What Is the Medigap Birthday Rule—And What Happens After I Use It?

If you’ve ever wanted to switch your Medigap (Medicare Supplement) plan but thought, “It’s too late” or “I’ll probably get denied,”—good news: You might have a second shot, and it all revolves around your birthday.

Key Takeaway: The Medigap Birthday Rule gives you a chance to change Medigap plans without going through underwriting—just for a short window around your birthday. But the rules vary by state, so timing is everything.

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Wait—There’s a Birthday Rule for Medicare Supplements?

Yes, and it’s one of Medicare’s best-kept secrets.

The Medigap Birthday Rule is a special guaranteed issue period that lets you switch Medigap plans without medical questions, usually around your birthday.

That means:

  • No new underwriting

  • No health exams

  • No being turned down for pre-existing conditions

But here’s the kicker: Not every state has this rule.

What States Have the Medigap Birthday Rule?

As of now, the rule applies in these states (with slightly different guidelines in each):

  • California

  • Oregon

  • Idaho

  • Illinois

  • Nevada

  • Missouri (has a similar anniversary rule, not birthday-based)

⚠️ Texas does not currently have an official Medigap Birthday Rule, but if you move to or from a state that does, or your current plan changes, you may still qualify for guaranteed issue rights.

That’s why it’s important to review your situation annually—especially if you're thinking about switching Medigap plans or moving states.

How the Birthday Rule Works (If You’re in a State That Has It)

Let’s say you're in California. Here’s how it would go:

  • You get a 60-day window starting on your birthday

  • During that time, you can switch to any plan of equal or lesser coverage (e.g., G to G, or F to N)

  • The insurance company can’t deny you due to health issues

Each state has slightly different rules (some only give 30 days, some allow more flexible plan options), so don’t assume they’re all the same.

What Happens After the Window Closes?

Once your birthday rule window passes, you're back to full underwriting—meaning:

  • You could be denied based on your health

  • Premiums could go up

  • Your switching options shrink

💡 This is why working with a local, independent agent is so important—we track your eligibility and timing so you don’t miss your shot.

People Also Asked

Can I switch Medigap plans any time?

Technically, yes—but unless you're in a guaranteed issue period (like a birthday rule window), you’ll likely go through medical underwriting.

What if I don’t live in a birthday rule state?

You still may qualify to switch under other guaranteed rights, like if your plan exits the market, you move, or you’re new to Medicare. A local broker can walk you through your options.

How do I know if switching Medigap plans is worth it?

We help you compare your current rate, benefits, and upcoming changes against what’s available—so you’re not overpaying or stuck in a plan that no longer fits.

Don’t Miss Your Window—Or Get Stuck in the Wrong Plan

The Medigap Birthday Rule is one of those “if you know, you know” things—and now? You know. 🎉

At Gruene Insurance Group, we’ll help you:

  • See if you qualify for guaranteed switching rights

  • Compare updated plan rates and options

  • Avoid unnecessary underwriting or confusion

📞 Contact us today to schedule a quick Medicare review. Whether it’s your birthday, your move, or your “maybe I should switch” moment—we’ve got you covered.

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