Medicare Supplement Birthday Rule: A Disappointing Surprise or a Helpful Option?
You may have heard that your birthday gives you a chance to change your Medicare Supplement plan, without going through medical underwriting.
It’s called the Medicare Supplement Birthday Rule. For many seniors, it sounds like a welcome opportunity to save money or get better coverage.
However, before you get too excited, there are some limitations you need to know about.
The Medicare Supplement Birthday Rule can be helpful for some seniors, but it’s not as generous or universal as many people think. If you live in a state where the birthday rule applies, there may be a short window each year when you can shop for a lower cost Medigap plan.
There are caveats, and those can be disappointing if you’re expecting more freedom or better rates. Let’s break it down in clear terms, so you can decide whether the birthday rule is actually worth acting on.
Table of Content
1. What Is the Medicare Supplement Birthday Rule?
2. How the Medicare Birthday Rule Works by State
3. Why Some Seniors Find the Birthday Rule Disappointing
4. The Fine Print to Watch Out For
5. Is the Medicare Supplement Birthday Rule Worth It?
6. Don’t Miss an Opportunity or Get Caught Off Guard
What Is the Medicare Supplement Birthday Rule?
The Medicare Supplement Birthday Rule gives some seniors a limited opportunity to change their Medigap plan each year without facing medical underwriting. That means you can apply for a new Medicare Supplement plan without having to answer questions about your health or undergo a review of your medical history.
But there’s a catch: this rule is only available in certain states, and it comes with tight restrictions.
If you live in a state, like Nevada, where the birthday rule for insurance coverage applies, your Medicare Supplement plan options are limited to the same or lesser benefits, meaning you can’t upgrade to a more comprehensive plan. You’re allowed to switch only to another plan with equal or fewer benefits than the one you already have.
Furthermore, only some insurance companies in those states offer plans that fall under the rule.
How the Medicare Birthday Rule Works by State
Each state that adopts the birthday rule has its own version. Let’s look at a few examples:
Nevada
Nevada adopted its own version of the birthday rule in 2023. Here’s how it works:
- If you already have a Medigap plan, you get a 60-day window starting on your birthday month to switch to a plan with equal or lesser benefits, without facing medical underwriting.
- This applies regardless of your health, but only to insurance plans with the same letter designation (like Plan N to Plan N).
- You must already be enrolled in a Medicare Supplement insurance plan to qualify, and not all insurance companies may offer the same options in your area.
This rule was part of broader efforts to give Medicare beneficiaries more flexibility without penalizing them for preexisting conditions, but it’s still important to act within your birthday window and compare rates carefully.
California & Oregon
These two states have the most widely known versions of the birthday rule.
- The California Birthday Rule gives you a 60-day window starting on your birthday to switch to another Medigap plan with equal or lesser benefits—no medical underwriting.
- In Oregon, the window is slightly shorter: 30 days from your birthday.
Both states limit you to switching between plans offered by the same Medigap carrier or another insurer that offers the same letter plan (e.g., Plan G to another Plan G).
Idaho & Illinois
In Idaho, the birthday rule applies for a 63-day window starting on your birthday, but only if you’ve had your current Medigap coverage for more than a year. Illinois offers a similar rule for people aged 65 to 75, with a 45-day switch period tied to the beneficiary’s birth month.
It’s important to note that not all insurance plans in these states participate equally, and some insurance companies make switching more complicated than it needs to be.
Check Your Eligibility Under Birthday Rule
Why Some Seniors Find the Birthday Rule Disappointing
On paper, the Medigap birthday rule sounds like a win. In practice, it can sometimes feel like a letdown.
Here’s why:
- Not every state offers it. If you don’t live in California, Nevada, Oregon, Idaho, or Illinois, the birthday rule doesn’t apply to you.
- You can’t upgrade. You’re only allowed to switch to a plan with equal or lesser value. If you’re hoping to go from a Plan N to a Plan G, for example, you’re out of luck.
- Insurers don’t always make it easy. Some insurance companies don’t actively advertise this window, or they may create unnecessary red tape.
- Rates may still go up. Even if you switch to the same plan with another carrier, your out-of-pocket costs may not go down. You might even pay more depending on your financial circumstances or location.
- States with Birthday open enrollments generally have higher Medigap premiums, so you might pay more overall in premiums in exchange for the flexibility to switch your plan each year.
The result? Some Medigap policyholders feel misled when they find out just how limited their options really are under the birthday rule.
Make the Most of Birthday Rule
The Fine Print to Watch Out For
Let’s take a closer look at the details that can trip you up:
- You only have a short window (often 30 to 60 days after your birthday) to switch plans.
- You can only switch to the same plan letter (like Plan G to Plan G), and only if the plan has equal or lesser benefits.
- Not every insurance company offers every plan in every ZIP code
- If you miss the window, you may be subject to health underwriting again—unless you qualify for a different special enrollment opportunity.
No matter your situation, knowing how the birthday rule works in your state and which insurance companies participate is the first step toward avoiding frustration.
Is the Medicare Supplement Birthday Rule Worth It?
For most seniors, the answer is likely yes.
If you’ve had a Medicare Supplement insurance plan for a while and your coverage is active, the birthday rule might help. It lets you switch to another plan with similar benefits, without going through health questions or medical underwriting. In some cases, you may even find a plan with lower premiums.
However, if you’re looking to increase coverage, change plan types, or find a cheaper premium in a tight health insurance market, you may be disappointed.
That’s why it’s a smart move to speak with a licensed Medicare broker who understands your local market. They will walk you through your options, explain how primary coverage and secondary coverage might be affected, and help you avoid losing benefits or paying more.
Review Your Medicare Plan This Birthday
Don’t Miss an Opportunity or Get Caught Off Guard
The Medicare Supplement Birthday Rule can be a helpful tool, but only if you know how to use it.
If you live in a birthday rule state like Nevada, mark your calendar each year. Keep in mind the same birthday, equal or lesser benefit rule, and narrow switch window.
If you don’t live in a qualifying state, be ready to act during your Medicare Open Enrollment period or if you qualify for a Special Enrollment Period due to other life events.
Live in Nevada and wondering how the birthday rule applies to you under Medicare in Reno? Not sure if your current Medigap plan still fits your needs?
Senior Insurance Agency, based right here in Reno, is here to help. Our local, licensed agents know the ins and outs of Nevada’s Medicare rules, including the new birthday rule. We’ll help you compare Medicare Supplement plans in Nevada with zero pressure, just clear answers.
Reach out to our team today to discuss health plans.
About the Author: Aliana Rushing
I have worked at Senior Insurance Agency since 2016, and became a licensed insurance agent in 2018. I specialize in senior products (Medicare Supplement, Medicare Advantage Part C, and Part D). I take much pride in my work and in providing my clients with exceptional service. My approach to Medicare…