The Indiana Birthday Rule was passed on March 25th, 2025. It is House Bill 1226 and went into effect on January 1st, 2026, as it did with nine other states. As we have learned to expect with all new initiatives and changes with Medicare insurance, it has been a bit of a bumpy road so far. Read on for a recap of this new rule, how it can impact your coverage and budget and how agents are navigating the application process to serve our clients best!
Who Qualifies for the Indiana Birthday Rule?
We need to clarify a fine point of this new rule as I have received a few inquiries from my clients on Advantage Plans. This rule has nothing to do with folks on Advantage Plans. I have had a few clients reach out that are currently on an Advantage Plan asking if they can leave the Advantage Plan on their Birthday and go back to Original Medicare and pick up a Supplement or Medigap plan. The answer is ‘no’. The new Birthday Rule only applies to clients already on a Supplement [Medigap] plan and are maybe paying very high premium rates. The new rule allows these individuals to change to another same type Supplement Plan for a lower premium rate with no health underwriting during the 60 day period following their birthday. With the new rule, there are more options and no denials or exclusions for chronic health issues.
Impact On Your Coverage and Budget
Medigap plan premiums have experienced larger than normal increases over the past two years, with some rate increases even hitting $100 per month in one year! These rate hikes are due to many factors, including medical inflation, higher utilization post-Covid with claims being paid and companies leveraging premiums to offset losses due to the IRA of 2022. Indiana Birthday Rule to the rescue! Beneficiaries now can keep their same Medigap plan coverage, but lower that monthly premium back down to a reasonable rate around their Birthday. Historically in Indiana, you could only do this if you were healthy and could pass medical underwriting. However, if you had any health issues, you were likely stuck in the same plan with increasing premiums. The new rule states you can change to the same letter plan. In other words, Plan G to Plan G. If you have Plan F, you can only move to another Plan F. This is particular to Indiana. Other states apply the rule differently. The good news is that it is the same coverage you are used to, but with a lower premium.
How It’s Going – Agent View
Since this rule is new to Indiana and was added as well to 9 other states, we are learning that the insurance companies are overwhelmed with the sudden flow of applications during a time of year that would normally be quiet. We are experiencing much longer application processing times and longer hold times if we have to reach out to Agent Support or Member Services. It has been extremely frustrating. What I have gleaned as a best practice is to give that application extra time. In other words, we may request an effective date for over 30 days out. Example: I am submitting a Plan G application on February 6th, but I may request an April 1st effective date. I want to allow extra processing time, so my client isn’t paying double premiums in March. You don’t want to cancel your existing plan until you know for sure the new plan is issued. We have 60 days from your Birthday to submit an application. The bottom line here is that patience will be required. My clients who know me well understand I may struggle with that patience part. We might have to start meditation or yoga!
Other Considerations
Through our training and webinars on the Indiana Birthday Rule roll out, we learned that you need a Certificate of Coverage or Letter of Active Coverage from your current Medigap plan. When we apply for a new plan during your Birthday window, we will have to show proof of what letter plan you currently have and that the plan is active. A copy of your current card will not be enough. So, if you are thinking about making a plan change during your Birthday this year, I recommend you go ahead and call your Member Services now and request the letter or certificate. You can find your Member Services phone number on the back of your insurance card. Many companies also offer an online member portal where you can set up an account and pull that document yourself if you are the tech-savvy type! Better yet, reach out to your techy grandchild for help with this one.
CDI is here to help you manage your healthcare costs and find the best options for your unique situation. We can meet in person or virtually. Reach out if you would like more information. Email carrie@cdi-cares.com or check out www.cdi-cares.com for a contact page and other helpful blogs.
Resources:
https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1226/HB1226.04.COMS.pdf