Virginia’s New Medicare Supplement Birthday Rule: No Health Questions Once a Year!

Virginia’s New “Birthday Rule” for Medigap Policies — A Game-Changer, But Not a Federal Law

A new law taking effect in Virginia on July 1, 2025, gives Medicare Supplement (Medigap) policyholders a valuable opportunity: the right to switch plans every year around their birthday without medical underwriting.

Known as a “birthday rule,” the law requires any insurer, health services plan, or HMO that issues Medigap policies in Virginia to offer an annual open enrollment period to each current policyholder. The window begins on the individual’s birthday and lasts for at least 60 days.

During that time, a policyholder can switch to any other Medigap plan offered in Virginia that provides equal or lesser benefits than their current plan. Insurers must accept the application without health screening or penalty pricing.

Insurers are also required to notify eligible enrollees 15 to 30 days before the birthday window begins, outlining their options, any changes to coverage, and applicable premiums.

Is This a Federal Rule?

No. Medigap policies are jointly regulated by federal and state law. Federal law guarantees only a one-time six-month Medigap Open Enrollment Period that begins when you are both 65 or older and enrolled in Medicare Part B. During that window, you can buy any Medigap plan sold in your state without health questions.

But that enrollment period doesn’t repeat. After it ends, insurers in most states are allowed to deny coverage or increase premiums based on health unless your state offers additional protections. Virginia’s birthday rule now Birthday Rule law provides this additional protection — and it’s being added at the state level, not the federal level.

What About Maryland and D.C.?

Maryland already has a birthday rule. Since July 1, 2023, Maryland residents with Medigap coverage have had a 30-day window beginning on their birthday each year to switch to a Medigap plan with equal or lesser benefits, without medical underwriting.

Washington, D.C., by contrast, does not offer any recurring Medigap enrollment window beyond the one-time federal six-month period. In D.C., once that window closes, any attempt to switch Medigap plans can be subject to medical underwriting.

What About Medicare Advantage? When Can You Change Plans Without Underwriting?

Medicare Advantage Plans (also called Medicare Part C), which we generally do NOT recommend because of their limitations that we've written about many times, operate under entirely different rules than Medigap/Medicare Supplement rules — and underwriting is never part of the equation. Changes to Medicare Advantage plans can be made during specific periods each year, and health status is never a factor in eligibility. Here’s how the timelines work:

Annual Enrollment Period (AEP): October 15 – December 7

Open to everyone with Medicare. You can:

• Switch from Original Medicare to Medicare Advantage
• Switch from Medicare Advantage back to Original Medicare
• Change from one Medicare Advantage plan to another
• Join, drop, or switch a Part D prescription drug plan

All of these changes are accepted without health screening or underwriting. Plan changes take effect on January 1 of the following year.

Medicare Advantage Open Enrollment Period January 1 – March 31:

Available only to people who are already enrolled in a Medicare Advantage plan. No underwriting applies. During this time, you can:

• Switch to a different Medicare Advantage plan
• Drop Medicare Advantage and return to Original Medicare (with the option to add a Part D plan)
• This window cannot be used to switch from Original Medicare into a Medicare Advantage plan.

Special Enrollment Periods (SEPs):

These are triggered by life events, such as:

• Moving to a new service area
• Losing existing health coverage
• Gaining or losing Medicaid eligibility
• Entering or leaving a nursing home or other institution

If you enter a nursing home, you are entitled to a continuous Special Enrollment Period for as long as you are institutionalized. You can change Medicare Advantage or Part D plans at any time during your stay, and for up to two months after discharge — again, with no medical underwriting.

How Is Medigap Different?

Medigap plans do not follow the same enrollment calendar as Medicare Advantage or Part D. Outside of your initial six-month enrollment window — or unless your state provides a special rule like the birthday rule — Medigap insurers may require you to undergo medical underwriting when switching plans.

Virginia’s new law changes that dynamic for Virginia residents, just as Maryland’s did the year before. But most states, including D.C., still leave consumers exposed to underwriting if they try to change Medigap coverage later in life.

Bottom Line

If you have a Medigap plan in Virginia, this new law gives you a guaranteed right each year — starting on your birthday — to shop for a plan that may cost less or better suit your needs, without worrying about being turned down because of your health.

If you’re in Maryland, you already have that right. If you’re in D.C., you don’t — and unless your health is perfect, your one-time federal Medigap enrollment window may have been your only opportunity.

Need more help understanding your Medicare options or Medigap rights -- contact a Medicare health insurance agent. Need help with Medicaid eligibility for long-term care? Call us -- our firm specializes in guiding families through the complex Medicaid long-term care eligibility process — especially when the stakes are high. Contact us today for a personalized consultation.

Stay proactive. Stay prepared. Stay healthy.