Beginning January 1, 2026, Indiana will implement a major change to its Medicare supplemental (Medigap) policy regulations through the adoption of the Medicare birthday rule, following the passage of House Bill 1226. This rule introduces a new annual opportunity for eligible Medicare beneficiaries to switch Medigap plans without medical underwriting, offering greater flexibility and potential cost savings.
Having worked with retirees and their families for more than 10 years, I know firsthand how important it is that both beneficiaries and those who support them – spouses, adult children, and individuals with power of attorney – understand how this rule works and how it may impact their financial and healthcare planning.
What Is the Medicare Birthday Rule?
The Medicare birthday rule allows individuals enrolled in a Medigap plan to switch to another plan of the same letter type (e.g., Plan G to Plan G) offered by a different insurance company within 60 days of your birthday – without being subject to medical underwriting.
This means no health screening is required, pre-existing conditions will not affect eligibility or premiums, and beneficiaries can shop for better rates and potentially reduce their monthly costs.
To take advantage of this rule, you must be age 65 or older, currently enrolled in a Medigap plan, and apply to switch plans within the 60-day window of your birthday.
Before this legislation, Indiana residents seeking to change Medigap plans outside of their initial enrollment period typically faced medical underwriting, which could result in higher premiums or denial of coverage due to health status.
Indiana becomes the 10th state to implement a version of the Medicare birthday rule. Each state’s version varies slightly, but the core principle remains: guaranteed issue rights during a birth-based enrollment window.
While the birthday rule offers clear benefits, it’s important to consider the broader financial implications: Insurance carriers may adjust premiums to offset the risk of guaranteed issue. States with similar rules have seen premium increases over time. Plus, market dynamics could shift, affecting plan availability and pricing.
These factors underscore the importance of reviewing your coverage annually and working with a professional financial advisor to make informed decisions.
What Should You Do?
If you or a loved one is enrolled in a Medigap plan in Indiana:
- Mark your birthday month on your calendar for 2026.
- Review your current plan and premiums.
- Compare offerings from other insurers for the same plan type.
- Consult with a licensed Medicare advisor or financial advisor to evaluate your options.
This rule empowers Indiana seniors to make more informed and cost-effective decisions about their healthcare coverage – without the barrier of underwriting.
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