What is the Birthday Rule and Why Can It Help Wyoming's Medigap Policyholders?

If you’ve ever tried to change your Medigap policy (Medicare supplement insurance), but worried about seeing your coverage costs increase dramatically, help may be on the way.

The Wyoming Insurance Department has proposed Wyoming join several other states in adopting what is called the Birthday Rule for Medicare enrollees who have a Medigap policy they would like to change. If the Governor signs this proposal into effect this spring, this could be a major benefit to Wyomingites by offering a chance to change your policy annually.

Click here to submit a comment to the Wyoming Department of Insurance.

If you are new to Medigap supplements, they are insurance policies used to cover out of pocket Medicare Part A and Part B (also referred to as “traditional Medicare”) cost-sharing requirements, such as co-pays, deductibles, or coinsurance. Medigap insurers are required to provide guaranteed issue for Medigap policies during a one-time, six-month open enrollment period when individuals first enroll in Medicare Part B. Guaranteed issue periods are enrollment times when you can sign up for a Medicare supplement without going through medical underwriting or insurance companies denying you for pre-existing conditions. Outside of that initial six-month guaranteed issue window, Medigap enrollees can only change plans without medical underwriting in a very limited number of special circumstances.

If the Governor signs the Birthday Rule proposal, Medigap enrollees would be able to annually switch to Medigap plans that offer the same or lesser benefits without being dinged for pre-existing conditions within 63 days around their birthday. Wyoming would be one of ten [JE1] states that offer the Birthday Rule, with seven other states offering either year-round or specific times of the year when a person’s current policy was purchased.

The Wyoming Department of Insurance oversees Medigap policies which are sold in the state, and accepts Medicare Advantage complaints, which it sends to the Centers for Medicaid and Medicare Services. The Department of Insurance submitted the proposal for public comment at the end of 2024 and will take comments until Feb. 19, 2025. At that point it will consider any public comments received before sending the rule proposal to the Governor who can decide to sign the rule into effect.

In review - if the Birthday Rule is signed by the Governor, those trying to change their Medigap supplemental insurance policy would be able to have an annual enrollment period around their birthday in which you can switch plans for same or lesser coverage without medical underwriting, or the insurance company determining your coverage and price based on medical history. If the Governor chooses not to sign this change, companies selling Medigap supplements can deny you based on medical conditions.

If you like what you see and wish to lend your public comment to the process, click here to submit a comment to the Wyoming Department of Insurance.

While this change will not have a direct impact on those wanting to change from one Medicare Advantage plan to another, it could benefit those who want to change from a Medicare Advantage plan back to a Medigap policy.

If you like what you see and wish to lend your public comment to the process, click here to submit a comment to the Wyoming Department of Insurance.