Medicare Supplement Birthday Rule: Which States Let You Switch Without Health Questions

The Medicare supplement birthday rule is a state law that gives people who already have a Medigap policy a yearly window, tied to their birthday, to switch policies without answering health questions. There is no federal birthday rule. Each state that has one writes its own version, so the window, the plans you can switch to and whether you can change companies all depend on where you live. This page lists the states we could verify on official state sources, shows how the rules differ, and walks through a switch step by step.

What is the Medicare supplement birthday rule?

Under federal law, your guaranteed right to buy any Medigap policy comes once. The CMS guide Choosing a Medigap Policy (March 2026) says your 6-month Medigap Open Enrollment Period starts the first month you have Part B and are 65 or older, and it doesn’t repeat every year. The same page adds that some states have additional open enrollment periods.

The Medicare supplement birthday rule is one of those state additions. In general, it works like this:

• You must already have a Medigap policy.
• Each year, a window opens around your birthday.
• During that window, you can buy a replacement policy with the same or fewer benefits, depending on your state’s wording.
• The insurer can’t turn you down or charge more because of your health.

Don’t confuse the Medicare supplement birthday rule with federal guaranteed issue rights. Those are tied to events, not dates. The CMS guide lists them on pages 16 and 17: for example, your Medicare Advantage plan leaves your area, your employer coverage that pays after Medicare ends, or you move out of a Medicare SELECT policy’s service area. Federal rights usually let you buy Plan A, B, D or G, and Plans C or F if you were eligible for Medicare before 2020. A birthday rule, by contrast, comes back every year whether or not anything has changed.

Outside these windows, the CMS guide says that in most cases you won’t have a federal right to switch Medigap policies. An insurer can ask health questions, and it can say no. Our Medicare supplement underwriting guide explains what those questions look like.

Why the medigap birthday rule matters for your premium

Medigap plans with the same letter offer the same basic benefits. The CMS guide puts it plainly: price is the only difference between policies with the same letter sold by different companies. Yet premiums for the same plan can vary widely by insurer, and they can rise over time. If your health has changed, you may be stuck with a high premium because no other insurer will accept you.

The medigap birthday rule breaks that lock once a year. In states that let you change companies, you can move to a cheaper insurer’s version of the same plan. In states that allow “same or lesser” benefits, you can also step down, for example from Plan G to Plan N. Our Plan G vs. Plan N comparison covers that trade-off. The CMS guide notes that Plan N has copays of up to $20 for some office visits and up to $50 for emergency room visits that don’t lead to an inpatient admission.

Medigap birthday rule states: verified state-by-state table

Every row below comes from that state’s insurance department, statute, legislature or State Health Insurance Assistance Program (SHIP). We read each source in October 2026. “Same or lesser” means you can keep the same benefits or reduce them; “same plan” means only the same plan letter. Always confirm with your state before you act.

New Mexico joins on January 1, 2027. The state’s Aging and Long-Term Services Department says the window will start in your birthday month and last sixty days, for Medigap holders 65 and older, for plans of equal or lesser value.

The NAIC’s chart (as of May 11, 2026) also lists Rhode Island with its own rule. We could not read current details on an official Rhode Island page, so it is not in the table. Ask Rhode Island’s SHIP.

Birthday rule states where Octans has state guides

Several medigap birthday rule states are on our states page. Here is what the rules mean in each one.

• Maryland. The window is short: your birthday plus 30 days. The Maryland Insurance Administration says insurers must mail a notice 30 to 60 days before your birthday. It also says a policy isn’t “lesser” if it adds a significant benefit or lowers your cost-sharing. If you were underwritten at a rate above the preferred rate, you’re entitled to the preferred rate during the window. See our Maryland page.
• Virginia. Virginia’s version is a same-benefits rule. You can move to any insurer’s policy with the same benefits, so Plan G to Plan G, but not Plan G to Plan N without underwriting. Insurers must send notice 15 to 30 days before the window opens. See our Virginia page.
• Wyoming. The Department of Insurance says the 63-day window starts on your birthday with no medical underwriting. Ask the DOI or your SHIP which plans and insurers qualify. See our Wyoming page.
• Missouri uses an anniversary rule instead, explained in the next section. See our Missouri page.

Anniversary rules and year-round states

A few states protect Medigap switchers in other ways. These aren’t a Medicare supplement birthday rule, but they often work better, because the right isn’t limited to a short window each year.

In its entry on the NAIC chart, Massachusetts reports that all carriers have elected continuous year-round open enrollment. Massachusetts also uses its own plans, Core, Supplement 1 and Supplement 1A, as the CMS guide notes. Our Massachusetts Medicare supplement guide has the details.

New York and Connecticut are widely described as year-round guaranteed issue states. We couldn’t confirm the current wording on an official page for either state, so check with the New York DFS or Connecticut Insurance Department before relying on it.

What “same or lesser benefits” means in practice

The phrase sounds simple, but states define it differently. Nevada’s Division of Insurance publishes a replacement chart as an example. For a 2020 Plan G, Nevada lists Plans A, B, D, G, K, L, M, N and high-deductible G as acceptable replacements. A Plan N can only go to another Plan N. A Plan A can only go to another Plan A.

Two other details matter:

• Extra perks don’t count. Delaware and Nevada both say innovative benefits, such as gym or vision extras, must not be considered when comparing benefits. Virginia’s statute says the same.
• Same plan only, in some states. Kentucky, Indiana and Virginia only let you keep your plan letter while changing insurers. That still helps if another company charges less for the same plan.

If you want more benefits, the Medicare supplement birthday rule won’t help. West Virginia’s law says so directly: nothing in it permits buying a policy with greater benefits. You would need to pass underwriting.

