Everything You need to know about the Birthday rule

Until now, anyone with a Medigap plan knows that generally speaking, it is not possible to change one’s supplement unless one goes through underwriting. 

The "Birthday Rule” effectively nullifies this requirement and allows an applicant to receive guaranteed issue beginning the month prior to their birthday up to one month after their birthday.  

On January 1, 2026, this brand new Indiana law took effect. Until Indiana changes the law, it is available to use annually.

With the passing of the "Birthday Rule,” the underwriting requirements are now waived. So, if your current supplement premium is higher than you like, you can call or text us at 574–544–2228, and we’ll be glad to see what we can do. 

We’ve already helped several people improve their situation. One person we recently quoted was paying nearly $400/mo for Plan G, and we were able to find another Plan G for just over $150/mo for identical coverage. 

The laws regulating supplements require that a Plan F, G or N with one company must offer the exact same benefits offered by any other company offering Plan F, G, or N. That means, the new company you switch to will pay just as well and cost you less.

Some supplement companies bundle and integrate additional benefits when you enroll. For example, both Humana and UHC offer supplements that include a fitness benefit, which pays for your gym membership. So, if you switch to a company that does not include that extra benefit, you will have to pay out of pocket for the gym membership. On the other hand, if you are saving $150/mo, you can easily afford to pay that gym membership!

Similarly, sometimes agents will bundle additional products when a client purchases a supplement, such as dental, vision, indemnity, or critical illness plans, etc. Since these are separate policies from the supplement, you can keep those additional products while still changing your supplement plan (they are bundled, not integrated).

Until Indiana state law changes again, beneficiaries can use the "Birthday Rule” every year to find the lowest cost premium possible.

Yes! As long as a company offers Plan F (and there are companies that still do), you can use the "Birthday Rule.” 

Plan F is no longer available to Medicare beneficiaries, so there are no longer younger, healthier people paying into the pot. As a result, Plan F costs are going up exponentially. 

Unfortunately, no. The "Birthday Rule” only allows Medigap policy holders to change to another Medigap policy of the same letter type. It does not allow changes to or from an advantage plan. 

It depends. Most states do not have a "Birthday Rule” or similar. 

Unfortunately, yes. Legislation like the "Birthday Rule” is frequently struck down in states considering them because of the negative impact they have on the overall market. 

The legislator that introduced and promoted the bill in Indiana said that it would reduce cost and offer more choice to Medicare beneficiaries, but the complete opposite happened. 

• Not long after the bill was passed, several companies immediately shut their supplement doors in Indiana resulting in less choice. 
• And across the board, supplement rates have risen. Over two thirds of supplement companies raised their rates by 10% or higher. 

This tracks with what happened in the other states listed above that had previously introduced the "Birthday Rule.” 

For the beneficiary whose premiums have climbed faster and higher than other available companies, that person can benefit from lower cost by using the "Birthday Rule.” But for the rest of beneficiaries whose rates are reasonable, the "Birthday Rule” is causing rates to rise for everyone. 

Like all businesses, insurance companies must make a profit to remain in business. Because the "Birthday Rule” offers the ability to change with guaranteed issue, it cannot assess the health/financial risk of the applicant or factor that into the premium charged. 

As a result, actuaries by default consider anyone using the "Birthday Rule” as “bad (unhealthy) business.” Unhealthy business means high expenses that are ultimately shared by all the other supplement holders in that company’s plan. 

Additionally, as explained above, most people who take out a supplement never change it until they eventually switch to a Part C Advantage plan. So, the supplement company can count on longer term business. Stable business means better cost projections and comparably cheaper rates. the "Birthday Rule” means everyone is now a flight risk. 

We are local, compassionate agents who represent you, not an insurance company. We care about our clients and always seek to do what is in their best interest. 

• Not all agents do this. 
• Not all agents offer all options. 
• Not all agents educate their members because of the potential negative impact it may have on their bottom line. 

Most importantly, we don’t cost you a penny, the plans and benefits we offer are identical to what you can find online or by calling 800, and you have a local resource you can lean on when you have questions, concerns, or problems. 

If you already have an agent that you are happy with, we recommend you check with them first. If you don’t already work with someone or are dissatisfied with their service, please give us a text/call at 574-544-2228.