Nevada Birthday Rule

Medicare in Nevada

Nevada is definitely a booming place! From Las Vegas to the Hoover Dam, there are a ton of ways to spend your retirement years. It is no wonder that there are half a million seniors enrolled in Medicare in Nevada. In 2022, Nevada has introduced legislature to help those Medicare beneficiaries when it comes to Medicare Supplement plans.

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Nevada Medicare Open Enrollment

Nevada open enrollment for Medicare Supplement plans is similar to the majority of other states. Anyone who is new to Medicare, whether turning 65 or using a special enrollment period to enter Medicare after retirement is entitled to a 6 month open enrollment window. During this 6 month window, which begins on your Medicare Part B effective date, beneficiaries are able to enroll in a Medigap plan without undergoing medical underwriting or answering any health questions.

part-b-open-enrollmentWhat this open enrollment window means is that when your Medicare Part B becomes effective, you will enter a 6 month long window of open enrollment. During this window you cannot be denied coverage due to pre-existing conditions or health history. It is critical to apply for a Medicare Supplement plan during this time period to guarantee your acceptance regardless of your health history.

Can I Change My Medigap Plan in Nevada

One of the most important reasons to enroll in a Medigap plan in Nevada during your initial open enrollment window involves your ability to change plans in the future.

If you DO NOT have a Medigap plan in Nevada and you want to enroll in a plan past your open enrollment window, you must go through medical underwriting. This means that you will by assessed by insurance carriers based on your medical history including diagnoses, prescriptions, hospitalizations, height and weight, and other health-related factors. Based on this history, the insurance carrier is given the option to either approve or deny you for a Medigap plan at their discretion. 

If you DO have a Medigap plan in Nevada, in 2022 a rule has been introduced that allows you to change your Medicare Supplement plan once per year without medical underwriting. This rule is called the Nevada Birthday Rule and occurs each year surrounding your birthday. If you qualify, insurance carriers must accept you into their plan, regardless of your health history.

So, what is the Nevada Birthday Rule?

Nevada Birthday Rule

The Nevada Birthday Rule is a new rule in 2022 that is specific to the state of California. This rule allows Medicare beneficiaries to change their Medigap plans without going through medical underwriting. This rule is extremely beneficial to Medicare beneficiaries, as it allows enrollees the ability to change plans regardless of health history or pre-existing conditions. 

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

Who Can Change?

In order to qualify for this rule, you must be currently 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 a Medigap plan A-N, you will qualify, but the plan you have will impact the moves you are able to make.

When Can I Change?

The best part about the Birthday Rule is that the name tells you exactly when you can make a move. It makes it hard to forget! In Nevada, every year starting on the first of the month of your birthday, you enter a 60 day window in which you can utilize this rule. The window will occur at the same time every year. 

What Changes Can I Make?

The Birthday Rule allows you to change your Medigap plan to one of equal or lesser coverage without any medical underwriting. To put it simply, you can change to a plan with equal benefits or a plan with lesser benefits, but you cannot change to a plan with higher benefits. If you want to increase your benefits, you would have to undergo medical underwriting. 

"I don't generally recommend Medicare Advantage plans due to the higher out of pocket costs and having to stay within a network of doctors and hospitals. I prefer freedom of choice."
Keith Armbrecht
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