West Virginia Medigap Birthday Rule (2026): Who Qualifies

The West Virginia Medigap birthday rule, created by 2026 House Bill 4869, lets a policyholder replace a Medigap policy once per calendar year with no medical underwriting. The West Virginia birthday right comes with conditions set by W. Va. Code § 33-15F-1: the current Medigap policy must have been in force for at least 24 months, the new policy normally has to come from the same insurer or an affiliated insurer, and it can offer only the same or lesser standardized benefits. The same 2026 West Virginia law gives people age 65 or older who lose Medicaid a separate 63-day window to buy a Medigap policy from any authorized insurer.1

In This Guide

• How West Virginia's Medigap Birthday Window Works
• Who Qualifies: The 24-Month Rule
• What You Can and Cannot Switch To
• When Your Insurer Has Nothing Comparable
• What the Insurer Cannot Do, and What the Rule Does Not Promise
• Timing Your Switch
• Which Policies West Virginia's Law Covers
• A Separate Right If You Lose Medicaid
• West Virginia Medigap Birthday Rule at a Glance
• Frequently Asked Questions
• Learn More

How West Virginia's Medigap Birthday Window Works

Under W. Va. Code § 33-15F-1(b), the West Virginia birthday guaranteed-issue application period begins on the first day of the month of your birthday and ends 60 days after that. If your birthday is anywhere in May, for example, the West Virginia window opens on May 1 whatever the day of your birthday.1

West Virginia's 60-day birthday window is an application window only. The statute says the birthday application period "does not require that the replacement policy become effective within the 60 day period," so you apply inside the window, and the new policy can start later (see Timing Your Switch).1

To use West Virginia's birthday rule, you have to hold a Medigap policy on your birthday itself. Under § 33-15F-1(b), a person who is not enrolled in a Medicare Supplement policy on his or her birthday is not eligible for the birthday guaranteed-issue right. West Virginia's birthday guaranteed-issue right can also be used only once per calendar year.1

If you don't have a Medigap policy yet, the birthday rule is not your way in. Brevy's guides to Medigap open enrollment and Medigap guaranteed issue rights cover the federal entry points.

Who Qualifies: The 24-Month Rule

West Virginia's 24-month requirement has three parts.1

It is measured on the new policy's start date. West Virginia's birthday right "is available only if the individual's existing Medicare supplement policy has been continuously in force for at least 24 months as of the effective date of the replacement policy." For West Virginia's 24-month test, the date that counts is when the replacement policy takes effect, not the date you apply.1

Every switch restarts the clock. Under § 33-15F-1(b), each replacement policy issued under West Virginia's birthday rule is subject to the same 24-month continuous coverage requirement before it can be replaced under the rule again. Because birthday windows come about 12 months apart, a West Virginia policyholder who switches under the birthday rule one year can't use it again the next year.1

A reissued policy still counts. For West Virginia's 24-month test, a policy is considered continuously in force if the same insurer or an affiliated insurer reissued or assumed it without a lapse in coverage. So if your insurer or an affiliated insurer reissued or assumed your West Virginia Medigap policy without a lapse in coverage, that change alone doesn't restart your 24-month clock.1

What You Can and Cannot Switch To

During the West Virginia birthday window, § 33-15F-1(b) lets you buy a Medicare Supplement policy that meets both of these tests:1

1. It is issued by the same insurer that issued your existing policy, or by an affiliated insurer.
2. It provides the same or lesser standardized Medicare Supplement benefits as the policy you're replacing.

Outside the 12-month exception below, West Virginia's birthday rule is not a chance to shop every Medigap insurer in the state.1

West Virginia's birthday rule never permits a move to greater benefits. Section 33-15F-1(b) says nothing in the subsection permits "the purchase of a Medicare supplement policy with greater benefits than the policy being replaced."1

Which standardized plans count as "the same or lesser" is a comparison of benefits, plan by plan. Brevy's Plan G vs. Plan N comparison and the Medigap hub explain how the standardized plans differ.

When Your Insurer Has Nothing Comparable

West Virginia's birthday rule has one exception to the same-insurer limit. If neither your insurer nor any affiliated insurer has accepted applications for a Medicare Supplement policy with the same or lesser standardized benefits for at least 12 months, § 33-15F-1(b) lets you buy a same-or-lesser policy from any insurer authorized to issue Medicare Supplement policies in West Virginia.1

The statute defines "accepted applications" narrowly. Under § 33-15F-1(a), an insurer has accepted applications when it "has actively marketed and issued at least one Medicare supplement policy of the applicable standardized benefit type in this state within the preceding 12 months, and has not formally closed the policy form to new enrollment."1

West Virginia's 12-month exception widens only which insurers you can approach. West Virginia's statute says the 12-month exception "does not waive the continuous coverage requirement" and "does not permit the purchase of a policy with greater benefits than the policy being replaced." Under the 12-month exception, West Virginia still requires 24 months of continuous coverage and still bars moving to greater benefits.1

