Does Your State Have a Medigap Birthday Rule?
Key Takeaways
- Certain states have a Medigap birthday rule, which allows people to change their Medicare Supplement plan without medical underwriting.
- A Medigap birthday rule offers more flexibility to get coverage that fits your needs and budget, but every state sets its own limitations on what plans you can choose and how much time you have to decide.
- As of 2025, California, Idaho, Illinois, Maryland, Oklahoma, Oregon, Kentucky, Louisiana, Nevada, Utah, Virginia, and Wyoming all have some type of a birthday rule.
- Additionally, Missouri has an anniversary rule, which is tied to the date you first enrolled in a Medigap plan.
People on Original Medicare, the federally administered health insurance program for U.S. adults who are over 65 or have certain disabilities, are responsible for paying monthly premiums, plus deductibles and a share of the costs for most covered outpatient services. Private insurance carriers offer Medicare Supplement plans, also known as Medigap, to cover some of those out-of-pocket expenses.
Generally, the best opportunity to join a Medigap plan is the first six months after you have turned 65 years old and enrolled in Medicare Part B, the part of Original Medicare that provides medical insurance. Following that enrollment period, you may be denied or charged more if you try to either get Medigap for the first time or switch plans.
However, some states have instituted rules that could give you greater flexibility with a yearly opportunity around the time of your birthday to switch to another plan without underwriting. As of 2025, California, Idaho, Illinois, Maryland, Oklahoma, Oregon, Kentucky, Louisiana, Nevada, Utah, Virginia, and Wyoming all have some version of a birthday rule.
If you’re currently enrolled in a Medigap plan and live in a state that passed a birthday rule, you should understand your options and how they could make a difference in your healthcare costs.
Medigap and Guaranteed Issue Rights
Most people in the U.S. can choose from eight standardized Medigap plan types after enrolling in Medicare Part B (Massachusetts, Minnesota, and Wisconsin standardize their plans differently):
All these policies help with the out-of-pocket costs from medical services, but the extent of the coverage varies by plan, and private insurance carriers can set their own monthly premiums.
During your six-month Medicare Supplement Open Enrollment Period, you have guaranteed issue rights, which means insurance carriers must sell you a policy and can’t charge more because of your health conditions or need for care. Later on, you’re only guaranteed Medigap coverage under certain circumstances. For example, if you switched from Original Medicare to a Medicare Advantage (Part C) plan when you first became eligible, you have up to one year to return to Original Medicare and join a Medigap plan with guaranteed issue rights.
After you’ve enrolled in a Medigap plan, you might decide that your premiums are too high or that another type of plan has benefits that better suit your needs. However, changing plans when you no longer have guaranteed issue rights often means going through medical underwriting and answering a series of health questions. If you have serious health conditions, you’re likely to be declined or to pay more for coverage.
What States Have a Medigap Birthday Rule?
To make switching Medicare Supplement plans easier, a growing number of states have adopted a birthday rule. In these states, you have the chance to go from one Medigap plan to another without the underwriting process.
However, there are limitations on what plans you can choose from and significant differences in how the rules work in many of the states. Some of the distinctions include whether you can switch carriers, what plan types you can choose from, and how much time you have to decide.
State | Insurance Carrier | Plan Options | Window |
California | Any | Equal or lesser benefits | 60 days starting on birthday |
Idaho | Any | Equal or lesser benefits | 63 days starting on birthday |
Illinois | Same as current plan | Equal or lesser benefits
| 45 days starting on birthday (through age 75) |
Kentucky | Any | Same as current plan | 60 days starting on birthday |
Louisiana | Same as current plan | Any | 30 days before through 63 days after birthday |
Maryland | Any | Equal or lesser benefits | 30 days after birthday |
Nevada | Any | Equal or lesser benefits | 60 days after birthday |
Oklahoma | Any
| Equal or lesser benefits | 60 days starting on birthday |
Oregon | Any | Equal or lesser benefits | 30 days before through 30 days after birthday |
Utah | Same as current plan | Equal or lesser benefits | 60 days starting on birthday |
Virginia | Any | Same as current plan | 60 days starting on birthday |
Wyoming | Any | Equal or lesser benefits | 63 days starting on birthday |
If you want to make changes that go beyond what’s allowed under your state’s birthday rule, you will likely need to go through medical underwriting.
What Is a Medigap Anniversary Rule?
An anniversary rule is essentially the same as a birthday rule, but it’s tied to the anniversary of the date you signed up for your Medigap plan, not your birthday. The only state currently following this model is Missouri.
In Missouri, you have 30 days before and after your Medigap policy’s anniversary to change your insurance carrier, which might allow you to save on premiums. You must stick with the same plan type you had before unless you’re willing to go through medical underwriting.
A Medigap birthday or anniversary rule is one way that many states are seeking to give people on Medicare more choices when it comes to their coverage. Whether you live in one of those states or not, it’s a good idea to take a careful look at your healthcare spending and review your options every year.