Home / Medigap birthday rules and guaranteed issue, state by state
Medigap birthday rules and guaranteed issue, state by state
Federal law does not let you switch Medigap policies without health questions. Many states do. Look up your state, then confirm the dates with your state insurance department or SHIP.
What a birthday rule is
Birthday rules let people who already have a Medigap policy switch each year, around their birthday, to another policy with equal or lesser benefits, without medical underwriting. Depending on the state, the new policy can come from the same insurer or a different one, and the window runs from 30 to 63 days. KFF counts 16 states with birthday rules: CA, DE, ID, IL, IN, KY, LA, MD, NV, NM, OK, OR, UT, VA, WV and WY. A birthday rule does not let someone without Medigap newly buy a policy, so it does not solve the problem of leaving Medicare Advantage.
States with their own rules
| State | Type | What the sources say | Source |
|---|---|---|---|
| California | Birthday rule | California gives people who already have Medigap an open enrollment window of 60 days or more starting on their birthday to buy another policy with equal or lesser benefits, from the same or a different carrier. | NAIC |
| Connecticut | Year-round guaranteed issue | Connecticut requires Medigap insurers to offer policies year-round to people 65 and older without regard to health (continuous guaranteed issue). | KFF |
| Delaware | Birthday rule | Delaware (law effective January 1, 2026) lets Medigap policyholders switch to a policy with the same or lesser benefits on a guaranteed-issue basis. The window starts 30 days before your birthday and continues for at least 30 days after. Delaware also gives Medicare Advantage enrollees 65 and older two annual guaranteed-issue periods (October 15 to December 7 and January 1 to March 31); insurers cannot deny them but may charge more based on health and impose a 6-month waiting period for pre-existing conditions. | NAIC; KFF |
| Idaho | Birthday rule | Idaho: 63 days from your birthday to change to another Medigap plan with the same or a lower level of benefits. You can also change insurance carriers. | NAIC |
| Illinois | Birthday rule | Illinois: 45 days from your birthday to change to another plan with the same or a lower level of benefits, with your current carrier or an affiliate of it. You must be 65 to 75 years old. Separately, one insurer (Blue Cross Blue Shield of Illinois) offers Medigap to anyone 65 and older on a guaranteed-issue basis all year, but that is not a legal requirement and could change. | NAIC; KFF |
| Indiana | Birthday rule | Indiana (effective January 1, 2026): if you are 65 or older with a Medigap policy, you can move to a different company for the same lettered plan during the period from one month before your birthday to one month after. This does not give guaranteed rights to people on Medicare Advantage. | Indiana SHIP; NAIC |
| Kentucky | Birthday rule | Kentucky (effective January 1, 2024): a Medigap enrollee can switch to another insurer's policy, plan for plan, within 60 days of their birthday. | NAIC |
| Louisiana | Birthday rule | Louisiana: 63 days from your birthday to select a different Medigap plan with equal or lesser benefits. This applies to plans with your current carrier or its affiliates. | NAIC |
| Maine | Annual guaranteed-issue window | Maine requires insurers to issue at least Medigap Plan A during an annual one-month enrollment period chosen by the insurer. Policyholders can switch to a policy with equal or lesser benefits at any time if there is less than a 90-day gap in coverage. Maine also extends the Medicare Advantage trial period from one year to three. | KFF; NAIC |
| Maryland | Birthday rule | Maryland (effective July 1, 2023): 30 days from your birthday to switch to another Medigap plan with equal or lesser benefits than your current plan. | NAIC |
| Massachusetts | Year-round guaranteed issue | Massachusetts regulation requires an annual guaranteed-issue period (February 1 to March 31), but all insurers in the state offer year-round open enrollment. Massachusetts also has its own standardized Medigap plans. | KFF; NAIC |
| Minnesota | Other switching rule | Minnesota (effective August 1, 2026): a one-time guaranteed-issue opportunity for people 65 to 70 during the Medicare open enrollment period (October 15 to December 7). Insurers may charge higher premiums under this rule. Minnesota also has its own standardized Medigap plans. | KFF |
| Missouri | Other switching rule | Missouri lets Medigap policyholders switch to an equivalent policy from a different insurer within 30 days before or after the annual anniversary date of the policy. | KFF |
| Nevada | Birthday rule | Nevada: 60 days from the first day of your birth month to change to another Medigap plan with the same or a lower level of benefits. You can also change insurance carriers. | NAIC |
| New Mexico | Birthday rule | New Mexico (effective January 1, 2027): for at least 60 days beginning in the policyholder's birthday month, you may switch to a plan of equal or lesser value and may change carriers. | NAIC |
