All Medicare enrollees have an annual opportunity, called the AEP, or Annual Election Period,  to review and adjust their Medicare coverage.  Many enrollees think that this applies to their Medicare Supplement Plan (AKA Medigap), but this enrollment period doesn’t allow you to change to a Medicare Supplement (Medigap) without medical underwriting (medical underwriting is where the insurance company looks at your health to decide whether they will allow you into their plan).

The AEP (October 15 through December 7th of every year) only applies to Medicare Advantage and Prescription Drug Plans, not Medigap plans.

Most people only get one Medigap open enrollment period in their lifetime, and that is when the Medicare Part B effective date starts and ends six months later.

Medigap plans are more flexible than Medicare Advantage Plans, but they can also cost more every month than Medicare Advantage Plans.  Many people select a Medicare Advantage plan without knowing the disadvantages of those plans.  For more information on the pros and cons of Medicare Advantage and Medigap plans, enroll in our free classes at https://MedicareQuick.com/Class

Because most states do not have more than one Open Enrollment Period, people starting Medicare for the first time need to understand the differences between these two plans.  And, because you may not be able to change from one Medigap plan to another once you start, you need to make sure that you “marry” the right company.

This is because you might not be able to change plans in the future when your health changes.  This is because insurance companies can use medical underwriting when you try to enroll beyond the Medigap open enrollment period (which is only once in your lifetime).

Only One Medigap Open Enrollment Period

As I mentioned earlier, the Medigap Open Enrollment Period, or MOEP,  starts on your Part B effective date and lasts for six months.  However, in most states, you must also attain the age of 65, so the MOEP generally does not apply when you’ve become eligible for Part B because of Social Security Disability.

During the MOEP, the insurance company can reject your application due to health issues.  Or they can accept your application but charge you a higher rate than healthier people.

Guaranteed Issue Rights

In addition to the MOEP, there are certain times when you have Guaranteed Issue Rights.  If you are eligible for a Guaranteed Issue Right, the insurance company must accept you into their plan.

And if you have Guaranteed Issue Rights, the insurance company cannot charge you more than a healthy person or make you wait before they cover your medical condition.

Guaranteed Issue Rights (GI) are different from the MOEP because they are based on specific circumstances happening.  Additionally, many insurance brokers will not want to assist you in using a GI right because in most cases, they will not be compensated for doing so.  However, they are important to be aware of.

Some states have more GI rates than the CMS rules.  However, all states include the following GI rights:

  • Your Medicare Advantage Plan is ending, or you are leaving its service area.
  • Your employer group plan is ending (and you have Medicare).
  • You have Medicare SELECT, and you are leaving its service area.
  • You have a TRIAL right (you started Medicare Advantage when you were first eligible for Medicare at age 65, and you want to switch to original Medicare within the first year of joining).
  • You dropped your Medigap Plan for the first time to join a Medicare Advantage Plan or a SELECT plan.  It’s been less than one year, and you want to change back.
  • Your Medigap Plan ends through no fault of your own.  For example, the company went bankrupt.
  • You leave a Medicare Advantage Plan (or another Medigap plan) because the company misled you or didn’t follow the rules.

Some states, including CA, CT, ID, IL, MA, ME, MO, NV, NY, and OR have additional Guaranteed Issue or Open Enrollment periods.

Birthday Rules

There are several states who have “Birthday Rules” which allow you to switch from one Medigap plan to another.  Those states are CA, ID, IL, OR, and NV. Birthday rule changes are generally considered Open Enrollment and thus, insurance brokers are happy to help you make these changes.

Keep in mind that the birthday rules only allow you to make a change to your Medigap Plan.  They do not allow you to go from Medicare Advantage to Medigap plans without underwriting.  The birthday rules also do not allow you to change your drug plan.  You must make those two changes during the Annual Election Period.

California allows you to change from one carrier to another, and you can also change your plan level to the same or a lower plan level within 60 days of your birthday.  At other times in the year, you will be subject to medical underwriting.  This means that even if you are accepted, you could have to pay more than a healthy person or be subject to waiting periods for your medical condition to be covered.

Idaho’s birthday rule works the same way but you have 63 days from your birthday to make a change.

Oregon also allows you to change insurance carriers, and change to the same or a lower level of benefits, but you have 60 days from the first day of your birth month, not your birthday.

Similarly, NV allows you 60 days from the first day of your birth month to make a change to another carrier or plan with the same level or lower level of benefits.

Illinois, on the other hand, does not let you change insurance carriers.  The IL birthday rule allows you to change to another Medigap plan with the same level or lower level of benefits within 45 days of your birthday.

Because these birthday rules generally require that the insurance company cover you at the same premium they would a healthy person, without waiting periods, we usually recommend that our clients who are eligible for a birthday rule change wait until then to make a change.

We reach out to our clients when it is getting close to their birthday. Even if you live in a state that does not offer the “Birthday Rule” it is important it is to talk to your agent every year about your current plans. Give us a call to speak with a licensed agent at (866) 445-6683 (TTY 7-11 M-F 9 am to 5 pm) or We reach out drop us a message HERE, if you have any questions.

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Medigap Guaranteed Issue and Birthday Rules

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