Switching Medicare Supplements, or Medigap plans, can be tough. This is especially true if your client has to answer the required health questions during the switchover process.
Answering these questions can open the door to higher premiums or denied coverage.
Fortunately, some states offer Medicare Supplement enrollees a birthday present every year: the chance for them to change their Med Supp coverage on or around their birthday! Read on to get the scoop on the Med Supp birthday rules.
Speaking of birthdays, never forget to send special wishes on your clients’ big days by setting up automated birthday messages. Learn how
What Are the Birthday Rules for Medicare Suplements?
Purchasing a Medicare Supplement is first available when your client turns 65 and has Medicare Part B. This opens a one-time, six-month Medicare Supplement Open Enrollment Period (OEP). Throughout this time, insurers can’t deny your client coverage or charge them higher rates based on health issues.
After the OEP closes, joining a Medicare Supplement or switching policies generally requires you to go through medical underwriting. Insurers can charge your clients more or reject them based on health conditions if your client doesn’t have a guaranteed issue right.
To combat this hurdle, certain states have implemented Medigap birthday rules. It acts as a sort of Special Enrollment Period (SEP) for Medicare Supplements (but it is not one).
Since each state has its own rules, it’s vital to explain your client’s state’s rules to them.
In Medicare Supplement birthday rule states, policyholders have a window of time around their birthday each year when they can switch to a Medicare Supplement with slight differences in benefits or the same benefits, depending on the state.
Since each state has its own rules, it’s vital you’re able to explain your client’s state’s rules to them. Some states even turn the window of time into a year-round possibility with guaranteed issue rights for plan switches.
What States Have Birthday Rules for Medicare Supplements?
Every state is a little bit different than others when it comes to their insurance birthday rules. It’s also crucial to note that less than half of all the states in the U.S. participate in the birthday rule or something similar. Knowing the rules in the states you sell in is paramount when discussing this topic with your clients.
The table below details which states have birthday rules or rules that have been expanded.
Medicare Supplement Birthday Rules by State
Source: MedicareGuide
1California’s original birthday rule took effect in 1997 but only allowed for a 30-day window.
2Individuals must be between the ages of 65 and 76.
3The original birthday rule was effetive 2018 but the window was expanded to 30 days prior to the birthdate in 2020.
Special Note: CT, ME, NY, VE, and WA do not have a state-specific birthday rule but provide year-round switching. There is no medical underwriting required, and switching at any time is a guaranteed issue right. MO has an anniversary rule that allows for a 60-day enrollment period, beginning 30 days prior to the applicant’s policy anniversary date and they must also choose the same plan as their current plan.
The table shows that a lot of these states have newly updated or created their legislation around birthday rules in the last couple of years. With all these recent changes, you can see a trend that other states may also begin to implement or update their own birthday rules.
Need to help your client through Med Supp underwriting? Dive into our eBook, A Comprehensive Guide to Medicare Supplement Underwriting for a crash course on all things underwriting for Med Supps!
Medigap Birthday Rules FAQs
When Should a Client Use Their State’s Medigap Birthday Rule?
Make sure that your client has a current Med Supp plan as well as resides in one of the states with a birthday rule. If your client is unhappy with their current coverage, they can use the birthday rule to switch carriers or plans, depending on the state.
A client could use the rule to:
- Switch to a lower-cost plan
- Change insurance carriers if they no longer like their current one
- Find another plan with better member care and services
- Change coverage due to changes in their health
Coverage changes will need to be made during the timeframe specified in the state’s birthday rule. Most times, this is during their birthday month. Sometimes it can start before their birthday and end a month after their birthday.
Important Note: In some states, your clients can apply for the new policy at any time during their respective windows, but the coverage may not go into effect until after their birthday. Be sure to check your client’s state-specific rules for further details.
What Are the Benefits of Your Clients Using the Birthday Rule?
Some of your clients may not even know how beneficial a Medigap birthday rule coverage switch could be. Using this rule could help them get:
- Lower premiums
- Coverage changes without medical underwriting
- A better insurance company for better service (despite similar prices and benefits)
What are the Medicare Supplement Birthday Rule Limitations My Clients Should Know?
As with all rules, the birthday rule has its limitations. Some of these include:
- Not available in all states — make sure your client knows whether this is even an option for them.
- They usually can’t switch to a plan with more benefits unless they qualify for guaranteed issue or can pass underwriting.
- If your client misses the deadline to apply, they will likely have to go through medical underwriting to switch plans.
- The plans your client is interested in may not be available, even with the birthday window of time.
Do All Insurers Have to Honor a State’s Birthday Rule?
Most insurance birthday rules differ from state to state. There may be some states where your client can switch to any carrier with differences in the benefits of the plan. There may also be some states where they can only switch to certain carriers or affiliates. If all eligibility criteria are met and the change holds up against the state’s law, then yes, the insurer should honor it.
Can Clients Use Medigap Birthday Rules to Switch to a Medicare Advantage Plan?
No. The switching is only available for Med Supp-to-Med Supp coverage.
Your client would have to wait for the Annual Enrollment Period (AEP), the Medicare Advantage Open Enrollment Period (MA OEP), or another SEP if they wanted to go from a Med Supp to a Medicare Advantage (MA) plan. They could also utilize their MA trial right if they have one.
Do Payments Applied to the Original Plan’s Deductible Carry Over to the New Plan’s Deductible?
No. When your client switches to a new policy, they receive a new deductible amount. A new policy is much like a new contract, even if it’s with the same insurance company. This is especially important in high-deductible plans, like High-Deductible Plan G.
Once your client switches plans, the new plan’s coverage — including the annual deductible — usually becomes effective on the first month after they apply for coverage.
You should help your clients weigh the cost savings of the new policy against the cost of paying their deductible all over again if:
- They are on a high-deductible plan.
- They have made significant payments towards their deductible for the year.
Either option may end up working better for one client over the other. Sitting down with them to discuss these options can help ease their anxiety over the switching and costs.
The Medicare Part B Deductible Exception
There is one, very specific exception in this case. If your client switches from a Med Supp Plan F to a Plan G, their new Plan G will not make them pay the Medicare Part B deductible again. This is only applicable if their previous Plan F already covered it for the year. The exception only works because the Part B deductible is handled by Medicare itself.
How Can I Help a Client Use This SEP?
Because there are so many rules that differ between select states, your clients may be a bit confused on how their specific state’s birthday rule applies to their situation. You can easily help them out by:
- Educating them about the birthday rules in their respective state
- Comparing different Med Supp plans with them to review their options
- Advising them about any coverage gaps they may experience during the switch
- Helping them complete their application for their new desired coverage
And we can help you out, too! Register with Ritter for free today and get access to tools and resources that can help bump up your business to the next level!
Because the birthday rules are not federal and vary on the statewide level, there are so many parts to consider if your clients are looking to switch their Med Supp coverage. With all this knowledge at your disposal, you can be your client’s trusted confidante as you both navigate the complex Medicare world.
You can also confide in us here at Ritter to be there when you need us. Registering with Ritter for free gives you several dynamic ways to enhance your business through our various resource channels!
Not affiliated with or endorsed by Medicare or any government agency.
Share Post