Which state has a birthday rule that allows Medigap policyholders to switch carriers without underwriting?
Asked by: Donald Eichmann | Last update: March 22, 2025Score: 4.3/5 (32 votes)
Which states allow you to change Medicare supplement plans without underwriting?
Medigap state variation
Five states (California, Idaho, Illinois, Nevada, and Oregon) have “birthday rules” that allow Medigap enrollees a 30-day window following their birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.
What states have the Medigap birthday rule?
Currently, eight states have enacted a version of the Medigap birthday rule, including California, Idaho, Illinois, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. Kentucky also passed legislation in 2023 to enact the birthday rule starting in 2024.
What 3 states allow year-round enrollment in Medigap?
- New York.
- Connecticut.
- Vermont.
- Washington.
- Oklahoma.
How does the birthday rule work?
If a child is covered under both parents' health plans, a provision known as the “birthday rule” comes into play, guiding how the coordination of benefits will work. The birthday rule says that primary coverage comes from the plan of the parent whose birthday (month and day only) comes first in the year.
Does Your State Have The Medicare Supplement Birthday Rule?
What are the exceptions to the birthday rule?
An exception to the birthday rule is also made during separation or divorce. The parent with child custody is usually responsible for primary payment before the other parent. If one of the parents remarries, their new spouse will provide secondary coverage. The plan of the parent with no custody will pay last.
What is the birthday rule for Medigap in California?
To qualify for a “birthday rule” plan change, you need to already be enrolled in a Medigap plan. California: You have 60 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers during this time.
Can I switch from Medicare Advantage to Medigap without underwriting?
It depends on the timing. You have a guaranteed issue right to buy any Medigap policy sold in your state if you signed up for Medicare Advantage and want to switch to Original Medicare in the first year of coverage. After the one-year trial period, you can be subject to medical underwriting and denials.
What is the Oregon birthday rule?
Oregon Birthday Rule
The birthday rule in Oregon means that for Medigap Plans only, your annual open enrollment period lasts 60 days, beginning 30 days before your birthday and ending 30 days after your birthday.
What is the birthday rule in Colorado?
The rule says if each parent has separate insurance, the newborn must be covered under the parent whose birthday falls earlier in the calendar year. Irwin's birthday is in January, and Rapp's birthday is a month later in February, so Jack had to be covered under his father.
Does Texas have the Medicare birthday rule?
The Medicare Supplement, also known as a Medigap Plan, Birthday Rule is gaining traction nationwide. At this time, nine states have already adopted this opportunity. The lucky nine states are California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon.
What is the birthday rule in Missouri?
Missouri: This state has an "anniversary rule," which allows enrollees the ability to change from one Medigap insurer to another (if both plans are the same letter) on a guaranteed-issue basis starting 30 days before their plan anniversary date and ending 30 days later; additionally, some Medigap plans are available ...
When applying the birthday rule of policyholders?
The 'birthday rule' is a term used to determine coordination of benefits in health insurance. When a family is covered by more than one health insurance plan, this rule is applied. In the case where policyholders have identical birthdays, the policy in effect the longest is considered as the primary policy.
What states are guaranteed issues for Medigap?
State laws can provide further protections, but only four states— Connecticut, Massachusetts, Maine, and New York—require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of their medical history.
What happens to my Medicare supplement if I move to another state?
In many cases, you can stay with your current Medicare Supplement (Medigap) insurance plan even if you're moving out of state as long as you still have Original Medicare. Medigap benefits can be used to cover Medicare Part A & Part B out-of-pocket costs from any provider that accepts Medicare, regardless of the state.
Why are people leaving Medicare Advantage plans?
But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up paying more in the long run in copays and deductibles if they develop a serious illness.
What states have a Medigap birthday rule?
Nine states have what are called “birthday rules” (CA, ID, IL, KY, LA, MD, NV, OK and OR), which require Medigap insurers to allow current policyholders switch each year to a different Medigap policy with equal or lesser benefits from either the same or different insurance carrier, depending on the state, around the ...
What is the golden birthday rule?
What is a Golden Birthday? Your golden birthday is when the date of your birth coincides with your age. For example, if you were born on October 8, your golden birthday took place when you turned 8. If you were born on December 21, your golden birthday took place when you turned 21.
What is the birthday rule in Maryland?
California: Medigap insurees can change their Medigap coverage to a lesser or equal plan for 60 days following their birthdays each year. Idaho: Medigap insurees have 63 days after their birthday to switch Medigap insurance.
How can we avoid Medigap underwriting?
You can enroll in a Medigap plan without going through medical underwriting (in other words, without having to answer any medical questions) if you enrolled in a Medicare Advantage (MA) plan when you first became eligible for Medicare at age 65 and then decided a Medicare Advantage plan was not for you.
Can I switch from Advantage to Medigap in Massachusetts?
You can buy a Medigap policy if you switch to Original Medicare. You must apply for a Medigap policy: 60 days before the date your Medicare Advantage Plan coverage ends. No more than 63 days after your Medicare Advantage Plan coverage ends.
Are Medigap policies being phased out?
For example, Medigap plans C and F will no longer be available to new Medicare recipients after January 1st, 2020.
What is the birthday rule in Kentucky?
Kentucky: Birthday Rule
For 60 days after one's birthday, you may change from your current Medicare Supplement Insurance Plan to another Medicare Supplement Plan of the SAME benefits with any carrier.
Can you change medicare supplement plans without underwriting California?
Yes, a person can change Medigap policies without medical underwriting if they are within the 6-month Medigap open enrollment period. They can also do so if they are eligible under a specific situation or guaranteed issue right.
What is the birthday rule?
The rule requires that the parent whose birthday comes first in the calendar year would cover the cost of delivering the new baby regardless of whether one parent has better health coverage for a newborn than the other.