Hypothetical example: using Maryland’s birthday window

Hypothetical example. Ruth lives in Maryland. Her birthday is March 10, and she has Plan G at $210 a month. A different insurer quotes Plan N at $160 a month. These premiums are made up for the example.

Step 1: the window. Maryland’s window is her birthday plus the 30 days after. March has 31 days, so March 10 plus 21 days is March 31, and 9 more days is April 9. Her window runs March 10 through April 9. In a non-leap year, her insurer’s notice should arrive between January 9 and February 8, which is 60 to 30 days before her birthday.

Step 2: the premium savings. $210 − $160 = $50 a month. Over a year, $50 x 12 = $600.

Step 3: the new costs. Plan N has copays of up to $20 for some office visits and up to $50 for ER visits without admission. If Ruth has 10 such office visits in a year, that is up to 10 x $20 = $200. Her net savings would be about $600 − $200 = $400, before any other differences between the plans.

If Ruth lived in Virginia instead, she could only move to another insurer’s Plan G. If that insurer charged $185, she would save $210 − $185 = $25 a month, or $300 a year, with no change in benefits.

How to use a birthday rule window step by step

1. Mark your window. Use your state’s medigap birthday rule from the table. Some count from your birthday; others from the first day of your birthday month.
2. Read the insurer’s notice. Maryland, Nevada, Delaware and Virginia require insurers to send one before the window opens.
3. Get quotes early. Compare the same plan letter across insurers, and price a lesser plan if your state allows it.
4. Apply inside the window. Oklahoma notes the 60 days is for submitting your application, not for the policy’s start date. West Virginia’s law says the same.
5. Don’t cancel yet. The CMS guide says not to cancel your first Medigap policy until you’ve decided to keep the second. You get a 30-day free look period on the new policy, and you’ll pay both premiums for the month you have both.
6. End the old policy. Once the new policy is in force, ask your old insurer to end coverage.

Keep a simple file while you switch: the insurer’s birthday notice, your application date, the new policy’s start date and the date your old coverage ends. If an insurer refuses an application during your window, the state insurance department in each of the medigap birthday rule states above is the place to complain. Indiana SHIP, for example, tells consumers to contact the Indiana Department of Insurance if a company denies enrollment.

Delaware adds a useful warning: switching mid-year from one high-deductible policy to another restarts the deductible under the new contract.

Limits and traps to watch for

• You must already have Medigap. West Virginia’s law says a person not enrolled on their birthday isn’t eligible. Indiana says its rule doesn’t help people in Medicare Advantage join Medigap.
• Some states require a waiting period. West Virginia requires your current policy to have been in force for 24 months. Oklahoma requires no coverage gap over 90 days.
• Age limits can apply. Illinois limits its rule to people 65 through 75, and Indiana and New Mexico apply theirs to people 65 and older.
• Moving can end your right. Delaware and Nevada say their rule does not apply to people who bought a policy there and now live out of state.
• Group plans may be excluded. Delaware says self-funded employer-sponsored group Medigap plans aren’t eligible.

Finally, the Medicare supplement birthday rule protects you from health-based pricing, not from all pricing. Indiana SHIP notes that insurers can still base your rate on age, gender, zip code and tobacco use. Nevada’s Division of Insurance says carriers can’t rate up people who use the rule and must charge their existing rates to new policyholders. Ask each insurer how it prices its policy, because the CMS guide explains that community-rated, issue-age-rated and attained-age-rated policies change differently as you get older.

Thinking about Medicare Advantage instead? That’s a different set of rules. See our guide on how to change Medicare plans.

Medicare supplement birthday rule: frequently asked questions

Is the Medicare supplement birthday rule a federal law?

No. It is a state rule. Federal law gives you one 6-month Medigap Open Enrollment Period plus specific guaranteed issue rights. The CMS guide says your state may give you more.

Which states have the medigap birthday rule?

We verified California, Delaware, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah, Virginia, West Virginia and Wyoming on official state sources. New Mexico starts January 1, 2027. Rules change often, so check with your state.

Can I upgrade from Plan N to Plan G under the birthday rule?

Not in the states we reviewed. They allow the same or lesser benefits. Moving up usually means answering health questions.

Can I switch to a different insurance company?

In most birthday rule states, yes. Louisiana limits you to your current insurer or an affiliate, Utah to your current insurer, and West Virginia to your insurer or an affiliate in most cases.

Does the birthday rule apply if I have Medicare Advantage?

No. It applies to people who already have a Medigap policy. Leaving Medicare Advantage has its own rules and timing.

Will the Medicare supplement birthday rule lower my premium?

Not by itself. It only lets you switch without health questions. Savings come from finding a lower-priced insurer for the same plan, or from moving to a plan with fewer benefits where your state allows it.

What if my state has no birthday rule?

You can still apply to switch at any time, but the insurer may use medical underwriting. You may also have a federal guaranteed issue right in specific situations, such as a move out of your plan’s area.

Get help with your birthday window

The Medicare supplement birthday rule only helps if you act inside a short window. Octans Insurance is an independent agency based in Massachusetts. Our licensed agents can compare Medigap options across the 120+ carriers we work with and check your state’s rules with you, at no fee. Call (617) 935-9220. You can also get free, unbiased help from your State Health Insurance Assistance Program at shiphelp.org, or call 1-800-MEDICARE (1-800-633-4227).

Keep Reading: Related Guides

• Medicare supplement underwriting
• Medicare Plan G vs Plan N
• What are Medicare supplements?
• How to change Medicare plans
• Medicare when moving to another state
• Birthday rule calculator (free tool)

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

This article is for general information and is not tax, legal, or medical advice.

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