What is the Medicare birthday rule? Medigap switching rules by state (2027)

The Medicare birthday rule is a state law that gives people who already own a Medicare Supplement (Medigap) policy a short window around their birthday each year to switch to another Medigap plan without answering health questions. Medicare itself has no birthday rule. Federal law only guarantees Medigap acceptance during your six-month Medigap Open Enrollment Period and in a handful of guaranteed-issue situations, so outside those windows most states let insurers medically underwrite you. Going into 2027, sixteen states have some version of a birthday rule on the books, and the details differ a lot from one to the next.

Birthday rule states

Rules in effect for 2027, as reported by the National Association of Insurance Commissioners (NAIC) state survey dated May 11, 2026, with state insurance department updates through October 2026.

States with a similar rule that is not tied to your birthday

Every other state, including Texas, Florida, Arizona, Pennsylvania, Ohio, Georgia, New Jersey, Wisconsin, Colorado, Iowa and Tennessee, has no birthday or anniversary rule going into 2027. Iowa's legislature dropped its birthday rule bill for the 2026 to 2027 session, and a Pennsylvania Senate bill for a 90-day window was introduced in February 2026 but has not passed. In those states, switching Medigap plans usually means passing medical underwriting unless you have a federal guaranteed-issue right, such as losing employer coverage or your Medicare Advantage plan leaving your area.

How the rule works in practice

• You must already have a Medigap policy. The birthday rule is a switching right, not a first-time enrollment right. It does not help someone on Medicare Advantage who wants to move to Medigap.
• "Equal or lesser benefits" follows the plan letter hierarchy. Plan F can move to any plan. Plan G can move to G, N or lower, but not to F. Plan N can move to N or lower. In same-letter states (Indiana, Kentucky, Virginia) you can only change companies, not plan letters.
• Price is the point. Medigap benefits are standardized, so a Plan G is the same Plan G at every carrier. The rule lets you shop for a lower premium every year without being locked in by a new health condition.
• Insurers can still rate you. They cannot decline you or add waiting periods, but they can charge based on age, gender, ZIP code and tobacco use.
• Timing matters. Most states let you apply during the window for coverage starting the first of the following month. Do not cancel the old policy until the new one is issued.

What to do if your state is not on the list

You can still apply to switch at any time, and many people pass underwriting. Common knockout conditions include insulin-dependent diabetes with complications, COPD on oxygen, heart failure, cancer treatment in the last two years, and a pending surgery. Read Can I pass Medigap underwriting? before you apply, and never drop existing coverage until the new policy is approved.

Related articles

• What is California's Medigap birthday rule?
• Illinois Medicare Supplement plans: easy guide and new rules
• Can I qualify for a Medicare Supplement plan in Indiana without any medical questions?
• Can I change my Medigap plan anytime?
• What is Medigap

Talk to a licensed iHealthAgents advisor

Want to know what your Plan G or Plan N would cost with another carrier this year? Book a free call at calendly.com/iha/medicare, or call 855-847-7020. We will check your state's window and quote every carrier in your ZIP code.

Sources: NAIC State Medigap Rules chart ("Birthday Rule" and coverage for under 65), May 11, 2026; Indiana SHIP HEA 1226 fact sheet (March 2026); Minnesota Commerce Administrative Bulletin 2026-3; state insurance department pages. Updated for the 2027 plan year, last reviewed October 2026. For educational use only. State rules change often and insurers may interpret window dates differently. Confirm with your state Department of Insurance or a licensed agent before you cancel any coverage.