When it comes to Medicare, your options can feel set in stone once you’ve made your initial decisions. But if you’re on a Medicare Supplement plan (also called a Medigap plan), there’s a little-known rule that might give you the flexibility to make a change—without jumping through hoops or answering health questions. It’s called the Birthday Rule, and if you live in a qualifying state like California, it can make switching plans simple and stress-free.
Let’s break down how it works and why it might be the right move for you.
Why You Can’t Switch Medicare Supplement Plans Anytime You Want
Many people are surprised to learn that once you’re on a Supplement plan, you can’t just switch to another plan whenever you want—at least, not without potentially going through medical underwriting. That means answering health questions, getting approval based on your current conditions, and possibly being denied or charged more.
This system keeps people in their current plans, even if they’re paying more than they should or are unhappy with their carrier. The fear of being declined holds many folks back from exploring better options.
When You Can Switch Supplement Plans
There are a few times when you’re allowed to switch plans without health questions:
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Your Initial Enrollment Period, after you first enroll in Medicare Part B
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Certain guaranteed issue rights, usually tied to life changes (like losing other coverage)
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State-specific rules, like the Birthday Rule
It’s important to note that the Fall Medicare Open Enrollment period (Oct 15 – Dec 7) is an opportunity to switch plans, but Supplement Plans are not always Guaranteed Issue. Most carriers will administer a health questionnaire to confirm you are eligible for the Supplement plan.
What Is the Birthday Rule?
The Birthday Rule is a state-specific regulation that gives Medicare Supplement policyholders the chance to switch plans around their birthday each year—without underwriting. This means you don’t have to answer health questions, and you can’t be denied coverage or charged more due to health status.
Each state has slightly different rules, but generally, the Birthday Rule lets you:
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Switch to another insurer
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Choose the same or a plan with fewer benefits
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Avoid any health questions or approval process
For example, if you’re on a Plan G and another insurer offers Plan G at a lower monthly rate, you can switch using the Birthday Rule. You can’t move up to Plan F or switch to a richer plan, but lateral or lesser moves are allowed.
Which States Offer the Birthday Rule?
As of now, states with some form of the Birthday Rule include:
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California
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Oregon
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Idaho
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Illinois
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Nevada
Each of these states has its own timeframe for when you can make the change—usually anywhere from 30 to 60 days starting on your birthday. It’s a limited window, so you’ll want to plan ahead.
Why the Birthday Rule Matters
The biggest benefits: Lower premiums. Over time, premiums for Medigap plans increase, especially if you’re with a carrier that adjusts rates frequently. By using the Birthday Rule, you can shop around and switch to a lower-cost Plan G (or whichever plan you currently have), all without worrying about being denied due to a health condition.
It’s a win-win: same great coverage, lower cost.
Let HealthyMarks Help You Take Advantage of the Birthday Rule
If your birthday is coming up, or if you just want to understand your options, reach out to HealthyMarks. We specialize in helping our clients navigate Medicare changes, and we’re here to make sure you never overpay for your coverage.
Let’s find you a better deal—no health questions required.
Keaton Marks is the owner and CEO at HealthyMarks including the medicare team. Keaton was born and raised in Encinitas. He often rode his bike through town and to the local beaches like Moonlight. Keaton knows it is important to have a local resource, someone who understands the area, the hospitals and networks of doctors. Keaton is proud to be a local Medicare broker who is able to assist the people in his town when selecting medicare plans.
Keaton believes one thing above all else: “Medicare is confusing… but it doesn’t have to be! That is where HealthyMarks Medicare comes in” Please contact me with any questions.