| New York | Year-round guaranteed issue | New York has continuous open enrollment for Medigap throughout the year, with community rating. | KFF; NAIC |
| Oklahoma | Birthday rule | Oklahoma: 60 days from your birthday to select a different Medigap plan with equal or lesser benefits, as long as you have not had a coverage gap. | NAIC |
| Oregon | Birthday rule | Oregon: beginning 30 days before your birthday and for 30 days after, you may change to another Medigap plan with the same or a lower level of benefits. You can also change insurance carriers. | NAIC |
| Rhode Island | Other switching rule | Rhode Island (2025 law): during the Medicare open enrollment period (October 15 to December 7), current Medigap policyholders may switch to any policy offered by any insurer, and Medicare Advantage enrollees 65 and older have an annual guaranteed-issue right to buy Medigap. The Medicare Advantage right does not apply to people in Original Medicare who have no Medigap. | KFF; NAIC |
| Utah | Birthday rule | Utah (2025 law): a 60-day annual window to switch to a plan of equal or lesser benefits without medical underwriting, but only with your current insurer. | NAIC |
| Virginia | Birthday rule | Virginia (effective July 1, 2025): a 60-day open enrollment period starting on your birthday each year. You can switch to any Virginia insurer's Medigap policy with the same benefits, regardless of health. It does not cover changes between Original Medicare and Medicare Advantage. | Virginia SCC |
| Washington | Other switching rule | Washington lets Medigap policyholders switch to a policy with equal or lesser benefits at any time if there is less than a 90-day gap in coverage. People with Plan A can switch only to another Plan A; people with Plans B through N can switch to any other Plan B through N. | KFF; NAIC |
| West Virginia | Birthday rule | West Virginia (effective June 11, 2026): 60 days starting with the first of the birthday month, available every two years with continuous coverage. You must generally stay with the same company or an affiliate, unless the lesser plan is not offered. | NAIC |
| Wyoming | Birthday rule | Wyoming: Medigap enrollees can switch to any available plan with the same or lesser benefits, without underwriting. The window begins on your birthday and continues for 63 days. | NAIC |
States with no rule found
The sources reviewed list no birthday rule or year-round guaranteed issue for: Alabama, Alaska, Arizona, Arkansas, Colorado, District of Columbia, Florida, Georgia, Hawaii, Iowa, Kansas, Michigan, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Wisconsin. Federal rules apply in these states, and some have other qualifying events not covered here. Wisconsin, Minnesota and Massachusetts also use their own standardized Medigap plans.
Dates change. Several of these rules are new (Delaware, Indiana, Virginia, Utah, West Virginia, Rhode Island, Minnesota) or not yet effective (New Mexico, January 1, 2027). The NAIC chart is dated May 11, 2026 and KFF's analysis October 13, 2026. Some states, such as California and Virginia, require your insurer to notify you before your window opens; in any state, confirm your exact dates with your insurer or SHIP.
How to use a birthday window
- Keep your current policy until the new one is issued and effective, to avoid a gap in coverage (Virginia's regulator gives this advice).
- Check the state's limits on benefits. Most states only allow a switch to a policy with equal or lesser benefits. Going up in benefits can mean underwriting.
- A deductible you already met may not carry over to a new policy.
- Compare prices first. Medigap premiums vary a lot by company, and the standardized benefits are the same for the same letter.
Sources
- KFF: Medigap Guaranteed Issue Requirements: An Overview of Federal and State Rules (Oct 13, 2026)
- NAIC: State Medigap Rules, "Birthday Rule" and Coverage for under 65 (as of May 11, 2026) (PDF)
- Virginia SCC: Medigap Open Enrollment "Birthday Rule"
- Indiana SHIP: Ask SHIP (July 2026) (PDF)
- SHIP National Technical Assistance Center: find your State Health Insurance Assistance Program
Common questions
Is there a Medigap birthday rule in Florida or Texas?
The sources reviewed list no birthday rule for Florida or Texas. Federal rules apply there, so changing Medigap companies generally involves medical underwriting unless another guaranteed-issue right applies.
Do birthday rules help me leave Medicare Advantage?
No. They apply to people who already have a Medigap policy and want to switch to another one.
What if my state is not listed?
The sources reviewed list no state birthday rule or year-round guaranteed issue there. Some states have other qualifying events. Ask your State Insurance Department or SHIP.
General information only. Medigap Atlas does not sell, recommend or enroll anyone in any plan, and is not affiliated with Medicare, CMS or any insurer. Rules and dates change and vary by state. Confirm your options with 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP) before you change coverage.