Medicare Supplement Birthday Rule | Medigap Plan Switching by State

If you’re enrolled in a Medicare Supplement (Medigap) plan, you may be locked into that coverage for life — unless you live in a state with a Medicare Birthday Rule. This rule gives Medigap policyholders an annual window around their birthday to switch plans without going through medical underwriting, meaning you cannot be denied coverage or charged more due to pre-existing conditions.

The Birthday Rule is one of the most powerful tools available to Medicare beneficiaries, and the number of states adopting it is growing every year. If you live in a state with this protection, you may be able to lower your premiums by switching to the same or equivalent plan offered by a competing carrier — without any health questions.

How the Medicare Birthday Rule Works

Under the Birthday Rule, eligible Medigap enrollees receive a guaranteed-issue window each year — typically starting on or around their birthday — during which they can switch to another Medigap plan without medical underwriting. Key details vary by state, but generally:

• You must already be enrolled in a Medigap plan to use the Birthday Rule
• You can switch to a plan with equal or lesser benefits (in most states)
• Some states allow you to change carriers; others restrict you to your current insurer
• The enrollment window ranges from 30 to 63 days depending on the state
• No health questions, no medical exams, no risk of denial

This is a significant departure from the normal Medigap rules, where insurers can use medical underwriting after your initial open enrollment period ends — potentially denying coverage or charging higher premiums based on your health history.

States with the Medicare Birthday Rule (Current as of 2025–2026)

The following states have enacted a Medigap Birthday Rule. Rules, windows, and carrier restrictions vary by state:

Note: Several additional states — including Indiana, Iowa, Michigan, Nebraska, Delaware, and Rhode Island — have introduced or are actively considering Birthday Rule legislation as of early 2026. We will update this page as new states adopt the rule. If you are unsure whether your state qualifies, call us at 1-888-972-0024 and we can check your state’s current status.

States with Year-Round Guaranteed-Issue Switching

A handful of states go even further than a birthday rule — they allow Medigap plan changes at any time of year without underwriting. These include Connecticut, Maine, New York, and Washington. Massachusetts has its own unique annual enrollment window in February and March.

Why the Birthday Rule Matters

Medigap premiums can increase significantly over time, and once your initial open enrollment period closes, you’re typically locked in unless you’re willing to go through health underwriting. The Birthday Rule changes that. If your state has adopted it, you can shop your coverage each year and potentially switch to the same plan at a lower premium with a competing carrier — all without risking your coverage due to health conditions.

As an independent Medicare Supplement broker, we represent multiple carriers and can quickly compare rates during your birthday window to see if a lower-cost option is available to you. The process is straightforward and at no cost to you.

This page is updated as states adopt new Medicare Birthday Rule legislation. Last reviewed: March 2026. This information is for general educational purposes and individual state rules are subject to change. Contact us or your state insurance department for the most current rules in your area.