What is the Medigap Birthday Rule?
Are you an agent with Medicare clients in California or Oregon? If so, be sure you understand the birthday rule, a yearly opportunity to switch Medicare Supplement companies WITHOUT underwriting.
Read the following questions and answers to understand how the rule works so you can keep your customers informed.
What is the Birthday Rule?
In California and Oregon, legislation has mandated that Medicare Supplement beneficiaries can compare prices and switch companies each year on their birthday. (Do you live in Missouri, Connecticut, Washington, New York or Maine? See end of post for their guarantee issue dates)
What time frame can you make changes?
If your Medicare customers are already on a Medicare Supplement they…
“qualify for an annual one-month Open Enrollment Period in the following way):
During the individual’s birthday month for those replacing another Medicare supplement plan (including Medicare Select). The enrollment application must be received during the month prior to, during, or the month after the individual’s birthday month.” 9
Why would someone change plans?
The main reason people may change plans is to get a lower rate on the same plan with another company or switch to lesser coverage. If they are paying a higher Medicare Supplement plan premium with their current company and wish to switch a Medicare Supplement Plan with another company of equal or less benefit level, they may do so during this period. Meaning they may move from a Plan N with their current company to a Plan N or plan of lesser value. However, United Health Care currently allows them to move to any plan, including a higher plan, if they are on or switch to a United Health Care plan.
Who qualifies and are you subject to health underwriting?
The birthday rule is open to residents of California and Oregon ONLY and who currently have a Medicare Supplement Plan. The change is guaranteed, regardless of your health, because there is NO UNDERWRITING required during the Birthday Rule period.
If you live in Missouri, Connecticut, Maine, Washington, or New York then see below for their enrollment periods and guarantee issue rules.
“You have the right to switch insurance companies each year during the 30 days before or after your policy’s anniversary date (the date on which your policy first started). For example, if your policy expires June 30, you can switch policies between June 1 and July 30. You can call the insurance company to get your anniversary date. If you change to the same-lettered plan – for example, from Plan F at Insurer XYZ to Plan F at Insurer ABC, the new insurer cannot deny you coverage and cannot impose a waiting period based on pre-existing conditions. If you change to a plan with fewer benefits, such as from Plan F to Plan C, you may or may not be subject to underwriting when an insurance company considers your health. Not all insurers allow you to change to a plan with fewer benefits. If you elect to go with a more extensive plan (later in the alphabet, such as from Plan C to Plan F) you will likely be subject to underwriting, and may be denied coverage or the insurance company may impose a waiting period, based on a pre-existing condition, for any new benefits under your new plan.” 3
“Beneficiaries can enroll or change their Medigap policy at any time. Plans are available on a guaranteed issue basis at all times and rates may not vary based on applicant’s age, gender, or health status. A pre-existing condition limitation may apply if applicant has no prior creditable coverage or has experienced a gap in coverage.” 4,5
“If you’re already enrolled in a Medigap plan B through N, you can switch at any time to another Medigap plan B through N. If you have a Medigap plan A, you can switch to any other Medigap plan A. In either of these situations, you do not have to take a written health screening questionnaire.” 8
“Any insurer writing Medigap insurance must accept a Medicare enrollee’s application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services.” 6
“In Maine, each insurer must designate at least one month each year during which an individual can enroll in Plan A, whether or not the individual is in their Open Enrollment period.” 7 To view the Guarantee Issue period for each company, see page 13 of the Medicare Supplement Guide.
We are happy to help with all your Medicare questions. Contact us and speak with our friendly agents representatives. CONTACT US HERE
- “AARP Medicare Supplement Insurance Plans, Producer Handbook by United Health Care, 2017”
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