There’s been a lot of talk — and even a few negative comments — about the Birthday Rule lately.
But is it really a bad thing? Or could it actually be one of the most beneficial tools for Medicare beneficiaries (and agents) alike?

Let’s break it down.

What Is the Birthday Rule?

Simply put, the Birthday Rule allows Medicare beneficiaries to change from one Medigap plan or carrier to another — with no underwriting — during their birthday month each year.

That means no health questions, no medical exams, and no denials based on preexisting conditions.

It’s not a federal rule — it’s implemented state by state, which means the specifics vary.
For example, California’s window might be 30 days before or after your birthday, while another state may allow 60 days. Always check your state’s Department of Insurance (DOI) for the exact details.

States That Have a Birthday or Anniversary Rule

When the Birthday Rule started, only a few states offered it.
Now? Nearly 19 states have implemented some form of it — either as a birthday or anniversary rule:

California, Connecticut, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Missouri, Massachusetts, Maine, New York, Utah, Virginia, Vermont, Washington, and Wyoming.

That’s almost half the country — and the list keeps growing each year.

How the Birthday Rule Impacts Commissions

Here’s where it gets tricky.
Birthday Rule applications are considered guaranteed issue business, and in some states, that can mean reduced commissions — sometimes 90–95% lower than traditional Med Supp sales.

For example:

• In Washington, commissions are often capped around 10% for all Medigap enrollments.

• In Utah, agents can only switch clients within the same carrier (like going from Plan F to Plan G).

• And in some cases, agents might only earn a one-time $50 payment — or nothing if they weren’t the original agent of record.

That’s why it’s critical to check with your carrier or upline before writing Birthday Rule business.

Why the Birthday Rule Is Growing Fast

Despite lower commissions in some states, the Birthday Rule is hugely popular with consumers — and for good reason.

Seniors are tired of watching their Med Supp premiums skyrocket year after year, especially after age 65.
In some cases, those “cheap” entry-level plans can double in cost by age 70.

The Birthday Rule gives beneficiaries the power to shop for better rates, even if they’ve developed health issues since their initial enrollment.

From the state’s perspective, it’s about fairness.
From the consumer’s perspective, it’s about relief.
And from the agent’s perspective, it’s about opportunity — if you know how to navigate it.

The Pros and Cons of the Birthday Rule

✅ Pros for Beneficiaries:

• Freedom to switch plans without health questions

• Protection from skyrocketing premiums

• More choice and flexibility

❌ Cons for Agents and Carriers:

• Reduced or no commissions in some cases

• Higher premiums across the board (especially early on)

• Increased administrative complexity for carriers

When Oregon implemented the rule, for example, premiums jumped 20–40% almost overnight as carriers recalculated risk. But over time, as actuaries gathered more data, the market stabilized — and both premiums and commissions became more predictable.

The Agent’s Opportunity

If you operate in a Birthday Rule state, this can actually be a goldmine — especially if you focus on the right niches:

• T65 / new-to-Medicare clients

• Open enrollment clients

• Birthday Rule renewals

With the right marketing strategy, you can write clean, compliant, guaranteed-issue Med Supp business all year long — without ever touching an underwritten policy.

And that’s exactly where we come in. 👇

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