What states have the Medigap "birthday rule" and what is it?

Question

Robert Barco · Accepted Answer

As of July 2025, there will be ten states that will have a "birthday rule" where existing owners of Medigap plans can change plans or change Medigap companies without underwriting. The ten states with the "birthday rule" are, California, Idaho, Illinois, Maryland, Oregon, Nevada, Louisiana, Kentucky, Utah, and Virginia.

Answered by Robert Barco on April 27, 2025

Broker Licensed in OH

Answered by Robert Barco Medicare Insurance Agent

Steven Bleicher · Answer

Every single State uses the birthday rule. That means that there is a 7-month window when you are about to turn age 65, when you can enroll with Medicare. First of all, you are eligible on the first day of your birthday month. Ergo, if your birthday is June 29th, then June 1st is your date of eligibility. So, the window is: 3-months before your birthday month, your actual birthday month and then three-months after your birthday month for a grand total of seven months!

Answered by Steven Bleicher on April 26, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

The "birthday rule" allows Medicare beneficiaries who are covered by a Medicare Supplement (Medigap) plan to switch their Medigap policy to another of equal or lesser benefits during a designated period around their birthday, without having to answer health questions on the application. 

The rule provides a guaranteed issue right for Medigap plan changes within a specific timeframe and is beneficial to beneficiaries who are usually unable to get through underwriting because of health issues.

As of right now, the following states have implemented this rule:
 * California
 * Idaho
 * Illinois
 * Kentucky
 * Louisiana
 * Maryland
 * Nevada
 * Oklahoma
 * Oregon

Indiana will be implementing this rule in January 2026.

Yasmery Vargas · Answer

There are 8 states currently that have the Medigap Birthday rule. The Medigap Birthday Rule allows you to move from one supplement plan to the next without underwriting. Each state has a unique set of rules and time frame. Look at the state's specific rules for exact time frame. Oregon, Idaho, Illinois, Oklahoma, California, Nevada, Maryland, Louisiana.

Answered by Yasmery Vargas on April 29, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Chad Watkins · Answer

CA, ID, IL, LA, MD, OR, OK and NV all have a Medicare birthday rule. Rules vary by state (for example IL it is only available for ages 65 to 75) but the general idea is that around your birthday, you can switch your Medicare supplement plan to one of equal or less value without going through underwriting and worrying about pre-existing conditions.

Answered by Chad Watkins on May 14, 2025

Agent Licensed in NJ, AK, AL & 48 other states

Answered by Chad Watkins Medicare Insurance Agent

Rick Boyd · Answer

As of 2025 there are 9 states that have some form of the Medigap Birthday Rule. The states are California, idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. Each state has differences in the amount of time around your birthday, to apply with a different company. While most allow you to move to the same or a lower coverage, and change companies, other states allow only like coverage to like coverage with a different company. All of these scenarios come with no medical underwriting.
The best advice is before your birthday, speak with a licensed Medicare insurance specialist to see what your options are in your specific state.

Fred Manas · Answer

The Medigap "birthday rule" is a policy that allows individuals in specific states to change their Medicare Supplement (Medigap) plan without medical underwriting during a designated period around their birthday. Currently, nine states have a version of this rule: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. 
Here's a more detailed explanation:
Purpose:
The birthday rule aims to provide flexibility for Medigap policyholders to switch to a different plan without facing potential medical underwriting issues, such as higher premiums or denial of coverage due to health conditions.
Timeline:
The rule allows a specific window of time around the policyholder's birthday to make the switch.
How it works:
During the birthday window, individuals can switch to a different Medigap plan, as long as it's of equal or lesser benefits than their current plan.
State Variations:
While the concept is similar across these nine states, the specific rules (e.g., the length of the birthday window, the types of switches allowed) can vary.

Tony Hardwick · Answer

The 9 states with the "birthday rule" are: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon. This allows Medigap policy holders to switch to another plan with equal or lesser benefits within a specific timeframe around their birthday (30-63 days) without needing medical underwriting.

Answered by Tony Hardwick on April 28, 2025

Agent Licensed in GA, AZ, CA & 15 other states

Answered by Tony Hardwick Medicare Insurance Agent

Chuck Winslow · Answer

The Medigap "birthday rule" allows people in certain states to change their Medigap plan around their birthday each year without medical underwriting. States like California, Oregon, Idaho, Illinois, and Nevada have versions of this rule, making it easier for Medicare beneficiaries to switch to a plan with equal or lesser benefits.

Answered by Chuck Winslow on April 28, 2025

Agent Licensed in IN

Answered by Chuck Winslow Medicare Insurance Agent

Kris Neupauer · Answer

California, Idaho, Illinois, Michigan, Nevada, Oregon and Washington have the birthday rule and the birthday rule means that within 30 days of your birthday, if you are on a Medigap plan, you can switch a plan to the same or lesser coverage with No underwriting—meaning they can’t deny you coverage based on health issues.

Answered by Kris Neupauer on May 1, 2025

Broker Licensed in MN, ND, SD & WI

Answered by Kris Neupauer Medicare Insurance Agent

Andy Kelly · Answer

The Medigap Birthday Rule is a regulation in certain U.S. states that allows Medicare beneficiaries to switch their Medigap (Medicare Supplement) insurance plans without medical underwriting around their birthday. This gives people a chance each year to change plans without worrying about being denied or charged more due to health conditions.

States with a Medigap Birthday Rule (as of 2025):
California

Oregon

Idaho

Illinois (similar rule, but not called the Birthday Rule)

Ingrid Kollmann · Answer

9 states;  California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon.

Jeffrey Barone · Answer

Currently 8 states. California, Idaho, Illinois, Louisiana Maryland. Nevada, Oklahoma and Oregon. 
It’s when subscribers can switch their Medigap plan on their birthday without medical underwriting

What states have the Medigap "birthday rule" and what is it?

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What states have the Medigap "birthday rule" and what is it?

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