What the Insurer Cannot Do, and What the Rule Does Not Promise

For a policy issued under West Virginia's birthday rule, § 33-15F-1(b) says an insurer may not:1

• Deny issuance
• Impose medical underwriting
• Impose a pre-existing condition exclusion or waiting period

The statute also sets limits: it does not "require an insurer to offer a Medicare supplement policy not otherwise offered in this state," so you can only pick from policies your insurer or its affiliates actually sell.1

West Virginia's birthday rule guarantees acceptance, not a price. Section 33-15F-1 does not "alter lawful rating classifications otherwise permitted under this article," and it does not "require an insurer to offer a particular premium rate or rating classification not otherwise permitted." Compare the premium on the replacement policy before you commit; Brevy's guide to how Medigap policies are priced explains what drives it.1

W. Va. Code § 33-15F-1 also says it does not "create an open enrollment period beyond those expressly provided" and does not "limit or replace guaranteed issue rights otherwise provided under federal law." Any federal guaranteed-issue right you have still applies alongside the state birthday rule.1

Timing Your Switch

Under § 33-15F-1(b), a Medigap policy issued under West Virginia's birthday rule "shall not become effective earlier than the termination date of the policy being replaced," and it must be coordinated to prevent duplicate coverage.1

Under West Virginia's birthday rule, the replacement Medigap policy's effective date can be delayed, at your request, for up to 90 days after the date of your application, so the old policy can end and you avoid paying two premiums at once. The statute allows that delay "for the purpose of coordinating termination of the existing policy and preventing overlapping premium obligations."1

Three practical checks follow from the statute's wording:

1. Find your current policy's effective date. West Virginia's 24-month test runs to the replacement's effective date, so you need both dates.1
2. Apply inside the 60-day window. West Virginia's birthday window opens on the first day of your birthday month; the new policy's start date can fall after it.1
3. Line up the end date and the start date. Ask the new insurer, in writing, for the replacement's effective date, and cancel the old policy only once the new one is confirmed.

Which Policies West Virginia's Law Covers

Two dates apply, and they measure different things.1

• June 1, 2026, the statute's applicability date. Under § 33-15F-1(g), the section applies to policies "delivered, issued for delivery, reissued, or extended in this state on and after June 1, 2026, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made."1
• June 11, 2026, the act's effective date. The West Virginia Offices of the Insurance Commissioner's Insurance Bulletin No. 26-02 lists House Bill 4869, the Medicare Supplement bill, as effective June 11, 2026.1

Because of the applicability clause, a Medigap policy issued in West Virginia before June 1, 2026 is reached when any term of the policy is changed or any premium adjustment is made, rather than on a single date for everyone. If you're unsure whether your policy has come under § 33-15F-1, ask your insurer to confirm it in writing.1

West Virginia's birthday rule is limited to Medicare Supplement policies. The statute says the section does not "apply to Medicare Advantage plans," so a Medicare Advantage enrollee has no birthday right under § 33-15F-1.1

A Separate Right If You Lose Medicaid

West Virginia's 2026 law adds a second guaranteed-issue right in § 33-15F-1(c), aimed at people leaving Medicaid. It applies to a person who meets all three of these tests:1

• Is 65 years of age or older on the date his or her Medicaid eligibility ends
• Is entitled to Medicare
• Loses eligibility for Medicaid, including full or partial dual eligibility

West Virginia's Medicaid-loss guaranteed-issue period begins on the date Medicaid eligibility ends and lasts 63 days. During those 63 days, the person may buy any Medicare Supplement policy that is actively offered for sale to new enrollees at the time of application, from any insurer authorized to issue Medicare Supplement policies in West Virginia.1

For a policy bought under West Virginia's Medicaid-loss right, the insurer may not deny issuance, impose medical underwriting, or impose a pre-existing condition exclusion or waiting period.1

West Virginia's Medicaid-loss right is wider than the birthday rule in two ways. It doesn't require a prior Medigap policy, since § 33-15F-1(c) applies "regardless of whether the individual was previously enrolled in a Medicare supplement policy," and it isn't tied to your current insurer. West Virginia's Medicaid-loss Medigap right also applies whether or not the person was eligible for or enrolled in Medicaid when first entitled to Medicare.1

One limit to know: under West Virginia law, Medicaid-loss guaranteed-issue rights "do not arise solely due to disenrollment from a Medicare Advantage plan." Losing Medicaid is the trigger, and West Virginia's 63-day Medicaid-loss Medigap guaranteed-issue period starts on the date Medicaid eligibility ends.1

If a parent age 65 or older is losing Medicaid in West Virginia, get the written notice showing the date eligibility ends and count 63 days from that date.

West Virginia Medigap Birthday Rule at a Glance

Table sources: West Virginia's birthday rule terms from § 33-15F-1(b)1, and the Medicaid-loss right from § 33-15F-1(c).1

Learn More

Find personalized help comparing Medigap options in West Virginia 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.