Maryland adopted a Medicare Supplement (Medigap) "birthday rule" that took effect on July 1, 2023, giving policyholders a yearly chance to switch with no medical underwriting. The Maryland birthday rule opens a window on your birthday and runs for 30 days, during which you can move to an equal-or-lesser plan from any insurer, and your carrier must mail you a notice of the right before your birthday arrives. This guide explains how Maryland's birthday rule works, the notice insurers must send, how the standardized A-through-N plans fit together, which plans are closed to newer enrollees, and who regulates Medigap in the state.
How Medigap works in Maryland
A Medigap policy is private insurance that pays the deductibles and coinsurance Original Medicare leaves to you. Medigap (Medicare Supplement Insurance) works only alongside Original Medicare, not with a Medicare Advantage plan, and each policy covers one person. A married couple who both want coverage need two policies.
Maryland uses the federal standardized framework. Medigap is sold as lettered plans, A through N, and the benefits inside each letter are fixed by federal rule. A Plan G from one Maryland insurer covers exactly what a Plan G from another covers. Insurers compete on price, service, and rate stability, not on what the plan pays. That makes the plan letter your first decision and the insurer your second.
The gaps Medigap closes are real. After the Part B deductible ($283 in 2026), Original Medicare pays 80% of the approved amount for most outpatient care and leaves you the other 20%, with no annual cap. Part A adds a hospital deductible of $1,736 per benefit period in 2026, and that deductible can apply more than once in a year. Medigap caps that exposure.
The Maryland birthday rule
Maryland's annual protection is the birthday rule, which took effect on July 1, 2023. Under Maryland law, a Medigap policyholder with a policy issued in Maryland has a 30-day window each year, beginning on their birthday, during which they may switch to a different Medigap policy with equal or lesser benefits, and a carrier cannot deny or condition the new policy based on health status, claims experience, or medical condition, according to the Maryland Insurance Administration.
The annual notice is a Maryland-specific feature worth watching for. Because insurers must send it 30 to 60 days ahead of your birthday, you should receive a reminder each year before the window opens. Use that lead time to shop, since the window itself is only 30 days. Maryland's rule applies to policies issued in Maryland.
The "equal or lesser benefits" limit is the key constraint. You can move sideways (Plan G to another Plan G) or down to a less generous letter (Plan G to Plan N), but the birthday rule does not let you move up to a more comprehensive plan. Moving up still requires medical underwriting outside a guaranteed-issue window, so a switch from Plan N to Plan G is not protected by the birthday rule.
How to use the Maryland birthday rule
The window is short, so use the advance notice to prepare.
- Watch for the notice. Your insurer must send a notice of the switch right 30 to 60 days before your birthday. When it arrives, that is your cue to start comparing plans.
- Confirm the new plan is equal or lesser. Identify your current plan letter, then pick a new policy of the same letter or a less comprehensive one. A Plan G holder can switch to another Plan G or down to Plan N.
- Apply within 30 days of your birthday. Submit the application during the window and tell the insurer you are using Maryland's birthday rule. The new insurer cannot apply medical underwriting to the switch.
- Keep the old policy until the new one starts. Don't cancel existing coverage until the new policy is confirmed and in force, so you're never uninsured.
Because the benefits inside a letter are standardized, a same-letter switch changes your premium and insurer, not your coverage. If you move to a lesser letter, your cost-sharing changes to match that letter.
Plan G and Plan N: the common choices
For someone newly eligible for Medicare, the practical choice in Maryland narrows to two plans.
Plan G is the most complete plan still available to people who became eligible on or after January 1, 2020. It covers every gap in Original Medicare except the annual Part B deductible: the Part A hospital deductible, Part A and Part B coinsurance, skilled nursing facility coinsurance, and Part B excess charges. After you pay that one Part B deductible for the year, a Plan G holder generally has no further cost-sharing on Medicare-covered services.
Plan N covers the same major gaps but shifts a little cost back to you. It pays the Part B coinsurance except for a copay of up to $20 for some office visits and up to $50 for emergency-room visits that don't lead to an inpatient admission, and it does not cover Part B excess charges. In exchange, Plan N premiums are usually lower than Plan G premiums.
| Feature | Plan G | Plan N |
|---|---|---|
| Part A hospital deductible | Covered | Covered |
| Part B coinsurance | Covered in full | Covered, minus up to $20 office / $50 ER copays |
| Part B excess charges | Covered | Not covered |
| Annual Part B deductible ($283 in 2026) | You pay it | You pay it |
| Skilled nursing facility coinsurance | Covered | Covered |
| Relative premium | Higher | Lower than Plan G |
Plans C and F are closed to newer enrollees
Plans C and F once covered the annual Part B deductible on top of the other gaps, which made Plan F the most complete plan on the market. Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), any Medigap plan that pays the Part B deductible is closed to people who first became eligible for Medicare on or after January 1, 2020.
