Does Texas Have a Medigap Birthday Rule?

Texas does not have a general annual Medigap birthday rule. If you already own a Medicare Supplement policy, turning another year older does not automatically allow you to switch insurance companies without medical underwriting.

That does not mean you are permanently locked into your current policy: other enrollment protections may apply, and you can usually submit an application to a different insurer.

What is a Medigap birthday rule?

Some states have laws that permit qualifying Medigap policyholders to change policies around their birthdays without health underwriting. The permitted window, whether the new plan must have equal or lesser benefits, and which insurers must accept applications vary by state.

Texas has not adopted a general annual rule of this kind. It is important not to apply a California or Oregon explanation to a Texas policy. For state-specific rules, consult Texas Department of Insurance's Medicare Supplement guide.

What happens if you want a cheaper Plan G?

Suppose a Texas resident has paid for Plan G for eight years and receives a renewal increase. Another insurer offers a lower advertised premium. Because Plan G benefits are standardized, comparing the two prices is useful.

However, outside a protected enrollment period the new insurer may review health history and decline the application. Do not cancel the current policy until the new insurer issues approval and confirms the effective date.

Read switching Medigap plans in Texas.

Turning 65 is a different rule

When you are at least 65 and enrolled in Part B, your federal six-month Medigap open enrollment period begins. This also generally gives a new protected opportunity to someone who first qualified for Medicare before 65 because of disability.

The six-month window is not repeated every birthday. If you delayed Part B while working, the window generally begins when Part B becomes effective after 65. See Medigap enrollment periods.

When can you switch without underwriting?

Some qualifying events create guaranteed-issue rights. Examples can include certain Medicare Advantage plan terminations, specified losses of employer or union coverage, and federal first-year trial rights.

The rules vary by event, including which plan letters are protected and how long you have to apply. Ordinary rate increases, birthdays after 65, and changes in personal preference do not generally create these rights.

See Texas guaranteed-issue rights and Medicare.gov's Medigap guidance.

Three real-world scenarios

Scenario 1: Age 72 with Plan G. The beneficiary wants to change insurers after a birthday. The birthday alone provides no general underwriting waiver.

Scenario 2: Age 65 after disability Medicare. The beneficiary may have a new six-month Medigap open enrollment window, which is not a recurring birthday rule.

Scenario 3: Medicare Advantage nonrenewal. A formal plan termination may create separate guaranteed-issue rights regardless of the beneficiary's birthday. Keep the official notice and verify the application deadline.

What questions will insurers ask?

Outside protected enrollment, an insurer may ask about recent diagnoses, ongoing treatments, certain medications, hospitalizations, surgeries and other conditions. Companies can have different underwriting guidelines.

A person declined by one insurer may have different options elsewhere, but approval cannot be assumed. Our underwriting questions guide explains common topics.

What about Plan N or High-Deductible Plan G?

Moving to a different plan letter can change your costs and benefits. Plan N generally has certain copayments and does not cover Part B excess charges. High-Deductible Plan G requires eligible out-of-pocket spending up to the annual plan deductible before the Medigap policy pays.

Compare Plan N and High-Deductible Plan G rather than treating every lower premium as an equivalent replacement.

How to review a premium increase

Check whether the increase reflects the insurer's base rate, your age-based rating method, or a change in household discounts. Compare same-letter quotes using identical applicant details.

For more on how insurers adjust premiums over time, read Medicare Supplement Rate Increases in Texas.

Ask whether medical underwriting applies before submitting an application. If switching is not possible, your existing policy generally remains guaranteed renewable when premiums are paid and policy conditions are met.

Frequently asked questions