What is the Medicare Birthday Rule?

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The Medicare Birthday Rule applies to those 65 or older, that have a Medicare Supplement or Medigap plans. In the state of Oregon, Medicare beneficiaries have a yearly opportunity to compare Medicare supplement prices and switch companies. They must keep the same plan type or choose one with lesser benefits.

Remember, if you are on an employer-sponsored group Medigap plan and are not eligible for the Medigap birthday rule, if you leave your employer-sponsored group Medigap plan, you may not be able to get it back if the employer plan rules do not allow it. And, if you have employer coverage, always double check with them before you make any kind of changes because you may not be able to go back to your employer coverage.

How Does the Birthday Rule Work?

If your Medicare card has an ‘F’ or a ‘G’ or an ‘N’ or something with one of those letters, you can change that plan on your birthday month.  In Oregon, the Medicare Birthday Rule is valid for the entire month of your birthday. So, if your birthday is February 2nd, you can review and change plans for the entire month of February.

The Medicare rules technically say that the Medicare Birthday Rule begins on your birthdate and ends 30 days later, but most of our carriers are rather lenient and you can make changes anytime during your birthday month. Be advised, the effective date of the new plan will always be the first day of the month following your birthday.

So, if your birthday is February 2nd and you change plans, the new plan would not take effect until March 1st.

Why Would You Change Medicare Supplement Plans?

Every Medicare Supplement plan is standardized by the government so that the benefits are exactly the same from on company to another. However, this is an opportunity to compare prices and apply for a new Medigap plan. Prices vary greatly from company to company. The coverage doesn’t change, but the premium and who administers it does.

Additionally, during your birthday month, this change is guaranteed regardless of your health. So, you don’t have to go through medical underwriting a second time, you will be guaranteed an issue and you can move yourself to a lower price plan.

What is Medical Underwriting?

Medical underwriting, in the case of the Medicare supplements, it’s not a physical one. They’re not going to come out to the house and take your blood or make you give a sample of any kind. Medical underwriting in the world of Medicare supplements is based on questions and how you answer them. And most of the questions revolve around COPD, chronic heart issues, vascular issues, cancers, histories of memory dementia, things like that.

So, if you answered yes, I have rheumatoid arthritis, that might mean that you wouldn’t be able to purchase this new plan for a lesser amount each month. But, during your birthday month you don’t have to even be asked those questions. You just bypass all of the health questions if you want to change plans during your birthday.

A lot of people get confused about open enrollment and the Birthday Rule. So, the Birthday Rule, this is for supplements, and then open enrollment is for Medicare Advantage plans. And if you have that letter, that ‘F’ or that ‘G’ or that ‘N’ your birthday is actually your renewal.

It might be a good idea to shop on your birthday. We would also caution you, if you do choose to make changes, that you don’t cancel your current Medigap policy until you have confirmed that the new one is in place.

It is the client’s responsibility to cancel their Medicare supplement plan. This is not something an agent can do on their behalf. We can help you get enrolled in a new plan, happy to help you get enrolled in a new plan. But once we have confirmation of that enrollment, it is the client’s responsibility to cancel their existing plan.

Bancorp’s insurance experts are available to provide you with a free review and consultation.  Contact Us – Bancorp Insurance Call 800-452-6826

Disclaimer: This content is provided for general information purposes and is not intended to be used in place of consultation with our agents.