If your Virginia Medigap premium just went up, a state law gives you a yearly window to shop a cheaper plan. It is called the birthday rule, and it took effect on July 1, 2025. This guide explains who qualifies, when your window opens, and what you can switch to.
In This Guide
- What the Birthday Rule Does
- Who Qualifies
- What You Can Switch To
- The Deductible Catch
- How to Use Your Window
- Frequently Asked Questions
What the Birthday Rule Does
Medigap (also called Medicare Supplement insurance) sits alongside Original Medicare and pays some of the costs Medicare leaves to you. The catch with Medigap is that, once your first six-month enrollment window closes, an insurer can normally make you pass medical underwriting to switch plans. If your health has changed, that can mean a higher rate or an outright denial, which leaves many people stuck on a plan whose premium keeps climbing.
Virginia's birthday rule changes that for one stretch of time each year. The law was enacted as 2025 House Bill 2100 (Chapter 530), is codified in Title 38.2, Chapter 36 of the Code of Virginia, and took effect on July 1, 2025. It requires every insurer that issues Medigap policies in Virginia to give each policyholder a 60-day open-enrollment period that starts on the policyholder's birthday. Inside that window the switch is guaranteed issue: the insurer cannot deny you, cannot charge you more because of your health, and cannot impose a waiting period.
The rule applies to Medigap policies only. It does not touch how you enroll in Original Medicare or Medicare Advantage, and it is not a way to move between those programs. Virginia Medigap policies are regulated by the Virginia State Corporation Commission (SCC).
| Question | Answer |
|---|---|
| Who qualifies? | Anyone currently insured under a Medigap policy or certificate issued by a licensed Virginia insurer, health services plan, or HMO. No age limit. |
| When is the window? | A 60-day period that starts on your birthday, every year. |
| What can you switch to? | A plan with the same benefits as your current policy. |
| Which insurers? | Any insurer issuing Medigap in Virginia, not just your current one. |
| Underwriting? | None. Guaranteed issue: no health-based denial, no higher rate, no waiting period. |
| Does a met deductible carry over? | It may not. Confirm before you switch. |
| Effective date | July 1, 2025 (2025 HB 2100, Chapter 530). |
Who Qualifies
To use the birthday rule you must already be insured under a Medigap policy or certificate issued by a licensed insurer, health services plan, or HMO in Virginia. The law sets no age limit, so it reaches policyholders well past 65 as well as those who qualified for Medicare early.
If you do not yet have a Medigap policy, the birthday rule is not your path in. Your entry point is the federal six-month Medigap Open Enrollment Period, which also gives you guaranteed issue. The national Medigap guide walks through that first window.
What You Can Switch To
This is the part that trips people up, so read it carefully. The birthday rule only protects a move to a plan with the same benefits as your current policy. If you hold Plan G today, the rule lets you switch to a Plan G from any other Virginia insurer with no underwriting. It does not let you trade up to a richer plan or trade down to a leaner one under the same protection.
Switching to a plan with more or fewer benefits falls outside the rule, and the new insurer may then require medical underwriting, which can mean a higher rate or a denial based on your health. So if your goal is to keep the exact coverage you have now but pay less for it, the birthday rule is built for you. If your goal is to change your level of coverage, the rule does not shield that move.
Because every insurer must price the same standardized benefit set, a same-benefits switch can still cut your premium. Two carriers selling identical Plan G coverage often charge different amounts, and the birthday rule lets you chase the lower price without a health questionnaire.
The Deductible Catch
One consumer caution is worth flagging before you sign anything. Any deductible you have already met under your existing Medigap policy may not carry over if you move to a new policy.
In practice that means timing matters. If you have already satisfied a deductible for the year on your current plan, switching mid-year could reset it, so you would owe it again on the new policy. Ask the new insurer in writing whether your met deductible transfers, and weigh any reset against the premium savings before you commit.
How to Use Your Window
Your window opens on your birthday and stays open for 60 days. Plan ahead so you are ready to compare plans the moment it starts.
- Confirm your current benefit level (for example, Plan G or Plan N) so you can match it exactly.
- Get quotes from several Virginia insurers for that same benefit level before your birthday.
- Ask each insurer to confirm in writing that the switch is guaranteed issue under the birthday rule and whether your met deductible carries over.
- Apply within the 60-day window. Once it closes, normal underwriting rules return until your next birthday.
Free, unbiased help is available through Virginia's State Health Insurance Assistance Program, VICAP, and questions about an insurer can go to the Virginia State Corporation Commission. For broader Medicare orientation, start with the Virginia Medicare hub.
Frequently Asked Questions
It is a 60-day open-enrollment period that starts on your birthday and repeats every year. You must apply for the new plan within those 60 days to keep the guaranteed-issue protection.
Yes. During your window you can move to a same-benefits plan offered by any insurer issuing Medigap in Virginia, not only your current carrier, and the insurer cannot deny you or charge more based on your health.
No. The birthday rule only protects a switch to a plan with the same benefits as your current policy. Moving to a plan with more or fewer benefits is not protected and may require medical underwriting.
It may not. Any deductible you have already met under your existing policy might not transfer to a new one, so confirm with the new insurer in writing before you switch.
Learn More
- Medicare in Virginia: Plans and Coverage
- Medigap: The National Guide
- Original Medicare vs. Medicare Advantage
- Medicare: Start Here
If your Virginia Medigap premium has climbed, mark your next birthday on the calendar and use your 60-day window to shop a same-benefits plan; for more eldercare guidance, visit 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.