Since 2011, we've helped more than 5 million people understand their Medicare coverage.

Find Medicare plans that fit your needs.*

Get coverage now!

The ‘birthday rule’: a gift to Medigap enrollees?

Medicare supplement plan changes are limited, but 12 states offer Medigap enrollees special enrollment – and six do it with a 'birthday rule.'

Tanya Feke, M.D. // December 21, 2022

Reviewed by our health policy panel.

Related articles

Confused about the difference between Medicare Advantage and Medigap? You’re not alone.

Confused about the difference between Medicare Advantage and Medigap? You’re not alone.

More than two-thirds of the respondents in our most recent survey indicated that they don’t understand the differences between Medicare Advantage and Medigap and are overwhelmed by the available choices.

Is there a best time to enroll in a Medicare supplement plan?

Is there a best time to enroll in a Medicare supplement plan?

The best time to enroll in a Medicare supplement plan is during your Medigap open enrollment period, a six-month window that begins on the first of the month you're enrolled in Medicare Part B and are 65 or older.

Does all Medicare private coverage have open enrollment periods?

Does all Medicare private coverage have open enrollment periods?

For Medicare Advantage and Medicare Part D, there’s an annual open enrollment period (October 15 to December 7, with enrollments effective January 1 of the coming year). During this time, you can switch to any other Medicare Advantage or Part D plan available in your area, regardless of your medical history.

Medigap – Medicare supplement insurance

Medigap – Medicare supplement insurance

Medigap helps with expenses such as copayments, coinsurance and deductibles. Learn about enrollment, plan benefits and costs. Get a free quote in minutes.

Do Medicare supplement plans include prescription drug coverage?

Do Medicare supplement plans include prescription drug coverage?

Modern Medigap plans do not include prescription drug benefits. Instead, Medicare offers prescription drug coverage under Part D. Medicare enrollees can get prescription coverage either by switching to a Medicare Advantage plan or by purchasing a stand-alone Medicare Part D plan (PDP) to go along with Original Medicare.

How well do you understand the difference between Medicare Advantage and Medigap?

How well do you understand the difference between Medicare Advantage and Medigap?

In our new survey, we’re hoping to see how confident our readers feel in their understanding of the differences between Medicare Advantage and Medigap plans.

Four ways to adjust your Medicare coverage

Four ways to adjust your Medicare coverage

If you're like most Medicare enrollees, you probably aren't planning to make any changes to your existing coverage for the coming year, but – like most beneficiaries – you should probably at least consider it during Medicare's open enrollment period. And if you have Medicare Advantage, you also have an opportunity to change your coverage between January and March each year.

Medicare enrollees have an annual opportunity to review and adjust their Medicare coverage each year, but that flexibility doesn’t apply to Medicare supplement plans – commonly referred to as Medigap. While Medicare Advantage and Medicare Part D have an annual open enrollment period (October 15 – December 7), federal rules only give Medicare beneficiaries one guaranteed-issue Medigap open enrollment period in their lifetime.

Medigap plans help to pay down costs that Original Medicare doesn’t cover – costs such as deductibles, copays, and coinsurance. Depending on your medical situation, you could need more or less coverage at different times in your life. Unfortunately, having only one Medigap open enrollment period does not give enrollees the flexibility to change plans, at least not affordably.

The truth is that you may or may not be able to change Medigap plans when you need to. That’s because insurance companies can use medical underwriting when you apply for a Medigap plan outside of the Medicare open enrollment period.

All enrollees get a single Medicare open enrollment period

Medigap open enrollment starts the day your Medicare Part B coverage begins and lasts six months. This generally applies to Medicare beneficiaries 65 and older – although some states allow Medicare beneficiaries under 65 to sign up for Medigap plans, too (in that case, the beneficiary will also have another guaranteed-issue open enrollment window for Medigap when they turn 65, under federal rules).

This enrollment period is the one time that qualifying Medicare beneficiaries can sign up for a Medicare supplement plan without medical underwriting. Put simply, it is a time when insurance companies cannot charge you higher rates for any pre-existing conditions you have. In addition, carriers can’t make you wait for their plan’s benefits to kick in.

Signing up for Medigap outside of that window could cost you a lot more. In some cases, insurance carriers could deny you coverage altogether.

Fortunately, there are Medigap protections in place that may qualify you for a special enrollment period. Believe it or not, your birthday may be one of them.

Some enrollees may qualify for Medigap special enrollment

You may qualify for a special Medigap enrollment period if you have guaranteed issue rights. In these cases, insurance companies cannot charge you more based on your medical conditions, put a waiting period on your coverage, and deny you coverage.

The Centers for Medicare and Medicaid has established a list of seven situations that require insurance companies to allow you to sign up for or change a Medigap plan without medical underwriting. This list of events is somewhat limited, but you may have even more options depending on what state you live in.

As of 2022, twelve states offer guaranteed issue rights that go above and beyond what the federal government does (this applies to annual enrollment or plan change opportunities; more than half the states go above and beyond federal requirements in terms of making guaranteed-issue Medigap plans available to beneficiaries under age 65).

A ‘birthday rule’ in six states allows users to switch Medigap plans

Of those dozen states, six have implemented a “birthday rule” that allows Medigap enrollees to switch Medigap plans without medical underwriting around the time of their birthday (the other six have other windows, either year-round, or a specific time of the year, or related to the anniversary of when the person’s current policy was purchased). To qualify, you need to already be on 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. This is an updated birthday rule that took effect on January 1, 2020. Prior to that the special enrollment period was only 30 days long.
  • Idaho: You have 63 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule starts on March 1, 2022.
  • Illinois: You have 45 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. This only applies to plans with your current insurance carrier. To qualify for this birthday rule, you must be 65 to 75 years old. This birthday rule took effect on January 1, 2022.
  • Oregon: You have 30 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. This birthday rule took effect on January 1, 2013.
  • Nevada: 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. This birthday rule took effect on January 1, 2022.
  • Louisiana: You have 63 days from the date of your birthday to select a different Medigap plan with equal or lesser benefits. This only applies to plans with your current insurance carrier.

If you live in one of these states, you may want to take advantage of these birthday rules as long as you understand how they work.

Are ‘birthday rules’ likely in more states?

Life is not predictable and your medical needs may change over time. What you can afford may change too. You deserve the opportunity to find an affordable plan that works for you.

While Medigap is an excellent option for people on Original Medicare, some policyholders may feel that they are locked into Medigap plans with high rates. Guaranteed issue rights can help, but the situations outlined by CMS are limited to very specific situations that apply to relatively few policyholders. (It would be more impactful if all policyholders had these rights – and every year.)

These states are being proactive for your health. As more of them enact these “birthday rules,” more Medicare beneficiaries will have the opportunity to shop around for plans. This will increase the market competition for Medigap plans in those states and could hopefully drive down rates.

Keep an eye out for more “birthday rules” in the future.


Tanya Feke M.D. is a licensed, board-certified family physician. As a practicing primary care physician and an urgent care physician for nearly ten years, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization review and medical necessity compliance. She currently works as a physician advisor at R1 RCM, Inc., where she performs case reviews for hospitals nationwide.

Dr. Feke is an expert in the field, having Medicare experience on the frontlines with both patients and hospital systems. To educate the public about ongoing issues with the program, she authoredMedicare Essentials: A Physician Insider Reveals the Fine Print. She has been frequently referenced as a Medicare expert in the media and is a contributor to multiple online publications. As founder of Diagnosis Life, LLC, she also posts regular content about health and wellness to her site at diagnosislife.com.

Find a plan.