05 Apr Understanding Medigap Birthday Rules

If you are about to become eligible for Medicare, you need to understand your different Medicare plan choices. And, if you think that you want original Medicare (Parts A and B) rather than a Medicare Advantage Plan (Part C), it is crucial for you to understand the rules about applying for a Medigap plan, so you don’t make any costly mistakes. This blog will explain Medigap plans, the rules about changing Medigap plans, the Medigap birthday rule, and which states have a Medigap birthday rule.

What is Medigap?

Medigap plans are additional insurance you can purchase to help pay deductibles, co-payments, co-insurance amounts, and other expenses original Medicare does not cover. You will pay an additional monthly premium for a Medigap plan, in addition to premiums for other Medicare parts.

You can buy a Medigap policy from any licensed insurance company in your state. Medigap plans are standardized, meaning every insurer offers plans lettered A-N.

To learn more about the Parts of Medicare and the costs involved see Triage Cancer's Extended Quick Guide to Medicare.

When do you sign up for a Medigap plan?

You can buy a Medigap plan during your Medicare initial enrollment period (IEP), which begins three months before the month you turn 65 and lasts 7 months. If you sign up for a Medigap plan during the IEP, you cannot be denied a plan.

But, if you wait to buy a plan outside of the IEP, you may face a pre-existing condition exclusion period up to 6 months, and/or the plan may cost more. You also may be denied a plan if you try to sign up after the IEP. Once you have a Medigap plan, it can only be canceled if you fail to pay the premiums.

If you are under 65, and have Medicare because of a disability, your state may not require insurance companies to sell you a Medigap plan. Visit TriageCancer.org/StateLaws for more information.

Can you change your Medigap plan?

You can change your Medigap plan, especially if you want a new insurance company, you are paying too much for your plan, or you want more benefits. However, there are specific rules if you want to change your Medigap plan. Learn more at Medicare.gov.

When you sign up for a new Medigap plan, you have 30 days to decide if you want to keep it. This is called your “free look period.” You will need to pay the premium for both plans for one month. It is important that you don’t cancel your previous Medigap plan until you are sure you want to keep the new one.

When can you change your Medigap plan?

Generally, if you want to switch Medigap after your IEP, you have to qualify for a special enrollment period. Special enrollment periods are limited, so you may have difficulty switching Medigap policies.

Special events in your life may trigger a special enrollment period. You will qualify for a special enrollment period if:

• You have been enrolled in a Medicare Advantage or PACE (Programs of All-Inclusive Care for the Elderly) policy for less than one year and want to switch to original Medicare.
• You previously had a Medigap policy, dropped it to enroll in Medicare Advantage or Medicare Select for the first time, and want to change back to a Medigap policy within one year.
• Your current Medigap policy ends abruptly without any fault of your own.

If you do not qualify for a special enrollment period, you may be required to show that your Medigap plan provider broke a federal government rule or has closed down, before you are allowed to switch Medigap plans without facing medical underwriting.

What is the Medigap birthday rule?

The Medigap birthday rule allows individuals currently enrolled in a Medigap plan to change their plan without a medical exam during a short window of time around their birthday.

Without a birthday rule, individuals with a Medigap plan may only change Medigap plans in limited circumstances. Even in those circumstances, enrollees may be subject to medical exams and questions to determine eligibility and pricing for plans. This process is called medical underwriting. If you are found to be a high-risk candidate for insurance, medical underwriting can hinder your ability to enroll in a new Medigap plan.

Which states have a Medigap birthday rule?

Oregon and California were the first states to allow people with Medigap plans to use the Medigap birthday rule. This year, Idaho, Illinois, and Nevada will begin to use birthday rules. Each state’s birthday rule is different:

California

• People with Medigap plans can change to a different Medigap plan that offers equal or lesser benefits.
• The enrollment window begins on the individual’s birthday and lasts for 60 days.

Idaho

• The Idaho birthday rule went into effect on March 1, 2022.
• People with Medigap plans can change to a different Medigap plan that offers equal or lesser benefits.
• The enrollment window begins on the individual’s birthday and lasts for 63 days.

Illinois

• Available to people who are between the ages of 65-75, with Medigap plans.
• People with Medigap plans can change to any Medigap plan offered by their current Medigap insurance company. The new Medigap plan cannot have more benefits than your previous plan.
• The enrollment window begins on the individual’s birthday and lasts for 45 days.

Nevada

• People with Medigap plans can change to a different Medigap plan that offers equal or lesser benefits.
• The enrollment window begins on the first day of the individual’s birthday month and lasts for 61 days.

Oregon

• People with Medigap plans can change to a different Medigap plan that offers equal or lesser benefits.
• The enrollment window begins on the individual’s birthday and lasts for 30 days.

For more information about Medicare, Medigap, and other health insurance topics, visit TriageCancer.org/HealthInsurance.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

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