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What is the Medicare Birthday Rule in Nevada?

Did you know that Medicare Supplement enrollees have an annual opportunity to review their Medicare Supplement policies each year? In fact, you can consider it an extra little birthday present of sorts.

Many Medicare beneficiaries purchase Medicare supplement plans in addition to their original Medicare coverage. Also known as Medigap plans, these supplemental policies provide coverage for out-of-pocket medical after Original Medicare, such as copays, coinsurance, and deductibles.

Nevada’s Medicare birthday rule allows policyholders to change their Medicare supplement plan each year around their birthday without going through the medical underwriting. 

Here’s what you need to know about the Birthday Rule.  


Unveiling The Birthday Rule (AB250)

Medicare beneficiaries only have one open enrollment period for Medicare supplement plans. This period starts when your Medicare Part B coverage begins and lasts for six months. 

To join a Medicare Supplement plan after this period, most beneficiaries will need to undergo medical underwriting to join their supplement plan, which means that your insurance company does not have to accept your enrollment on to the plan.

In 2022, Nevada became one of several Medicare birthday rule states. These states have implemented an annual open enrollment period for Medigap, which makes it easier for beneficiaries to switch to a different company without medical underwriting. This birthday rule is only available to those who are already Medicare Supplement policyholders; it is not available for those who chose not to join a Medigap policy when their Part B started.

In short, this means you can switch carriers without going through medical underwriting. 

With the Nevada birthday rule, your open enrollment period will start on the first day of your birth month, regardless of your exact birthdate. This period lasts 60 days, during which you can switch to a new Medigap policy with equal or lesser benefits.


Exercising Your Rights Under The Birthday Rule

Medicare supplement plans are administered by private insurance companies and regulated by the state Division of Insurance and the National Association of Insurance Commissioners (DOI & NAIC).. This means that different states can have different laws in place for their Medicare supplement policies.

Over time, you might find that you want to switch plans, typically due to premium increases or a poor experience with your insurance provider. This is a common occurrence, and one Nevada has accounted for.

The Medicare Supplement birthday rule provides a convenient opportunity to review and potentially switch your Medigap plan. This can mostly help in lowering your premium costs while maintaining the same coverage.  

Here’s how it works in Nevada:

How Does The Enrollment Period Work?

Senior Insurance Agency can help you compare potential plan options from the 21 insurers who offer Medigap plans in Nevada.

Of course, the Medigap birthday rule still has some limitations – you can only change to supplements with equal or lesser coverage. This means you cannot switch to a plan with higher benefit levels without medical underwriting. 

For example, if you are currently on a Plan G, you can switch to another carrier offering a Plan G, or you can reduce your coverage to a Plan N. However, if you are on a Plan N, and you want to increase your benefits by applying for a Plan G, you would be subject to medical underwriting since the law does not allow changes to greater coverage than the policy you currently hold. 

This open enrollment is only for reviewing Medigap policies, so you cannot switch from a Medigap plan to a Medicare Advantage plan during this time.

The Benefit of Guaranteed Acceptance 

One of the biggest benefits of the birthday rule for Medicare in Nevada is the guaranteed issue of your new plan. There’s no need to go through medical underwriting, which is when insurance companies review your medical history before deciding on your eligibility.

This means that even if your health has changed over the past year, you can still switch plans without worrying about pre-existing conditions. There’s no fear of being rejected or charged higher premiums due to your medical history.

Key Considerations for Using the Birthday Rule

Associated Costs

Keep in mind that switching Medigap plans during the birthday rule period may come with financial implications. While the rule allows for a change without medical underwriting, you should be aware that new premiums may apply.

This is typically the most beneficial reason to change during this period. Many times, you will only change if it lowers your premium amount while maintaining the same coverage. 

At Senior Insurance Agency, we can help you review these options to determine whether or not it is in your best interest to change your Medigap policy.

Provider Network

Another benefit to the Nevada Open Enrollment Birthday Rule is the access to the Medicare Provider network. 

For Medicare Supplement plans, each carrier has a contract with Medicare for electronic claims filing, called Claims Crossover. This means that the provider you see does not need to have a contract with your Medicare Supplement plan, they only need to be contracted with Medicare. 

When your provider is contracted with Medicare, they will bill Medicare for the services rendered, and Medicare will then electronically notify your Medicare Supplement plan. The Supplement policy will pay your provider as secondary once they receive the electronic claims crossover from Medicare.

This is a great thing about the birthday rule – changing your plan does not change your provider network. You can review plans and lower your premium cost, while maintaining coverage with all your current doctors.


Find Your Medigap Plan With Senior Insurance Agency

Although the federal rules for Medigap enrollment are strict, Nevada residents have more flexibility with the birthday rule. This annual enrollment period gives beneficiaries the option to switch plans each year as their needs change.

Understanding the ins and outs of Medicare can be overwhelming, especially when there are so many plans to choose from. At Senior Insurance Agency, our knowledgeable insurance agents are here to guide you through the process. 

We’ll get to know you and your healthcare needs and recommend plans to help you make an informed decision. We’ll also show you how to apply for Medicare in Nevada and answer any questions you have. 

Ready to find your Medigap plan? Give us a call today to get started. 

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FAQs About the Medicare Birthday Rule

The Nevada Birthday Rule Law was passed through the dedicated efforts of several key stakeholders, including the Senior Insurance Agency, which collaborated closely with the Nevada State chapter of the National Associations of Benefits and Insurance Professionals (NABIP). 

This partnership focused on advocating for policies that would benefit consumers, particularly by allowing them to change their Medicare Supplement plans without undergoing new medical underwriting during their birth month. The combined efforts of these organizations were crucial in highlighting the need for greater flexibility and accessibility in health insurance options for Nevada residents.

Following the successful passage of the Birthday Rule Law, Senior Insurance Agency continued its advocacy work by addressing the issue of brokers’ commission rights. Recognizing that brokers play an essential role in helping clients navigate complex insurance options, the agency worked on a follow-up law that protected brokers’ commission rights, ensuring they could provide valuable services without compromising their livelihood. 

Through their significant contributions to the drafting of AB 250 via the NABIP – Nevada association, Senior Insurance Agency ensured that brokers could continue to offer client-focused guidance while maintaining financial stability.

The Medicare birthday rule exists to provide greater flexibility and accessibility to Medicare beneficiaries in specific states, like Nevada. It allows beneficiaries to review and adjust their Medigap plans annually to better meet their healthcare needs without facing the barriers of medical underwriting.

This rule acknowledges that healthcare needs and financial situations can change over time and provides an opportunity for individuals to switch to plans that may offer more suitable coverage or lower premiums.

Open Enrollment and Guaranteed Issue are two separate periods related to Medicare supplement plans.

Open Enrollment is a six-month period that begins when a person first enrolls in Medicare Part B, during which they can purchase any Medigap policy available in their area without undergoing medical underwriting. This means insurers cannot deny coverage or charge higher premiums due to pre-existing conditions during this time.

In contrast, Guaranteed Issue rights arise in specific situations outside the Open Enrollment period, such as when a person loses other health coverage involuntarily. During a Guaranteed Issue period, insurers must offer certain Medigap policies without medical underwriting, but the choice of plans may be more limited compared to Open Enrollment.

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We do not offer every plan in your area. Currently, we represent (See Below) organizations which offer (See Below) products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
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