Medicare-Eligible Health Insurance Article

Oregon Medigap Plans: Special Rules and Amazing Options

Oregon Medigap Plans have a special rule that allows you to switch your Medigap Policy within 60 days each year, known as the Birthday Rule, which is available in only a few states.

OR Medigap Basics

Medigap, also known as Medicare Supplement Insurance, is a type of private health insurance designed to help cover the “gaps” in coverage left by Original Medicare (Parts A and B). These gaps can include out-of-pocket costs like deductibles, copayments, and coinsurance which can add up quickly for those with high medical expenses. Medigap plans are sold by private insurance companies and are regulated by both federal and state laws. For a detailed article about Medigap in Oregon check out the Oregon Medigap Buyers Guide

In Oregon, Medigap plans are standardized into ten different plan types, labeled A through N. This means that each plan type offers the same benefits, regardless of which insurance company you purchase it from. If you need help finding the right coverage for you, please contact at 800-930-7945 x 3.  There is never a charge for their services.

Who is eligible for an Oregon Medicare Supplement Plan?

To be eligible for a Medigap plan, you must first be enrolled in Original Medicare (Parts A and B). You must also be a resident of OR and be at least 65 years old or have a qualifying disability or medical condition.

In addition to meeting these basic eligibility requirements, it’s important to note that you can generally only enroll in a Medigap plan during certain enrollment periods. During this time, you have a guaranteed right to purchase any Medigap plan available in your area, regardless of your health status.

After the initial enrollment period, you may still be able to enroll in a Medigap plan, but you may be subject to medical underwriting and may not be able to purchase the plan of your choice.  This is why it is so important that you work with a licensed independent insurance agent to help you select the right plan when you are first eligible. Feel free to call at 800-930-7956 for assistance.

What is the Oregon Medigap Birthday Rule?

The OR birthday rule is a law that enables individuals with a Medigap plan to switch to another plan without undergoing medical underwriting. In OR, they have established an annual 60-day window based on your birthday to change plans, giving it the nickname “birthday rule”.

Most states do not have a birthday rule or similar option, so individuals outside of Oregon with Medigap plans who want to switch to a more affordable competitor usually must complete an application and answer questions regarding their current health condition to be approved.

How do Oregon Medigap Plans Implement the Birthday Rule?

The Birthday Rule for Medigap plans in certain states, including Oregon, allows individuals to switch plans during a 60-day window surrounding their birthday each year. Specifically, this window begins 30 days before your birthday and ends 30 days after your birthday. If you’re interested in making the switch, you can check out the following link to see which plans are available for exchange.

Before making the change, you have to keep this in mind:

  • The change is guaranteed, regardless of your health.
  • If you choose to switch from one Medigap Plan F High Deductible policy to another mid-year, the high deductible will restart under the new carrier’s policy contract. Therefore, it’s crucial to carefully consider the annual deductible before making the switch.
  • New coverage for a Medigap plan typically begins on the first day of the month following the application date. It may be possible that coverage may even start before your birthday, depending on when you applied, the insurance carrier, and when your birthday falls in the calendar year.
  • Finally, it’s crucial not to cancel your current Medigap policy until the new policy is issued. In some cases, you may even need to pay two premiums for a single month to ensure a seamless transfer from the old to the new policy.

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