The closure works by eligibility date, not purchase date. If you became eligible for Medicare before January 1, 2020, you can still buy or keep Plan C or Plan F in Maryland. If you became eligible on or after that date, those two plans are off the table, which is why Plan G has become the default top-tier choice for newer enrollees: it's identical to Plan F except that you pay the one Part B deductible yourself.
When you can buy or switch in Maryland
Maryland gives you more than one protected window. Three matter most.
- The federal Medigap Open Enrollment Period. This is a one-time, six-month window that begins the first month you're both age 65 or older and enrolled in Medicare Part B. During it, insurers must sell you any Medigap policy they offer at their best available rate regardless of your health, with no medical underwriting. This is the single best time to buy, because you can choose any plan, including Plan G.
- The annual birthday rule. The 30-day window described above, repeating each year, for switching to an equal-or-lesser plan from any insurer with no underwriting.
- Federal guaranteed-issue rights. Certain life events, such as losing other coverage or an insurer leaving the market, trigger a federal guaranteed-issue right to buy specific plans without underwriting.
Outside these windows, a Maryland insurer can require medical underwriting and charge more, or decline to sell you a policy, based on your health. That's why the choice between Plan G and Plan N is best made during your six-month open enrollment: if you start on Plan N to save on premiums and later want Plan G, the birthday rule won't cover that move up, and underwriting could make it expensive or impossible.
What Medigap costs and how it's priced in Maryland
Medigap premiums vary widely. The benefits inside a letter are fixed, but the price is not: it depends on the insurer, your age, and in many cases your gender and tobacco use. Nationally, median Plan G premiums run about $150 to $175 a month and Plan N about $125 to $150, though your Maryland quote can fall outside those ranges.
Insurers use one of three pricing methods, which shapes how your premium changes as you age:
- Community-rated policies charge everyone the same premium regardless of age.
- Issue-age-rated policies base your premium on your age when you buy, and that starting point doesn't rise simply because you get older.
- Attained-age-rated policies start lower but increase as you age, so a low first-year quote can climb over time.
Ask which method each insurer uses, not just the first-year premium. The birthday rule pairs well with this: because you can switch to any insurer, if your attained-age policy climbs, the annual window lets you move an equal-or-lesser plan to a cheaper carrier without underwriting. Note that Medigap does not include prescription drug coverage, so you add a separate Part D plan for that.
Who regulates Medigap in Maryland
Maryland Medigap policies are regulated by the Maryland Insurance Administration, which oversees the insurers that sell these policies and handles consumer complaints. If you have a question or a complaint about a specific policy, or you did not receive the required birthday-rule notice, that is the agency to contact.
Frequently asked questions
Maryland gives Medigap policyholders a 30-day window each year, beginning on their birthday, to switch to a Medigap policy of equal or lesser benefits from any insurer, with no medical underwriting, per the Maryland Insurance Administration. The rule took effect July 1, 2023, and applies to policies issued in Maryland.
Yes. Maryland requires your insurer to mail you a notice of the switch right at least 30 days, but no more than 60 days, before your birthday. If you did not receive it, you can contact the Maryland Insurance Administration.
Yes. The Maryland birthday rule lets you switch to an equal-or-lesser plan from any insurer, not just your current company. Because the benefits inside a plan letter are identical across insurers, this is how Marylanders move comparable coverage to a lower-priced carrier once a year.
Only if you first became eligible for Medicare before January 1, 2020. Plans C and F, which cover the Part B deductible, are closed to anyone who became eligible on or after that date under MACRA. Plan G is the closest available alternative; it's identical to Plan F except that you pay the annual Part B deductible yourself.
Maryland Medigap policies are regulated by the Maryland Insurance Administration, which oversees the insurers that sell these policies and handles consumer complaints.
Learn More
- Medicare plans and coverage in Maryland
- Medigap (Medicare Supplement): how the lettered plans work
- What is Medicare? Parts A, B, C, and D explained
- Original Medicare vs. Medicare Advantage
Find personalized help comparing Medicare Supplement plans in Maryland at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.