If you have a Medicare Supplement (Medigap) plan and your premiums keep climbing, your birthday might be the key to a better deal. The Medicare birthday rule is a state-level protection that gives you a short window each year to switch Medigap plans without medical underwriting, meaning your health history will not be held against you.
Confused about whether you can switch your Medigap plan? Talk to an independent Medicare broker who can walk you through your options at no cost to you.
As of 2026, 16 states have adopted some version of the birthday rule, and more are considering it. But the details vary widely. Some states let you switch to any carrier. Others limit you to the same insurer. Some give you 30 days; others give you 63.
This guide breaks down exactly what the Medicare birthday rule is, which states have it, how each state’s version works, and what to do if your state does not offer this protection.
What Is the Medicare Birthday Rule?
The Medicare birthday rule is a state-level consumer protection that grants Medigap policyholders a guaranteed-issue window around their birthday each year. During this window, you can switch your Medigap plan without going through medical underwriting. That means insurance companies cannot deny you coverage or charge you more based on pre-existing health conditions.
Under federal law, you get just one Medigap open enrollment period in your lifetime. That six-month window begins when you turn 65 and enroll in Medicare Part B. After it closes, insurers in most states can use medical underwriting to decide whether to accept your application or how much to charge.
The birthday rule changes that. In states that have adopted it, you get a fresh chance every year to shop for lower premiums or better coverage terms on your Medigap plan.
How Does the Medicare Birthday Rule Work?
While the specifics differ by state, the birthday rule generally works like this:
- A window opens around your birthday. Depending on your state, the window may start 30 days before your birthday and extend 30 to 63 days after it.
- You can apply for a new Medigap plan. The insurer must accept you at the standard rate for your age, regardless of your health status.
- Restrictions on plan type may apply. Most states limit you to a plan with equal or lesser benefits than what you currently hold. A few restrict you to the exact same plan letter (for example, Plan G to Plan G).
- Carrier rules vary. Some states let you switch to any insurance company. Others require you to stay with your current insurer or an affiliated company.
- Your new coverage begins after your current plan ends. There should be no gap in coverage if you time the switch correctly.
Ready to find out if you can save on your Medigap premiums this year? Call The Big 65 at 877-850-0211 for a free, no-pressure consultation.
Which States Have the Medicare Birthday Rule in 2026?
As of 2026, 16 states have enacted some form of the Medicare birthday rule. The table below summarizes each state’s rules, including the switching window, what types of plan changes are allowed, and whether you can switch carriers.
| State | Window Length | Plans You Can Switch To | Can You Change Carriers? | Year Enacted |
|---|---|---|---|---|
| California | 60 days from birth month | Equal or lesser benefits | Yes | 2020 |
| Delaware | 30 days before to 30+ days after birthday | Same or lesser benefits | Yes | 2026 |
| Idaho | 63 days from birthday | Equal or lesser benefits | Yes | 2022 |
| Illinois | 45 days from birthday (ages 65-75) | Equal or lesser benefits | Same insurer or affiliate (as of 2026) | 2022 |
| Indiana | 60 days from birthday | Same plan letter only | Yes | 2026 |
| Kentucky | 60 days from birthday | Same plan letter only | Yes | 2024 |
| Louisiana | 63 days from birthday | Same or lesser benefits | Same insurer or affiliate | 2022 |
| Maryland | 30 days from birthday | Equal or lesser benefits | Yes | 2022 |
| Missouri (anniversary rule) | 63 days from policy anniversary | Equal or lesser benefits | Yes | 2021 |
| Nevada | 60 days from birthday | Equal or lesser benefits | Yes | 2021 |
| Oklahoma | 60 days from birthday | Equal or lesser benefits | Yes | 2023 |
| Oregon | 30 days before to 30 days after birthday | Equal or lesser benefits | Yes | 2020 |
| Utah | 60 days from birthday | Same or lesser benefits | Same insurer or affiliate | 2025 |
| Virginia | 60 days from birthday | Same plan letter only | Yes | 2025 |
| West Virginia | 60 days from birthday | Same or lesser benefits | Same insurer or affiliate (unless unavailable) | 2026 |
| Wyoming | 63 days from birthday | Equal or lesser benefits | Yes | 2025 |
Note: New Mexico signed birthday rule legislation in March 2026. That law takes effect January 1, 2027, and will grant a 60-day (or longer) guaranteed-issue window around your birthday.
States with Continuous Guaranteed-Issue Rights
A few states go even further than the birthday rule. These states offer continuous (year-round) guaranteed-issue rights for Medigap, meaning you can switch plans at any time without medical underwriting:
- Connecticut allows Medigap policyholders to switch plans year-round without underwriting.
- New York requires all Medigap insurers to use community rating and accept all applicants regardless of health status, at any time of year.
- Vermont provides year-round guaranteed-issue rights for Medigap plan changes.
If you live in one of these three states, you already have stronger protections than what the birthday rule provides. You do not need to wait for a birthday window to switch plans.
Additionally, Washington allows certain Medigap plan-to-plan changes throughout the year, and Maine and Massachusetts have expanded Medigap protections beyond the federal minimum.
What If Your State Does Not Have a Birthday Rule?
If you live in a state without a birthday rule or continuous guaranteed-issue protections, you still have some options for changing your Medigap coverage:
- Federal guaranteed-issue rights. Certain life events, such as losing employer coverage, having your Medicare Advantage plan leave your area, or moving out of your plan’s service area, trigger a federal guaranteed-issue right that lets you enroll in specific Medigap plans without medical underwriting.
