" for anyone wishing to switch their Medicare Supplement insurance policy.

What is the Medicare Birthday Rule?

California and Oregon have what equates to an extra guaranteed issue period beyond that provided by federal law. With the "birthday rule," Californians and Oregonians can switch Medicare Supplement insurance plans without any medical underwriting for up to 30 days after their birthday each year.

What's significant about the birthday rule isn't that you're allowed to switch Medigap policies - you can always switch policies throughout the year - the significance is that with the birthday rule you can switch policies without any medical underwriting. Why is no medical underwriting important? Medical underwriting means you'll need to qualify medically for a Medigap plan. If you don't qualify, you can be denied coverage. Under the birthday rule, you can't be denied coverage due to your health.

There is one caveat to the birthday rule: you can only switch to a plan of equal or lesser coverage. If you started with Medigap Plan F (the most comprehensive plan) then this caveat is irrelevant because you can switch to any of the other plans. If, on the other hand, you started out with a more basic plan, you'll be more limited in your options. Regardless, it makes a ton of sense to take advantage of the birthday rule and make sure your current policy is the cheapest option.

Another way to think about it: in California and Oregon, everyone gets a mini Initial Enrollment Period every year for their birthday. If you're in California or Oregon, it's important to take advantage of this gift! No, you don't need to switch Medigap plans every year, but it's worth seeing whether a less expensive plan is available.

The best part is you can have a qualified Medigap insurance agent (like us) run free quotes for you. Just make sure it's an independent agent so that they can run quotes for all the highly-rated Medigap insurance companies and they aren't beholden to just one company.

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