Idaho Birthday Rule

Medicare in Idaho

Idaho is a great state tucked away in the Pacific Northwest. With almost a half million residents in Idaho enrolled in Medicare, that makes up for about 1/4th of the overall state population! It is no wonder that Idaho in 2022 introduced new legislation known as the Idaho Birthday Rule to help Medicare beneficiaries obtain the best Medigap coverage with protection from future rate increases. 

Did You Watch

Idaho Medicare Open Enrollment

When you first enroll in Medicare, whether you are turning 65 or retiring, all beneficiaries are given an open enrollment period to enroll in a Medicare Supplement plan. This open enrollment period is a 6-month long window allowing individuals new to Medicare the ability to enroll in a Medigap plan without having to undergo medical underwriting or answer any health questions.  


The easiest way to think of this open enrollment window is to consider your Part B effective date as the start of a ticking time clock. Once your Part B becomes active, you enter the 6-month long open enrollment window. This window is extremely important, as you do not have to undergo medical underwriting to enroll in a Medigap plan, which means that you can’t be denied coverage based on any pre-existing conditions. Once this window expires, medical underwriting becomes active to enroll into a Medigap plan, except under one specific state-specific circumstance.

Can I Change My Medigap Plan in Idaho?

One of the most important reasons to enroll in a Medicare Supplement plan in Idaho during your open enrollment period has to do with the ability to change your plan in the future.

If you DO NOT have a Medigap plan in Idaho and you want to enroll in a plan after your open enrollment window has expired, you must undergo medical underwriting. Medical underwriting will entail things such as a detail medical history questionnaire including diagnoses, prescriptions, hospitalizations, height and weight, and other health-related factors. Based on the information obtained during medical underwriting, insurance carriers are then given the option to either approve or deny your enrollment into a Medigap plan at their discretion. 

However, if you DO have a Medigap plan in Idaho, there is a state-specific rule that gives you the option to change your Medicare Supplement plan once per year without having to undergo medical underwriting. This rule is known as the Idaho Birthday Rule. If you qualify for this rule, insurance carriers have no option but to accept you into their plan, regardless of your health history.

So, what is the Idaho Birthday Rule?

Idaho Birthday Rule

New for 2022! The Idaho Birthday Rule is a Medicare Supplement rule specific to the state of Idaho that allows Medicare beneficiaries who are enrolled in Medigap plans to change their plans annually without having to undergo medical underwriting. This rule is extremely beneficial for enrollees, as it gives them the ability to shop plans on an annual basis regardless of pre-existing conditions. 

In order to utilize the Idaho Birthday Rule, you must meet certain criteria:

Who Can Change?

It is first important to determine if you qualify for the Idaho Birthday Rule. In order to qualify, you must currently be enrolled in a Medicare Supplement plan. If you are enrolled in a Medicare Advantage plan or do not have any supplemental coverage, you will not qualify for the Birthday Rule. As long as you are enrolled in one of the lettered Medigap plans (plans A-N), you will qualify for this rule, but the plan you have will impact the moves you are able to make. 

When Can I Change?

Luckily for us, this question is answered by the rule’s name! The time to change your Medicare Supplement plan with the Idaho Birthday Rule takes place around your birthday. This rule is a 63-day period that begins on the Medigap policyholder’s birthday. The 63-day window will occur once per year, every year.

What Changes Can I Make?

The Idaho Birthday Rule allows your to change your Medicare Supplement plan to another plan of equal or lesser coverage. Essentially, you can change your plan to another plan that has the same benefit level, or a plan with a lower benefit level, but not to a plan with a higher benefit level. If you want to increase your benefits, you would have to undergo medical underwriting.


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