Jesse Smedley
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
Medicare Supplement Plans can be expensive. So, just wait until your health needs are more extensive, perhaps when you are a little older and enroll then, right?
Wrong!
In most states, you can only enroll in a Medigap Plan without medical underwriting in the six months after you turn 65 and enroll in Part B. Should you choose to enroll outside of this six month window, you may be subject to medical underwriting, which means you could be charged more or denied outright.
This doesn’t just apply to your initial policy. If you want to change Medigap plans for any reason down the line, again if you are outside of the 6 month window, you could be subject to medical underwriting.
If you enroll in a less expensive, lower coverage medigap plan and decide to switch to a higher coverage plan at a later date when your medical needs are more extensive: medical underwriting.
If you enroll in an attained age policy vs an issue age or community rated policy and suddenly your premiums have dramatically jumped, you can’t just switch to a less expensive carrier without, you guessed it, medical underwriting.
Now there are a few exceptions to this rule. There are a few states with more lenient enrollment policies, and many more states seem to be jumping on the band wagon.
Is this a good thing? There are pros and cons. Let’s discuss.
Open Enrollment
There are a few states that already offer an open enrollment period every year. In New York and Connecticut, Medigap plans are guaranteed-issue year-round.
Massachusetts has a window each year during which Medigap plans are guaranteed-issue. That means no medical underwriting.
This makes enrollment so much easier and less stressful. But there is a downside.
When you enroll in a Medigap plan or any type of health insurance, you are basically paying your plan to take on your medical risk. That is why your Medigap enrollment in other states can be limited by medical underwriting.
In order to keep monthly premiums affordable, insurance carriers do not wish to take on those with the largest medical risk.
When you eliminate that safety net for insurance carriers, they look to other means to protect their bottom line; namely, increased monthly premiums. And that is why Medigap monthly premiums can be so much more expensive in these states than others.
Other states are interested in expanding their enrollment to have more flexibility, similar to NY, MA, and CT.
Minnesota is also looking to adopt the same practices. An interesting fact about Medigap in Minnesota is that they are one of the states in which the benefits are not standardized to align with the rest of the states. This will actually come to fruition in August 2026. The rest of the states we are about to discuss are still up in the air.
California already has a birthday rule in place, but there is proposed legislation to expand enrollment to a 90 day window from January to March. There would be no medical underwriting during this time.
Washington is also looking to jump on board. Like California, WA already has some legislation in place. Currently, you can switch from one plan and or carrier to another at any time during the year. They would like to expand their initial enrollment period to an annual open enrollment as well.
You can add to this list, NJ and NH as well.
Birthday Rule
Several other states have also adopted a birthday rule in varying fashions, with more looking to hop on board. California, Idaho, Illinois, Nevada, Louisiana, and Oregon, and now OK & KY have “birthday rules” that allow Medigap enrollees a birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.
In most states it is about 60 days. The problem with this is that most people wish to switch to a plan with higher coverage in their older age (not a plan with lesser coverage!)
Illinois has some other issues. For example, currently this birthday rule only applies to those age 65-75 and you can only switch to a plan offered by the exact same carrier. As of Jan 1, 2026, you should be able to switch to any carrier (although again only if you are between 65-75)
Nebraska, Georgia, Michigan, Rhode Island, South Carolina, Virginia, Utah, Ohio, and Texas all have proposed legislation in place to adopt some type of birthday rule although at this time, they are all still up in the air.
Additionally, New Mexico has proposed legislation, but this would allow you not just to switch carriers or downgrade, but possibly to upgrade to a plan with more comprehensive coverage as well.
In most states, enrolling in a Medigap plan that most closely aligns with your long term needs in that initial six month window is still your best.
