During this time, you can buy a new Medigap policy without having to go through medical underwriting or a waiting period.

However, only certain states offer this benefit, and the rules for each enrollment period differ by state. In this article, learn more about Medicare Supplement Insurance, medical underwriting, and the Medigap "birthday rule" that can help you avoid underwriting.

How does Medicare Supplement Insurance work?

Medicare Supplement Insurance helps "fill the gaps" left by Original Medicare. These plans help pay your out-of-pocket costs when you have Original Medicare. Medigap plans are not standalone health insurance, but instead supplement your Medicare coverage. They do not pay for benefits that Medicare doesn't cover, like dental care, vision, and hearing services.

Medigap plans are sold by private insurance companies and standardized by Medicare, meaning every Medigap plan of the same letter has the same benefits. There are 10 standard supplement plans, each with different benefits, so it's important to do your research to choose the right one for you.

Related Reading: Compare Medicare Supplement Plans (The Ultimate Guide)

What is medical underwriting?

Whether it’s homeowners’ insurance, an auto policy, or for healthcare, insurance companies want to know how likely it is that you'll file a claim. They use a process called underwriting to make that guess.

As the name implies, medical underwriting is based on your medical history. When you apply for a Medigap plan, you answer a series of questions related to your health, including your age, history of tobacco use, weight, and any pre-existing conditions you may have. In some cases, it may include a physical exam performed by a doctor.

Findings during the underwriting phase dictate how much your premium will be and whether the company will sell you a Medigap policy at all.

Related Reading: Medicare Supplement Underwriting Questions: What to Expect

How to avoid medical underwriting

There are some instances when you may be able to avoid medical underwriting for a Medigap policy. One is if you have Medigap guaranteed issue rights. There are several situations when you could qualify for guaranteed issue Medicare Supplement coverage including (but not limited to):

• The Medicare Supplement Open Enrollment Period, which begins the day you are both age 65 and older AND enrolled in Medicare Parts A and B. It lasts for six months.
• If you lose your Medicare Advantage plan coverage because you move outside of the plan's service area, the plan leaves the Medicare program, or it stops serving people in your area, you can apply for a Medigap policy starting 60 days before your MA coverage ends.
• If you have Original Medicare and secondary insurance, you may apply for a Medigap policy when your secondary coverage ends.
• If you join a Medicare Advantage plan in your first year of having Medicare and decide to switch back to Original Medicare within 12 months, you can apply for a Medigap policy 60 days before your plan's scheduled end date and closing 63 days after coverage ends.

Related Reading: Medigap Guaranteed Issue

Additionally, some states offer greater consumer protections for Medigap customers called the Medigap birthday rule.

What states recognize the Medigap birthday rule?

Not all states recognize the Medigap birthday rule, but those that do allow consumers to buy a new Medigap policy without medical underwriting or a new waiting period. This "open enrollment" happens for 30 days after your birthday each year. Because there is no medical underwriting, your Medigap application would not be rejected, and your premium would not increase.

The "birthday rule" can vary by state:

California birthday rule

If you have a Medigap policy in California, this rule applies to you. During the 30 days before your birthday and 60 days after, you can change to any plan of equal or lesser benefit with any carrier without having to go through medical underwriting.

Idaho birthday rule

Consumers can enroll in another Medigap plan of equal or lesser benefit with any carrier, beginning on their birthday and lasting for 63 days.

Illinois birthday rule

Those who have a Medigap policy and are ages 65-75 can enroll in any plan with equal or lesser benefit from their current carrier. This begins on their birthday and ends 45 days later.

Nevada birthday rule

Beginning on the first day of the birth month and lasting for 61 days, beneficiaries can change their carrier or plan to one with equal or lesser benefit.

Oregon birthday rule

Beneficiaries can change to any carrier or plan with equal or lesser benefit starting 30 days before their birthday and ending 30 days following.

