New States Expand Medigap Birthday Rule Protections

Three more states—Wyoming, Virginia, and Utah—have announced they are adopting a Medigap Birthday Rule, giving Medicare beneficiaries in those states more flexibility to change their Medicare Supplement plan without going through medical underwriting. This is great news for those who may have been locked into plans due to pre-existing health conditions.

Let’s break down what this rule means, how it affects your options, and which states currently offer this important consumer protection.

What Is the Medigap Birthday Rule?

The Medigap Birthday Rule is a state-level regulation that gives Medicare beneficiaries a guaranteed window of time around their birthday each year to change their Medigap policy without medical underwriting.

Medical underwriting is the process insurance companies use to evaluate your health history before deciding whether to accept your application or how much to charge. In states without this rule, you can be denied or charged more due to pre-existing health conditions if you’re trying to change your plan outside of your original enrollment period.

The birthday rule allows beneficiaries to:

• Switch to another Medicare Supplement Plan of equal or lesser benefits
• Avoid penalties or denials due to health conditions
• Make changes annually during a predictable window

Guaranteed Issue Rights vs Medigap Birthday Rule

Guaranteed Issue Rights are federal protections that allow you to buy a Medigap policy without being denied coverage or charged more due to health issues.

Normally, these rights apply during certain situations, and they are not confined to the state you reside in. Losing creditable coverage or your insurer going bankrupt are both examples of situations that would grant you Guaranteed Issue Rights. The Medigap Birthday Rule effectively adds another guaranteed window each year to make changes (in states that allow them), which is especially valuable for those with pre-existing health concerns.

When Can I Change My Medicare Supplement Plan?

Generally, you can apply to change your Medicare Supplement Plan any time of year. Contrary to popular belief, you do not have to wait until the Annual Enrollment Period (AEP) to change your Medicare Supplement Plan. AEP—held each fall from October 15 to December 7—only applies to Medicare Advantage and Part D drug plans, not Medigap policies.

However, unless you qualify for a Guaranteed Issue period or a Medigap Birthday Rule, you may be subject to medical underwriting. That means the insurance company can review your health history and potentially deny coverage or charge more based on pre-existing health conditions. If your state has adopted a Medigap Birthday Rule, you may have a special annual window to change Medicare Supplement plans without underwriting, making it easier and safer to shop for better coverage.

It is most advantageous to change plans:

• During a birthday rule window (if your state has one)
• During your Open Enrollment Period (when you first get Medicare Part B)
• After certain qualifying events, like losing creditable coverage

If you’re in a birthday rule state, you’ll have a set number of days (typically 30 to 60) surrounding your birthday to make changes without underwriting.

States With Medicare Supplement Birthday Rules

As of June 2025, the following states have enacted Birthday Rules for Medigap policies:

• California
• Oregon
• Idaho
• Oklahoma
• Kentucky
• Nevada
• Illinois
• Louisiana
• Maryland
• Wyoming (Effective June 4, 2025)
• Virginia (Effective July 1, 2025)
• Utah (Effective May 7, 2025)

While not technically birthday-based, Missouri allows a switch during the anniversary month of your current plan, with similar guaranteed protections. Connecticut, New York, Vermont, and Washington have year-round Open Enrollment, but enrollment rules vary in each state. Additionally, Maine and Massachusets have expanded state Guaranteed Issue rights. For more specific information on any of the above-mentioned states, be sure to consult with your AMAC Medicare advisor.

Key Takeaway

The expansion of the Medigap Birthday Rule to Wyoming, Virginia and Utah is a win for Medicare beneficiaries. It helps protect your right to switch Medigap plans without worrying about medical underwriting or pre-existing health conditions. If you live in one of the states with a birthday rule, mark your calendar and take advantage of your annual window to review your coverage. You may be able to save money or get better benefits without sacrificing coverage due to your pre-existing health conditons.

Be sure to follow us to stay informed on your state’s Medigap rules as they change, or speak with an experienced AMAC Medicare advisor today. Share this article with friends and family to help spread the word about these important protections!

For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote here.