A Birthday Benefit You May Not Know About: The Medigap Birthday Rule
Updated: Sep 17
When most of us think about our birthday, Medicare coverage probably is not the first thing that comes to mind. However, for some Medicare Supplement policyholders, a birthday brings the opportunity to reconsider their current coverage.
This opportunity is known as the Medigap Birthday Rule. It allows eligible policyholders to explore certain Medicare Supplement plans each year around their birthday without medical underwriting for pre-existing conditions.
However, the rules are not the same everywhere. Maryland, Delaware, and Virginia each have different enrollment periods and guidelines. Understanding your state’s rules can help you know when you are eligible and which options may be available.
What is the Medigap Birthday Rule?
Medigap, also called Medicare Supplement insurance, works alongside Original Medicare to help pay some of the healthcare costs that Medicare does not fully cover.
When someone is 65 or older and enrolls in Medicare Part B, they typically receive a one-time, six-month Medigap Open Enrollment Period. During this time, insurance companies cannot deny Medigap coverage or charge someone more because of their health history.
Changing policies can become more complicated after this initial period ends. An insurance company may be allowed to review an applicant’s medical history through a process called medical underwriting.
What is medical underwriting, you might ask? This is when an insurance company evaluates someone’s health history to decide whether to:
Accept or deny an application
Charge a higher premium because of health conditions
Apply other health-related restrictions
That’s where a state’s birthday rule may help. It gives qualifying Medigap policyholders another protected period each year to explore certain policies without being denied or charged more based on their health.
It is important to understand:
Applies to Medicare Supplement (Medigap) policies
It is separate from Medicare's Annual Open Enrollment Period
Does not mean that you HAVE to change your coverage
Does not necessarily allow you to choose any Medigap plan
Does not guarantee that another policy will have a lower premium
Think of it as an annual opportunity to determine whether another qualifying policy may better fit your current needs.
Select your state below to learn more about your state's birthday rule:
Maryland's Birthday Rule
Since July 1, 2023, eligible Medicare Supplement policyholders have an annual enrollment period that begins on their birthday and continues for the following 30 days. In some cases, the company may extend this period, but it will always include the policyholder’s birthday and the next 30 days.
Another benefit of this rule is that the application doesn't have to be fully processed before the window closes. It just needs to be completed and submitted.
During this period, an eligible policyholder may apply for a Medigap (Supplemental) policy with equal or lesser benefits without medical underwriting. The new policy is also allowed to come from a different insurance company, so you are allowed to switch from your current carrier.
Which plans are considered equal or lesser depends on the person’s existing Medigap plan. Below are three examples of what would be an acceptable swap:
Scenario 1
Someone with Plan N may switch to another Plan N
Scenario 2
Someone with Plan M may switch to another Plan M or Plan N
Scenario 3
Someone with Plan G can switch to Plan A, B, D, K, L, M, High F, High G, or N
Maryland insurers must provide policyholders with notice of their Birthday Rule rights AT LEAST 30 days, but no more than 60 days, before their birthday.
Delaware's Birthday Rule
Delaware’s birthday rule, Senate Bill 71, was signed into law by the Delaware Government on September 3, 2025. For Delaware Medigap policyholders, they receive an enrollment period beginning 30 days before their birthday and continuing for at least 30 days after it.
Just like the Maryland birthday rule, during this window, a policyholder may apply for a Medigap policy that has the same or lesser benefits without medical underwriting. The rule generally applies to people who currently live in Delaware with an individual Medigap policy. Certain employer-sponsored group Medigap plans are not eligible for the birthday rule, so people with this type of coverage may not have the same opportunity to switch policies.
Before switching, it’s important for policyholders to confirm when their new coverage begins and avoid cancelling their current policy until the new one has been issued. Those with high-deductible plans should also know that changing policies during the year may restart their deductible.
Virginia's Birthday Rule
Virginia’s birthday rule took effect on July 1, 2025. Eligible Virginia residents receive a 60-day enrollment period beginning on their birthday to switch to a Medigap policy offering the same benefits as their current policy.
Unlike Maryland and Delaware, which allow changes to policies with equal or lesser benefits, Virginia’s rule only protects moves to policies with the same benefits. The new policy may be purchased from a different insurance company, and the applicant cannot be denied or charged more because of health conditions or previous claims.
Insurers must send eligible policyholders a notice 15 to 30 days before the enrollment period begins. To qualify, the person must currently live in Virginia and have an eligible Medigap policy or certificate. If they have moved out of Virginia, the rules of their current state may apply instead.
Should You Change Your Medigap Policy?
The birthday rule does not mean you have to change policies. It simply gives the eligible policyholders an opportunity to compare qualifying options.
Before switching, consider the following:
The benefits and monthly premiums.
Available discounts
High-deductible requirements
When the new coverage begins.
Whether your location affects eligibility.
Medigap policies with the same letter generally provide the same standardized medical benefits, but costs, discounts, and customer service can vary. Most importantly, do not cancel your current policy until the new one has been approved and you have confirmed its start date.
Is your birthday approaching?
Schedule your FREE 30-MIN consultation with me at MyHealthGap to review your Medicare options today. Click the link above labeled "Click here to begin", email me at amanda@myhealthgap.com, or call 760-822-3325.
Together, we can begin sorting through your Medicare options with greater clarity and confidence!
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