Other states that offer Medigap underwriting protection

There are other states that have state-specific Medigap rules to protect consumers, including some that allow you to make changes to your plan without going through underwriting. Those states include:

• Arkansas: Medigap insurers must offer at least one plan on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• Arizona: Medicare beneficiaries who qualify due to a disability are eligible for a Medigap enrollment period when they turn 65 and do not have to undergo medical underwriting. State law also prohibits Medigap insurers from charging higher premiums for those who qualify for Medicare due to a disability.
• Colorado: Disabled Medicare beneficiaries can qualify for a Medigap enrollment period when they turn 65 and do not have to undergo medical underwriting.
• Connecticut: All Medigap plans are always sold on a guaranteed-issue basis.
• Delaware: State law grants a six-month guaranteed issue window for Medigap when people become eligible for Medicare, even if under age 65.
• Florida: Those under age 65 are granted a six-month enrollment window when Medigap plans are guaranteed issue (if they already have Part B).
• Georgia: Those under age 65 are granted a six-month enrollment window when Medigap plans are guaranteed issue (if they already have Part B).
• Hawaii: All Medigap insurers must offer plans on a guaranteed-issue basis during the six-month window after the beneficiary enrolls in Part B, regardless of age.
• Indiana: Offers Plan A to disabled enrollees under age 65 without medical underwriting, with another six-month enrollment period when they turn 65.
• Kansas: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• Louisiana: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• Maine: All insurers must designate at least one month per year when applications will be accepted in Plan A, regardless of medical history; those under 65 are granted a six-month guaranteed-issue enrollment period when eligible for Medicare; Medigap enrollees can switch to a different equal or lesser benefits plan from their current or a different insurer; Medigap premiums cannot vary by age.
• Maryland: Offers Plan A to disabled enrollees under age 65 without medical underwriting, with another six-month enrollment period when they turn 65; if the insurer also offers either Plan C or Plan F to those 65+, they must also make that available to those under 65 who were eligible for Medicare before 2020; if the insurer offers either Plan D or Plan G to those who are 65+, they must also be offered to those who are under 65 and eligible for Medicare.
• Massachusetts: This state has a Medigap Open Enrollment Period from February 1 to March 31 each year, when people have a guaranteed-issue chance to enroll in Medigap for the first time, or to switch from one plan to another; coverage must also be offered to those under age 65.
• Michigan: Medigap insurers that also sell major medical health insurance must make Medigap Plans A and G guaranteed issue for beneficiaries under age 65.
• Minnesota: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65; insurers also cannot base premiums on the enrollee's age.
• Mississippi: State law grants a six-month guaranteed issue window for Medigap when people become eligible for Medicare, even if under age 65.
• Missouri: This state has an "anniversary rule," which allows enrollees the ability to change from one Medigap insurer to another (if both plans are the same letter) on a guaranteed-issue basis starting 30 days before their plan anniversary date and ending 30 days later; additionally, some Medigap plans are available guaranteed-issue for those under age 65.
• Montana: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• New Jersey: All Medigap insurers must offer plans on a guaranteed-issue basis during the six-month window after the beneficiary enrolls in Part B, regardless of age, and those under age 65 won't pay higher premiums for their coverage.
• New York: If you're enrolled in Part A and Part B, you can enroll in a Medigap plan at any time and premiums do not vary based on your age or health status without medical underwriting.
• North Carolina: Offers Plan A to disabled enrollees under age 65 without medical underwriting, with another six-month enrollment period when they turn 65; if the insurer also offers either Plan C or Plan F to those 65+, they must also make that available to those under 65 who were eligible for Medicare before 2020; if the insurer offers either Plan D or Plan G to those who are 65+, they must also be offered to those who are under 65 and eligible for Medicare.
• Oklahoma: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• South Dakota: Medicare beneficiaries under age 65 have the same Medigap Open Enrollment Period as those who are gaining access to Medicare when they turn 65, and insurers cannot charge those under age 65 higher premiums than they'd charge enrollees who are 75.
• Tennessee: State law grants a six-month guaranteed issue window for Medigap when people become eligible for Medicare, even if under age 65.
• Texas: Offers Plan A to disabled enrollees under age 65 without medical underwriting, with another six-month enrollment period when they turn 65.
• Vermont: Medigap insurers must offer coverage on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• Virginia: Medigap insurers must offer at least one plan on a guaranteed-issue basis to people who became eligible for Medicare prior to age 65.
• Washington: State law gives Medigap enrollees the ability to switch to a different Medigap plan at any time without medical underwriting.
• Wisconsin: Medigap insurers are required to offer the Medigap Basic Plan to applicants under the age of 65, guaranteed issue.

Additionally, there are a few states that maintain a pre-ACA high-risk health insurance pool, and Medicare beneficiaries who are unable to qualify for a Medigap plan can enroll in that supplemental coverage. These states are Alaska, Iowa, Nebraska, New Mexico, North Dakota, South Carolina, Washington, and Wyoming.

Is a Medigap plan right for you?

Everyone's situation and needs are unique, which is why we are here to help. Search through plans in your area with our Find a Plan tool, or call 1-844-430-2322 TTY: 711 to speak with a licensed agent today.