The Medicare birthday rule gives people with a Medicare Supplement (also known as Medigap) plan the chance to switch plans each year around their birthday — without going through medical underwriting.
That said, it’s not a one-size-fits-all rule. The details — like timing, what plans clients can choose, and whether they can switch companies — depend heavily on the state you live in.
In simple terms, once someone is past their initial Medicare enrollment period, the birthday rule can act as a yearly opportunity to revisit and adjust their coverage.
If you’re working with Medicare clients, the birthday rule creates a built-in reason to reconnect every year. It’s a natural touchpoint to review coverage, check for savings, and make sure clients still have the right plan for their needs.
The number of states offering some version of the birthday rule has grown, and it’s still evolving.
The most established states include:
Other states — like Louisiana, Maryland, Oklahoma, Kentucky, Indiana, Virginia, Utah and Wyoming — have introduced similar rules or are in the process of doing so, though they may work a bit differently.
The big takeaway: fewer than half of all states offer a true birthday rule or something equivalent. Because of that, understanding the specifics in each state you work in is essential.
While the general idea is the same, states differ in three main ways:
For example:
A few states are even stricter, requiring you to keep the same plan letter (like Plan G to Plan G).
These differences can have a big impact on how you quote and position options for clients.
It’s easy to confuse the birthday rule with Medigap’s open enrollment, but they’re not the same.
Think of the birthday rule as a second chance to make changes — but not with the same level of flexibility as that initial window.
Not exactly.
The birthday rule shares some similarities with guaranteed issue — mainly that underwriting is typically waived — but it’s more limited.
Guaranteed issue rights are triggered by specific life events and usually offer broader plan access. The birthday rule, on the other hand, is tied to a yearly window and comes with stricter plan rules.
In most states, yes.
That means:
This is a big deal, especially for clients whose health has changed over time.
Sometimes.
States like California, Oregon, Idaho and Nevada generally allow carrier switching. Others — like Illinois — often limit changes to the same carrier or an affiliate.
This matters when you’re comparing options, since it can affect how competitive your recommendations can be.
There are rules here. Most states require equal or lesser benefits. For example, moving from Plan G to Plan N might be allowed, but upgrading to richer benefits usually isn’t.
These restrictions are meant to prevent people from increasing coverage without underwriting, while still allowing them to lower costs.
Even though underwriting is waived, there are still rules to follow:
Missing any of these can still lead to a declined application.
As more states adopt the birthday rule, carriers are getting more structured in how they handle compensation.
In general:
Carriers also tend to track birthday rule business separately, which can affect reporting and long-term compensation. There are many birthday rule states that have reduced commissions or will pay at the guarantee commission rate. Some states require the carrier to pay full commissions so this can also vary by state and carrier.*
Need assistance using the birthday rule to gain additional sales and commission? Senior Market Sales® (SMS) is here to help. With more than 40 years of Medicare market success, no field marketing organization (FMO) is more equipped to help agents save time, make more money and differentiate their practice, than SMS. Contact an SMS marketing consultant at 1.877.888.9996 to discuss this Medicare Supplement sales opportunity.
For additional birthday rule information, read The Birthday Rule: Is It in Your State and What It Means for Agents and Med Supp Clients.