The Birthday Rule: What It Means for Med‑Supp Agents & Clients

Why the Birthday Rule Matters

Medicare Advantage beneficiaries can review and change plans each fall during AEP, but Medicare Supplement (Med‑Supp) policyholders haven’t always had the same opportunity. For many, this has meant being locked into plans with increasing premiums or reduced benefits as they age.

To address this, some states have adopted a “Birthday Rule,” giving Med‑Supp policyholders a special window—typically tied to their birthday—during which they can change plans without going through health underwriting.

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How It Works and Where It Applies

The Birthday Rule is not a nationwide standard. Currently, about 14 states have adopted or proposed some version of it. Key elements vary by state, including:

• Timing: Some allow 30 days from the client’s birthday, others extend to 60 days.
• Plan Switching: Many states limit switching to the same or lesser coverage, while others are more flexible.
• Carrier Participation: Each carrier may apply the rule differently based on state guidance.

It’s essential that agents stay up to date on how these rules apply in their licensed states.

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Benefits for Clients

• Freedom to Compare: Clients can reassess their coverage annually to make sure their plan still meets their needs.
• Health Underwriting Waived: No underwriting required during the birthday window—ideal for clients with changing health.
• Potential Savings: Clients may be able to reduce monthly premiums by switching to a more cost-effective plan.

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What Agents and Carriers Need to Know

While the rule creates new opportunities, it also comes with some industry challenges:

• Premium Increases: To offset the risk of guaranteed-issue enrollments, some carriers raise rates—sometimes significantly.
• Commission Adjustments: Certain carriers may reduce commissions on plans sold under the Birthday Rule.
• Carrier Limitations: Agents must understand which carriers follow the Birthday Rule and how their underwriting rules apply.

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How CareValue Supports You

At CareValue, we’re here to help you navigate these changes with confidence. We provide:

• Up-to-Date State Info: Track which states have Birthday Rule laws and what they allow.
• Carrier & Plan Guidance: Get personalized help identifying which carriers participate and what restrictions may apply.
• Agent Training & Support: Access training, compliance updates, and best practices to better serve your Med‑Supp clients.
• Legislative Monitoring: We stay on top of evolving regulations so you can stay focused on sales and service.

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Make the Most of the Birthday Rule

This rule can be a powerful sales opportunity—if you’re ready. Start by:

• Identifying clients in Birthday Rule states.
• Reaching out before their birthday window opens.
• Reviewing current plans and available alternatives.
• Helping clients transition smoothly—without underwriting delays.

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