Oregon Medigap Guaranteed Issue Birthday Rule
Starting Jan. 1, 2013, Medicare beneficiaries have a yearly opportunity to compare Medicare
supplement prices and switch companies. They must keep the same plan type or choose one
with lesser benefits. For example, a Plan F enrollee can switch to any 2010 Medicare Supplement Plan A - N, except for an Innovative Plan F).
Medicare supplement plans (also called Medigaps) help cover the "gaps" in insurance that
Original Medicare (Parts A and B) do not cover. The plans are named by letter, Plan A through
Plan N. The plan benefits are standardized, meaning Plan A benefits are exactly the same from
company to another.
This rule is a response to frequent consumer complaints of being locked into plans with large
annual increases. Here are some facts about how this works:
- The opportunity to compare prices and change Medigap plans starts on the beneficiary's
birthday and ends 30 days later.
- This chart shows what replacement plans are possible. For example, you cannot go
from a standard Plan F to an Innovative Plan F because the Innovative Plan F has more
benefits. On the other hand, you may switch from a Plan C to a Plan C Select, which
does not have added benefits.
- The change is guaranteed, regardless of your health.
- New coverage begins on the first day of the month following the birthday month (so a
May 1 birthday results in a June 1 effective date).
- Do not cancel the current Medigap policy until the new Medigap policy is issued.
- This rule does not apply to Medicare supplement policies issued before Jan. 1, 1990.
- Agents whose clients have 1990s plans will want to help clients compare both benefits
and prices when considering whether to change supplements.
- Some people with December birthdays can take advantage of this new rule as long as
the policy is not applied for or issued prior to Jan.1, 2013. (Dec. 1 and Dec. 2 birthdays
in 2012 will not be eligible because the 30-day period expires before Jan. 1.)
- People with an employer-sponsored standardized Medicare Supplement policy can use
the time around their birthday to switch to a non-employer sponsored supplement as
long as the new plan does not have additional benefits. Keep in mind that if you leave
your employee sponsored plan you may not be able to go back if the employer plan
rules do not allow it.
- The rules that apply can be found here: OAR 836-052-0143.
- For additional information or assistance you may contact CDA Insurance at 800.884.2343 or the
Senior Health Insurance Benefit Assistance (SHIBA) program sponsored by the Oregon
Insurance Division and speak with a certified SHIBA counselor at 800.722.4134.