The Medicare Supplement Birthday Rule allows beneficiaries (who reside in certain states) to change their Medigap plans each year without undergoing medical underwriting. This rule offers a Guaranteed Issue Right that allows Medicare beneficiaries to make changes to their Supplement policies without facing the usual restrictions related to medical underwriting.

Medical underwriting typically involves a review of the applicant’s health status, and pre-existing conditions may impact the ability to obtain coverage or affect premium rates. Bypassing medical underwriting gives the beneficiary a window to obtain new coverage they may not have been able to qualify for otherwise.

Key Features of the Birthday Rule:

1. Annual Opportunity: The Medicare Supplement Birthday Rule provides an annual window during which beneficiaries can switch or upgrade their Medigap plans without being subject to medical underwriting.
2. Limited Time Frame: Beneficiaries have a limited time frame to make changes to their policy. Specific time frames depend on the state the beneficiary resides in, but it usually surrounds their birthday each year.
3. No Medical Underwriting: The biggest advantage of the Medicare Supplement Birthday Rule is that insurance companies cannot deny coverage or charge higher premiums based on the individual’s health status. This is particularly beneficial for those who may have developed health conditions since initially enrolling in their Medigap plan.
4. Like-to-Like Coverage: Beneficiaries can typically switch from one Medigap plan to another with similar or lesser coverage, but specific rules vary depending on the state.
5. Guaranteed Issue Rights: The Birthday Rule grants beneficiaries guaranteed issue rights, ensuring that insurance companies must offer coverage without medical underwriting.

How to Utilize the Birthday Rule: To take advantage of the Medicare Supplement Birthday Rule, beneficiaries should follow these steps:

1. Determine Eligibility: Confirm eligibility for the Birthday Rule by checking if your state allows them and what the time frame is to make changes.
2. Research Options: Explore available plans to identify a policy that better suits your current healthcare needs.
3. Contact an Insurance Brokerage: Inquire about plan options and coverage details, then provide necessary information, such as your current Supplement plan and birthday.
4. Enroll in the Chosen Plan: Once a suitable plan is identified, proceed with the enrollment process within the time window. Insurance companies are typically obligated to accept the application without medical underwriting during this period.

The Medicare Supplement Birthday Rule offers beneficiaries flexibility and ensures that individuals can adapt their coverage to better meet their changing healthcare needs as they age. Don’t wait to check if you may be eligible for the birthday rule, our dedicated Medicare advisors are here to help!

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