Idaho's Medigap Birthday Rule: How the 63-Day Window Works

Why this matters more than it sounds

Medigap policies are standardized by letter. A Plan G from one company covers exactly the same Medicare gaps as a Plan G from any other company. What differs is the price, and how that price has changed over the years. Many people pick a policy at 65, then watch the premium climb, and assume they're stuck because they've developed a health condition that a new company might not accept.

The birthday rule removes that worry once a year. During your window, your health can't be used against you, so you can compare what other companies charge for the same plan letter and move if a better price exists. For someone who has had the same policy for several years, that once-a-year check can be worth real money.

Who can use it, and who can't

The rule is only for people who already hold a Medigap policy in Idaho. It is not a way into Medigap for the first time, and it doesn't help someone on a Medicare Advantage plan move to Medigap. Those moves generally involve health questions unless another guaranteed-issue right applies, such as leaving a Medicare Advantage plan you joined when you first became eligible at 65 within your first 12 months, or your plan leaving your area.

It also only works sideways or down in coverage, never up. The new policy must have similar or lesser benefits than the one you have now. The Department of Insurance's own example: someone who already has Plan F can buy Plan F or a lesser plan during the window. Someone with Plan N can't use the window to move to Plan G, because Plan G covers more.

• You can: keep the same plan letter and move to a different company.
• You can: move to a plan letter with fewer benefits, for example Plan G to Plan N.
• You can't: move up to a plan letter with more benefits.
• You can't: use the window to leave Medicare Advantage for Medigap.
• You can't: use it to buy Medigap for the first time.

The pricing change that came with it

The same 2021 law changed how new Medigap policies in Idaho are priced. Policies issued after February 28, 2022 are community-rated, which means the company charges the same premium for the same plan regardless of your age. Before that, most Idaho Medigap policies were issue-age rated, priced on the age you were when you bought the policy.

If you already have an older issue-age policy, nothing forces you to change. The Department of Insurance says companies can't make you move to a community-rated policy. But if you use the birthday rule to switch, the new policy will be community-rated. So when you compare, look at more than this year's premium: ask how each company's rates have moved in recent years, and think about how the two pricing methods will play out for you over the next decade.

How to use your window, step by step

The window is 63 days long, which is enough time if you start early and not much time if you don't. Here's a simple routine for the month before your birthday.

• Find your current plan letter (A through N), your monthly premium, and your latest renewal or rate notice.
• Compare what other companies charge for the same plan letter, and for any lesser plan you'd consider. Ask about each company's rate history, not just today's price.
• If you find a better fit, apply during your 63-day window, which starts on your birthday.
• Keep paying your current policy until the new one is approved and in force. Then cancel the old policy in writing so you never have a gap.
• Put next year's birthday on your calendar. The window comes back every year.

Mistakes to avoid

The most expensive mistake is canceling your current policy before the new one is approved. If something goes wrong with the new application, you could be left without supplemental coverage and outside any protected window. Always overlap, then cancel.

Two other common mix-ups: the birthday window has nothing to do with Medicare's Open Enrollment from October 15 to December 7, which is for Medicare Advantage and Part D drug plans, not Medigap. And the birthday rule doesn't touch your Part D drug plan at all; if you also want to change drug plans, that happens during Medicare's Open Enrollment. If you're weighing Medigap against Medicare Advantage more broadly, our Medicare Supplement guide explains the trade-offs.

Where to get help in Idaho

SHIBA, the Senior Health Insurance Benefits Advisors program run by the Idaho Department of Insurance, gives free, unbiased Medicare counseling at 1-800-247-4422 and can explain your rights under the birthday rule. SHIBA doesn't sell insurance.

If you'd like help comparing policies during your window, Eric Jenkins is licensed in Idaho and works with Idaho clients by phone or video, at no cost to you. Call or text him at (702) 249-0514. Jordan Jenkins, who runs this site, is licensed in Wyoming and Utah only. For more on how Medicare works in the state, see our Idaho Medicare page and Idaho FAQ.