- Medicare Advantage open enrollment. If you currently have a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (January 1 to March 31) lets you switch back to Original Medicare and apply for a Medigap plan. However, medical underwriting may still apply for the Medigap application, depending on your state.
- Apply with underwriting. You can apply for a new Medigap plan at any time. If you are in good health, you may pass underwriting and potentially get a lower premium than what you currently pay.
- Contact your state insurance department. Some states have additional protections or exceptions beyond the birthday rule. Your state’s Department of Insurance can tell you what rights apply in your situation.
Not sure what protections apply in your state? Call 877-850-0211 to speak with a licensed broker who covers 33 states and can explain your specific options.
How to Use the Birthday Rule to Switch Medigap Plans
If your state has the birthday rule and you are thinking about switching, follow these steps:
- Mark your calendar. Note when your birthday window opens and closes. In most states, this is 30 to 63 days around your birthday. Missing the window means waiting another full year.
- Review your current coverage and premiums. Look at what you are paying now and whether your plan still meets your needs. A plan with equal benefits from a different carrier could cost significantly less.
- Compare plans in your state. Medigap plans are standardized by letter (Plan G, Plan N, etc.), so the benefits are identical regardless of which insurer sells them. The only difference is the premium.
- Work with an independent broker. An independent Medicare broker like The Big 65 can compare rates across multiple carriers at no cost to you. Whether you need help finding a Medicare agent in Ohio or any of the other 33 states we serve, insurance companies pay the broker’s commission, so the price you pay is the same whether you use a broker or go directly to the insurer.
- Submit your application during the window. Make sure your application is filed before the deadline. Your new plan should be set to begin the day after your old plan ends to avoid a coverage gap.
- Confirm cancellation of your old plan. Once your new plan is approved and active, cancel your previous Medigap policy. Do not cancel until the new coverage is confirmed. Learn more about Medicare special enrollment periods that may also apply to your situation.
Can the Birthday Rule Save You Money?
Yes, and the savings can be significant. Medigap premiums vary widely between carriers even though the plan benefits are standardized. For example, two different insurers may both offer Plan G in the same ZIP code, but one could charge $150 per month while the other charges $250.
Over time, some carriers increase premiums faster than others. If your current insurer has raised rates several years in a row, switching to a competitor during your birthday window could save you hundreds of dollars per year, all without changing your benefits.
According to data from state insurance departments, beneficiaries who shop during their birthday window save an average of $300 to $600 per year on their Medigap premiums. Over five or ten years, those savings add up.
Common Questions About the Medicare Birthday Rule
Is the Medicare birthday rule a federal law?
No. The Medicare birthday rule is a state-level protection. There is no federal birthday rule for Medigap. Only the states listed in this guide currently offer this protection. Federal law provides a one-time, six-month Medigap open enrollment period when you first enroll in Medicare Part B at age 65 or older.
Can I upgrade to a better Medigap plan during my birthday window?
In most states, no. The birthday rule typically limits you to switching to a plan with equal or lesser benefits. For example, if you have Plan G, you could switch to another Plan G from a different carrier or move to Plan N (which has fewer benefits). You generally cannot jump from Plan N to Plan G using the birthday rule. A few states have slightly different provisions, so check your state’s specific rules.
Does the birthday rule apply to Medicare Advantage plans?
No. The birthday rule applies only to Medigap (Medicare Supplement) plans. Medicare Advantage and Part D plans have their own enrollment periods, including the Annual Election Period (October 15 to December 7) and the Medicare Advantage Open Enrollment Period (January 1 to March 31).
What if I miss my birthday window?
If you miss your state’s birthday rule window, you will need to wait until the following year for it to come around again. In the meantime, you can still apply for a new Medigap plan, but the insurer may require medical underwriting. If you are in good health, underwriting may not be a barrier. If you have health conditions, you may want to wait for the next birthday window.
Does Missouri have a birthday rule?
Missouri has an “anniversary rule” instead of a birthday rule. The 63-day window is tied to the date you first enrolled in your Medigap plan rather than your birthday. You can switch to a plan with equal or lesser benefits from any carrier during this window.
I live in a state that recently passed a birthday rule. When does it take effect?
Several states have recently enacted birthday rules. Indiana and Delaware’s rules took effect on January 1, 2026. West Virginia’s rule takes effect June 11, 2026. New Mexico signed its law in March 2026, with an effective date of January 1, 2027. Check with your state insurance department for the most current effective dates.
Are more states likely to adopt birthday rules?
Yes. As of early 2026, Iowa and Pennsylvania both have active birthday rule legislation under consideration. The trend has been growing, with six states (Kentucky, Utah, Virginia, Indiana, Wyoming, and Delaware) joining the list in 2024, 2025, and 2026. New Mexico and West Virginia are the most recent additions.
What The Big 65 Can Do for You
Sorting through Medigap options on your own can be overwhelming, especially when the rules differ from state to state. That is exactly what The Big 65 is here to help with.
The Big 65 is an independent Medicare broker licensed in 33 states, representing 10 insurance organizations and over 50 Medicare products. Founder Karl Bruns-Kyler has been helping Medicare beneficiaries for more than 20 years. Because The Big 65 is independent, they compare plans from multiple carriers to find the best fit for your needs and budget.
There is never a charge for their services. Insurance companies pay the broker’s commission, so the price you pay for a plan is the same whether you use a broker or go directly to the carrier.
Whether your state has a birthday rule, continuous guaranteed-issue rights, or no special protections at all, a licensed broker can help you understand exactly what options are available to you.
Call The Big 65 today at 877-850-0211 or learn more about working with a Medicare broker.