Have you ever wanted to change your Medicare supplemental (Medigap) plan? If you live in Oregon, you’re in luck: the “Birthday Rule” has you covered.
There are a number of ways in which the Birthday Rule can help you, depending on what your needs are, what plan you currently have, and what the other plans offer.
Today we’ll look at this very important rule for Oregon residents, as well as the circumstances under which it might be able to help you get coverage that better reflects your needs.
Medigap Plans and State-Specific Policies
Medicare is a federal program available in every state and every U.S. territory, while Medicare supplemental plans, also known as Medigap, are sold by private companies.
Medigap plans are important, because as the name suggests, they are designed to help cover the gaps in Medicare insurance coverage.
You may still have a balance left over for some medical expenditures even after Medicare and your Medigap plan, but, depending on the nature of the expense and how much, you likely stand to benefit a great deal by having a Medigap policy.
There are a lot of rules surrounding Medigap policies. In Oregon there’s a special regulation called the Birthday Rule: every year on your birthday, you get a 30-day window in which to obtain a different Medigap policy.
If you choose to take advantage of this rule, there are some important parameters: you have to keep the same type of plan, or else choose one that has lesser benefits. The plans are standardized by letter, making them easy to compare.
What’s So Great About the Birthday Rule?
The key thing to understand about the Birthday Rule is that it is your opportunity to get a plan from a company that offers a better deal for your needs.
During the 30-day period that starts on your birthday, you can apply for a Medigap plan either of the same type or one with lesser benefits with no medical underwriting.
How big of a deal is this? What happens if you want to switch plans at some point during the year before or after this 30-day period starting on your birthday?
You’ve probably guessed the answer: if you don’t wait, or wait too long, you’ll be subject to medical underwriting.
This means the issuer of the Medigap policy can review your health status and decide whether or not you’re eligible.
This means they can take a look at your medical history and how much care you need or are likely to need.
In other words, this means they can say No.
If there’s any reason you might want to change companies for your Medigap plan, the Birthday Rule is your friend.
But why might you want to change companies? Let’s consider some potential answers to that question.
What’s So Great About Changing Companies?
There are any number of reasons you might be happy with your Medigap plan and the company that issues it, but they probably boil down to some version of: “It provides good coverage at a reasonable price.”
Unless, of course, that’s not true.
What if you could find the exact same plan, but at a much better price from a different company?
In that case, it might well be in your best interest to switch companies.
You might be skeptical that this is the case, but because Medigap plans are issued by private insurers, it’s entirely possible you haven’t found the very best deal. When was the last time you checked and tried to find out?
There’s a surprisingly easy way to check and see if this is the case, one we mentioned above: because Medigap plans are standardized with letters of the alphabet, you can compare them by letters and know that you will still receive the same benefits.
Ergo, if you find a Medicare Supplement Plan A in your state at a better cost than the Medicare Supplement Plan A that you have right now, you can get cheaper premiums and still have the same benefits.
Of course, let’s be clear about one thing: the Birthday Rule is not a free pass to apply for a better plan. If you have a standard Plan F, you cannot use the Birthday Rule to apply for an Innovative Plan F without medical underwriting, because that plan offers more benefits.
However, if you’re unhappy with the insurer that issues your standard Plan F, you might find another company offering the same plan at a better price. In addition, when you switch companies the new company cannot impose any waiting periods or exclude pre-existing medical problems.
This is one straightforward reason you might want to switch, but there are others.
For example, you may have signed up for a plan, and later come to realize, over the years, that it covers many things you don’t need and don’t ever expect to need.
If you have a plan that covers many benefits, but your health is very good, you might well find it to be in your interest to switch to a plan that offers fewer benefits and a lower premium.
Finally, not all insurance companies are created equally. It might well be the case that you have had other issues with your insurance company that go beyond the total amount you’re paying, and have some reason to believe that another insurer will offer you a better experience, even if you end up with the same plan at the same price.
Conclusion: Should You Change Your Plan?
While it may go without saying, ultimately only you can determine whether you should switch your plan. However, there are a few important considerations to take into account:
- Whether you can get better value: perhaps a change will offer you better value for your money.
- Whether you can save money: perhaps a different plan, or the same plan from a different insurer, will save you money while still meeting your needs.
- Whether you’re happy with your insurer: perhaps you aren’t, in which case a different insurer might be the answer.
These considerations ought to be able to help you make the decision about your Oregon Medigap plan that is right for you.
How Can We Help?
Navigating your Medicare choices and options can be confusing. We can help. And our advice is free. Contact us to learn more.