Oregon Birthday Rule

Medicare in Oregon

Oregon is a beautiful state with so many attractions such as Crater Lake National Park, Mount Hood National Forest, and Columbia River Gorge National Scenic Area. It is no wonder so many people have chosen to make this state their forever home, including a large amount of Medicare beneficiaries. Oregon values it’s Medicare-aged residents so much, there is actually legislation in place that specifically benefits those with Medicare Supplement plans!  

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Oregon Medicare Open Enrollment

In Oregon, when you first enroll in Medicare Part B, you are given a 6-month open enrollment window to enroll in a Medicare Supplement plan. You will be given this window whether you enroll in Medicare Part B at age 65, or you want until you retire, you will be given this open enrollment window either way. This window gives Medicare enrollees the ability to enroll in a Medigap plan without going through medical underwriting.

part-b-open-enrollmentEssentially, when you are new to Medicare, you can enroll in a Medicare Supplement plan during the first six-months of your Part B enrollment without having to answer any health questions. During this window you cannot be denied for any pre-existing conditions. Once this window expires, however, insurance carriers will require applicants to undergo underwriting to apply for a Medicare Supplement plan. It is important to enroll in a Medigap plan during your open enrollment window to guarantee your plan acceptance. 

Can I Change My Medigap Plan in Oregon?

In Oregon, it is crucial to enroll in a Medicare Supplement plan during your 6-month Part B open enrollment window, because it will impact your ability to change plans in the future.

If you DO NOT have a Medigap Plan in Oregon and you want to enroll past your open enrollment window, you must undergo medical underwriting. During medical underwriting, insurance carriers are given the ability to assess your application based on your medical history, including diagnoses, prescriptions, hospitalizations, height and weight, and other health-related factors. Based on your report, the insurance carrier has the option to either approve or deny your Medicare Supplement application at their discretion. 

If you DO have a Medigap Plan in Oregon, changing your plan is surprisingly easy! Oregon has enacted the Oregon Birthday Rule, which give Medicare Supplement plan enrollees the ability to change their plan once per year, without going through medical underwriting. If you qualify for the Oregon Birthday Rule, insurance carriers must accept you into their plan, regardless of your health history.

So, what is the Oregon Birthday Rule?


Oregon Birthday Rule

The Oregon Birthday Rule is a Medicare Supplement rule that is state-specific to Oregon. This rule is extremely beneficiary to individual enrolled in Medigap plans, as it allows enrollees the ability to change their plans without having to go through medical underwriting. This rule allows beneficiaries to shop their Medigap plans year to year regardless of any pre-existing conditions.

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

Who Can Change?

It is important to first understand who qualifies for the Oregon Birthday Rule. In order to utilize this rule, you must currently be enrolled in a Medicare Supplement plan. You can be enrolled in any supplement plan, but your plan will impact what choices you can make. If you are enrolled in a Medicare Advantage plan or do not have any form of supplemental coverage, you will not qualify for this rule. 

When Can I Change?

The Oregon Birthday Rule- luckily the timing is in the title! You can utilize this rule once per year, every year, around your birthday. The rule begins 30 days prior to your birthday, and concludes 30 days after your birthday. You are allotted a 60 day window to make changes to your Medicare Supplement plan, and the window will occur every year.

What Changes Can I Make?

The Oregon Birthday Rule allows you to change your current Medicare Supplement plan to one of equal or lesser coverage without going through any medical underwriting. This means that you can change to your exact same plan with a different insurance carrier, or to another plan with lesser benefits than your current plan. If you want to increase your benefits, you will have to go through medical underwriting. 

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