Navigating the Medicare Birthday Rule: What Every Agent Should Know

Navigating the in’s and out’s of Medicare can be difficult, especially when you consider the rules and regulations surrounding it.

Although a fairly new term, and one that isn’t frequently discussed, is the “Birthday Rule“. This rule is a key aspect of Medicare that agents and beneficiaries should know about.

The Birthday Rule applies to those who are currently enrolled in a Medigap (Medicare Supplement) plan. The rule gives beneficiaries an annual opportunity to switch their Medigap plan during their birth month without medical underwriting.

Our post will provide you with a clear understanding the Birthday Rule, how it can benefit your clients, and the knowledge you need to help them make informed coverage decisions.

How Does the Rule Affect Clients?

The Birthday Rule directly affects beneficiaries looking to change their supplemental coverage.

It works like this:

The Birthday Rule allows Medigap members to switch to another Medigap plan with the same or lesser benefits without undergoing medical underwriting. This is an annual opportunity that comes around the beneficiary’s birthday.

This rule was created to protect beneficiaries from being locked into a Medigap plan they may no longer need or are unable to afford.

Typically, the rule provides a 30-day window after a beneficiary’s birthday to switch plans.

*It’s important to remember that the new plan must have the same or less benefits. Plan upgrades are not allowed without underwriting.*

The Birthday Rule: State by State

The Birthday Rule is not a federally mandated ruling. Currently, twelve states have adopted the rule. It’s important to note that each participating state has it’s own eligibility requirements and regulations.

State variations include:

• Length of enrollment period
• What plans beneficiaries can enroll in
• If beneficiaries can change carriers

Here’s a deeper dive into state specific regulations:

California:

• Change is active 30 days before the beneficiaries birthday and ends 60 days after
• Can switch to a plan of equal or lesser benefit with any carrier, without underwriting

Oregon:

• Change is active on the beneficiaries birthday and ends 31 days after
• Can switch to any plan of equal or lesser benefit with any carrier, without underwriting

Idaho:

• Change is active on the beneficiaries birthday and ends 31 days after
• Can switch to any plan of equal or lesser benefit with any carrier, without underwriting

Illinois:

• Applies to those 65-75 years old
• Change is active on the beneficiaries birthday and ends 45 days after
• Can switch plan type but can’t switch carrier
• The new plan must be equal or lesser benefit and does not require underwriting

Louisiana:

• Change is active 30 days before the beneficiaries birthday and ends 63 days after
• Can switch plan type but can’t switch carrier
• The new plan must be equal or lesser benefit and does not require underwriting

Maryland:

• Change is active on the beneficiaries birthday and lasts 30 days after
• Can switch to any plan of equal or lesser value with any carrier, without underwriting

Nevada:

• Change is active on the first day of the beneficiaries birth month and lasts 61 days
• Can switch to any plan of equal or lesser value with any carrier, without underwriting

Oklahoma:

• Change is active on the beneficiaries birthday and lasts 60 days after
• Can switch to any plan of equal or lesser value with any carrier, without underwriting

Kentucky:

• Change is active on the beneficiaries birthday and lasts 60 days after
• Can switch to a different carrier but can’t switch plan type
• The new plan must be equal or lesser value and does not require underwriting

Utah:

• Change is active on the beneficiaries birthday and lasts 60 days after
• Can switch to any plan of equal or lesser value with any carrier, without underwriting

Virginia:

• Change is active on the beneficiaries birthday and lasts 60 days after
• Can switch to any plan of equal or lesser value with any carrier, without underwriting

Indiana:

• Change is active on the beneficiaries birthday and lasts 60 days after
• Can switch to a different carrier but can’t switch plan type
• The new plan must be equal or lesser value and does not require underwriting

If your clients reside in these states, this rule may be something they would like to take advantage of. It’s important that you, as their agent, understand the state specific rules and communicate with clients.

*Other states are considering implementing the Birthday Rule – that’s why it’s important to stay up to date on Medicare news…but as always, as a Tidewater partner, we make sure to provide you with all the industry updates you need. We are monitoring this closely and will give you updates as they come.*

Going Forward: Agent Guide

Reach out to us here at Tidewater with questions. We are here to assist and guide you!