Oregon Medigap Guaranteed Issue Birthday Rule
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 typically begins on the first of the month following the application date. However, it cannot start before your birthday. Example: A Jan. 23 application date results in a Feb. 1 effective date. Insurers can adjust the effective date so consumers do not have two policies that are active at the same time. In some cases, this means the policy start date is more than 30 days from the date of application. For example: Jane’s birthday is July 5. She applies to a new company on July 20 but requests a Sept. 1 effective date to allow time to cancel the existing policy.
- “Mid-month” effective dates are discouraged, as applicants typically must give their prior carrier notice.
- Do not cancel the current Medigap policy until the new Medigap policy is issued. You may have to pay two premiums for one month to ensure a smooth transfer from the old to new policy.
- Switching mid-year from one Medigap Plan F High Deductible policy to another will restart the high deductible under the new carrier’s policy contract. Consider the annual deductible before switching policies.
- Switching from a Medigap Plan F to a Medigap Plan G will not require you to pay the Medicare Part B deductible if the Plan F policy already paid it to Medicare for the plan year.
- 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.
- 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.