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Take Action On Your Birthday Medigap Policy Holders

Posted on Monday, January 15th, 2024


Have you wanted to shop for a less-expensive Medicare Supplemental (Medigap) Plan but been turned down by insurers due to your health status?

Under a new rule in Oklahoma, Medicare beneficiaries already enrolled in a Medigap plan can now change plans each year without answering a health questionnaire. A “medical underwriting exception” was implemented last fall by the Oklahoma Insurance Department.

It is called the Oklahoma Medigap Birthday Rule because it can be utilized only around the insured’s birthday each year.

One citizen saved almost $500 a month by invoking the Birthday Rule during her birthday month last December. The 75-year-old kidney transplant patient is unable to pass a health questionnaire any other time of the year. But with medical underwriting off the table, her rates plummeted. Instead of paying $619 a month in premiums, she is now paying $140 a month. She successfully changed plans with her same insurance company, in her case choosing to go from Plan F to Plan G.

Beginning on your birthday, you will have 60 calendar days to change your current Medigap policy to one of equal or lesser coverage with no medical questions asked. You can change plans with your current insurance company or, if more cost-effective, change insurance companies.

According to the Oklahoma Insurance Department, an example of changing to a plan of equal value is going from one Plan G to another Plan G. An example of changing to a plan of lesser value is going from Plan G to Plan N, or going from Plan F to Plan G.

An example of going to a plan of greater value is going from Plan N to Plan G, or going from Plan G to Plan F. In those cases, the Birthday Rule will not create a “guaranteed issue” policy. Medical underwriting would still apply, and you could make this switch at other times of the year besides around your birthday.

By law, all same-letter Supplemental Plans have the same core benefits – every Plan G is the same as every other Plan G, for example, in the services covered. The only thing that differs is the premium an insurance company charges.

As a result it is best to shop around to find the insurance company that has the lowest premiums. Your local agent who sold you your supplemental plan can help you search for a replacement policy.

Also, the State Insurance Department has an excellent resource. It is the Senior Health Insurance Counseling Program (SHIP), which is a non-profit organization that helps inform the public about Medicare and other senior health insurance issues. A SHIP counselor can be called at 800-763-2828.

“Alan,” a counselor on duty last week said that SHIP will mail an exact quote of the lowest premium costs for all Medigap plans being offered in Oklahoma for the caller’s age and sex.  The applicant then could call the insurer and work with an agent to enroll.

The Birthday Rule does not apply to Medicare Advantage. There are no supplemental plans involved in that coverage, and the Birthday Rule does not infer the right to change Medicare Advantage plans around birthdays.