Insurance Talk — What is the Medicare Birthday Rule?

Insurance Talk — What is the Medicare Birthday Rule?

Rex and Cheri have the answers. Listen here.

Insurance Talk — What is the Medicare Birthday Rule?

Cheri Martinen – Today we are talking about a question we get a lot, and it’s about the Medicare Birthday Rule. What is the Birthday Rule?

What is the Medicare Birthday Rule?

Valerie Best – Let me tell you about the Oregon Birthday Rule. This applies to folks that have Medicare supplement or Medigap plans. In the state of Oregon, 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. Please remember if you are on an employer-sponsored group Medigap plan and are not eligible for the Medigap birthday rule, if you leave your employer-sponsored group Medigap plan, you may not be able to get it back if the employer plan rules do not allow it.

CM – In Oregon, we have this really, really special thing called the Birthday Rule.

VB – And all I wanted to add to that was that if you have employer coverage, always double check with them before you make any kind of changes because you may not be able to go back to your employer coverage. Regarding Medicare supplements for the regular folks.

How Does the Birthday Rule Work?

CM – So regarding the regular folks, it’s the regular people, if you have an ‘F’ or a ‘G’ or an ‘N’ or something with one of those letters, you can change that plan on your birthday month. So does it have to be, say, my birthday is October 2nd, is it the whole month of October? How does that work?

VB – What the rules say is that the 30-day guaranteed issue period actually begins on your birthday and ends 30 days later. Most of our carriers are rather lenient and you can make that change anytime during your birthday month. Be advised, the effective date of the new plan will never be before your birthday. It will always be effective the first of the month following your birthday.

CM – So like my example, where I said my birthday is October 4th, I couldn’t get my new plan to start until November 1st.

VB – November 1st unless you wanted to change that plan on November 3rd then it would be a December 1st effective date.

CM – Got it. And then I guess my other question with this is why would you switch?

Why Would You Switch?

VB – Every Medicare supplement plan is standardized by the government so that the benefits are exactly the same from one company to another, but this is an opportunity to compare prices and apply for a new Medigap plan. Because the prices vary from company to company. Who administers the plan and how much you pay for premium changes between the companies. The coverage doesn’t change, but the premium and who administers it does. And something to note that during your birthday month, this change is guaranteed regardless of your health. And that’s one of the things that we like a lot, too. So you don’t have to go through medical underwriting a second time, you will be guaranteed an issue and you can move yourself to a lower price plan.

CM – And what is medical underwriting, maybe for people who don’t do insurance every day?

VB – Medical underwriting, in the case of the Medicare supplements, it’s not a physical one. They’re not going to come out to the house and take your blood or make you give a sample of any kind. Medical underwriting in the world of Medicare supplements is based on questions and how you answer them. And most of the questions revolve around COPD, chronic heart issues, vascular issues, cancers, histories of memory dementia, things like that.

CM – So if you answered yes, I have rheumatoid arthritis, that might mean that you wouldn’t be able to purchase this new plan for a lesser amount each month. But during your birthday you don’t have to even be asked those questions.

VB – Exactly. You just bypass all of the health questions if you want to change plans during your birthday.

CM – And I think this is a big deal because a lot of people get confused about open enrollment and the Birthday Rule. So the Birthday Rule, this is for supplements, and then open enrollment is for Medicare Advantage plans. And so if you have that letter, that ‘F’ or that ‘G’ or that ‘N’ your birthday is actually your renewal.

VB – You know that’s a great point to bring up. Yes, it revolves all around your birthday. It has nothing to do with the Medicare annual enrollment periods.

CM – And that’s just one of those little tiny details that I think gets missed a lot. So if you feel like you’re paying too much for your Medicare supplement, it might be a good idea to shop on your birthday.

VB – It might be a good idea to shop on your birthday. And I would also caution you, if you do choose to make changes, that you don’t cancel your current Medigap policy until you have confirmed that the new one is in place. And the other thing I want to remind folks of is that it is the client’s responsibility to cancel their Medicare supplement plan. This is not something an agent can do on their behalf. We can help you get enrolled in a new plan, happy to help you get enrolled in a new plan. But once we have confirmation of that enrollment, it is the client’s responsibility to cancel their existing plan.

CM – And that’s for good reason really. You don’t want just random people canceling your insurance. The insurance company wants to make sure that it’s you who really wants to end your coverage.

VB – Exactly. And not your offspring may be hoping to increase their inheritance.

Bancorp Insurance Can Help

CM – Yeah, something tricky like that. So if you’re interested in shopping your Medicare supplement on your birthday, you can always give Bancorp Insurance a call, 1-800-452-6826. We’d be happy to help you, Valerie would probably actually be the one to answer the phone and put you all the way through the process. So you’re talking to the gal.

VB – We are happy to help, and sometimes people ask questions about the deductible because there is a Part B deductible and that is something to consider when switching policies. If you switch from a Plan F to a Medicare, Medigap Plan G, you will not be required to pay the Part B deductible if the Plan F has already paid it to Medicare on your behalf. And the same thing on a Plan G, if you have not met your deductible and you change plans that does not go with you, you would still have to meet that deductible.

CM – So the deductible starts over with the new plan.

VB – Yes it does. Unless it’s already been paid by the carrier.

CM – Excellent. Come shop on the Birthday Rule, 1-800-452-6826. You can also find us online at www.bancorpinsurance.com or you can listen to this podcast anytime you want on any podcast streaming station.

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