Quick answers
- Does Oklahoma have a Medigap birthday rule?
- Yes. Since September 1, 2023, Oklahoma lets you switch to a Medigap policy with the same or fewer benefits, from any company, without medical underwriting, during the 60 days that start on your birthday each year (OAC 365:10-5-129(f)).
- Who can use the birthday rule?
- Oklahoma residents who already have a Medigap policy and have had no break in Medigap coverage longer than 90 days. It doesn't help you move from Medicare Advantage to Medigap.
- When is my Medigap open enrollment period?
- The 6 months that start the first month you are 65 or older and enrolled in Part B. During it, companies must sell you any policy they offer in Oklahoma, regardless of your health.
- Can I buy Medigap in Oklahoma if I'm under 65?
- Yes, if you have Medicare because of a disability. Each company must offer at least one standardized plan during the 6 months after your Part B starts, at a premium no higher than its lowest rate for people 65 and older.
- How long do I have to return a new Medigap policy?
- 30 days from delivery for a full premium refund, under 36 O.S. § 3611.1(G).
What is Medigap?
Medigap, also called Medicare Supplement Insurance, is a policy sold by private insurance companies to people who have Original Medicare (Part A and Part B). It pays some or all of the costs Original Medicare leaves to you, such as the Part A hospital deductible, the 20% Part B coinsurance and skilled nursing facility coinsurance. Current Medicare amounts are on Medicare costs in 2027.
- Medigap works only with Original Medicare. You can't use it with a Medicare Advantage plan.
- It doesn't include drug coverage, so most people also join a Part D drug plan.
- You pay a monthly premium to the Medigap company on top of your Part B premium.
- Each policy covers one person. Spouses buy separate policies.
- Companies selling Medigap in Oklahoma are licensed by the Oklahoma Insurance Department (OID), but the benefits of each plan letter are set by federal law.
What are Oklahoma's Medigap rules?
Oklahoma's Medicare supplement law is 36 O.S. § 3611.1, which directs the Insurance Commissioner to set minimum standards. The detailed rules are in the Oklahoma Administrative Code, Title 365, Chapter 10, Subchapter 5, Part 13 (OAC 365:10-5-129 and 365:10-5-129.1 cover enrollment). The Oklahoma Insurance Department enforces them. Here is what they mean for you:
Birthday rule every year
Since September 1, 2023, current Medigap policyholders can switch to a policy with the same or fewer benefits, from any company, with no medical underwriting, during a 60-day window that starts on their birthday (OAC 365:10-5-129(f); OID Bulletin 10-2023).
Under 65 with a disability
Every company must offer at least one of the standardized plans to people under 65 who have Medicare because of a disability, during the 6 months after they first enroll in Part B. The premium can't exceed the company's lowest rate for that plan for people 65 and older (OAC 365:10-5-129(d)).
A second window at 65
If you got Medicare early because of a disability, you get the regular Medigap open enrollment period when you turn 65. Your Medigap company must remind you 60 to 90 days before the month you turn 65 (OAC 365:10-5-129(g)).
Pre-existing conditions
During open enrollment, a company can make you wait no more than 6 months for coverage of a condition treated or diagnosed in the 6 months before your policy starts, and that wait is shortened by months of earlier creditable coverage. With 6 months of continuous creditable coverage, there's no wait (OAC 365:10-5-129(b)-(c)).
30 days to return it
You can return a new Medigap policy within 30 days of delivery and get your premium back if you aren't satisfied for any reason (36 O.S. § 3611.1(G)). If you're replacing a policy, keep the old one until you decide.
Policies from another state count
OID says it doesn't matter which state you bought your current Medigap policy in: once you are an Oklahoma resident who meets the rule, you can use the birthday rule. See moving to Oklahoma with Medicare.
How does Oklahoma's birthday rule work?
Oklahoma is one of a small number of states with a yearly Medigap switching right. The rule, OAC 365:10-5-129(f), requires companies to sell a policy with the same or fewer benefits to a current policyholder who has had no break in Medigap coverage longer than 90 days. OID's Bulletin 10-2023 says a company meets the rule by offering a 60-day open enrollment period beginning on the policyholder's birthday each year. Here is how the Oklahoma Insurance Department explains it:
- Know your window. It opens on your birthday (day 1) and lasts 60 days. You must apply within the window; the new policy can start after it, usually the first of the month after the company accepts you.
- Check that you qualify. You must have a Medigap policy now, or have dropped one no more than 90 days ago, and live in Oklahoma. Group Medigap plans through an employer don't qualify.
- Pick a plan with the same or fewer benefits. Use OID's chart below. You can stay with your company or choose another one. A plan with more benefits can be bought only with underwriting.
- Apply before you cancel. Keep your current policy until the new one is approved and in force, so you're never without coverage.
- Check your deductible. Switching doesn't reset the Part B deductible, which is yearly. Ask the new company whether a high-deductible Plan F or G deductible starts over.
| If you have | You can switch to, without health questions |
|---|---|
| Plan A | A |
| Plan B | A, B |
| Plan C | A, B, C, D, K, L, M, N |
| Plan D | A, B, D, K, L, M, N |
| Plan F | Any plan |
| High-deductible F | High-deductible F, high-deductible G |
| Plan G | A, B, D, G, K, L, M, N, high-deductible F, high-deductible G |
| High-deductible G | High-deductible G |
| Plan K | K |
| Plan L | K, L |
| Plan M | M |
| Plan N | M, N |
Source: Oklahoma Insurance Department, Medicare Supplement Open Enrollment FAQs. Plans C and F can still be sold only to people who were eligible for Medicare before January 1, 2020.
The birthday rule doesn't cover Medicare Advantage. OID says Medicare Advantage members aren't eligible. If you leave a Medicare Advantage plan for Original Medicare, you can be asked health questions for Medigap unless you have one of the guaranteed-issue rights below. Under-65 policyholders can use the birthday rule too, but OID notes companies need to offer them only one plan.
How are Medigap premiums priced in Oklahoma?
Medigap benefits are the same from company to company for the same plan letter, but prices are not. The Oklahoma Insurance Department lists the things that can affect your premium: your age when you bought the policy (if it is issue-age rated), your current age (if it is attained-age rated), your health when you apply outside open enrollment, and tobacco use. Premiums usually change every year as medical costs rise, and companies submit their rates to OID for review. Before you buy, ask the company which rating method it uses and how its rates have changed. The birthday rule exists partly so that people in older, closed groups of policies can move to a policy with a lower rate.
When should I buy? Your Medigap open enrollment period
Your Medigap open enrollment period lasts 6 months and starts the first month you are both 65 or older and enrolled in Part B (OAC 365:10-5-129(a)). It happens once. During it, any company selling Medigap in Oklahoma must sell you any policy it offers, and can't charge you more or delay coverage because of your health, except for the limited pre-existing condition wait described above. If Social Security approves your Medicare retroactively, the 6 months are counted from the date you were notified (OAC 365:10-5-129(e)).
Delaying Part B delays this window. If you're still working with employer coverage, your Medigap open enrollment period doesn't start until you sign up for Part B. See working past 65. Outside your open enrollment period, the birthday rule and guaranteed-issue rights, Oklahoma companies can use medical underwriting.
When else can I buy Medigap without health questions?
Federal law and Oklahoma's rule (OAC 365:10-5-129.1) guarantee you can buy certain policies, with no health questions and no pre-existing condition exclusion, in situations like these:
- Your Medicare Advantage plan leaves your county or stops serving Medicare, or you move out of its service area. You can buy Plan A, B, D, G (including high-deductible G), K or L from any company, or C or F if you were eligible for Medicare before January 1, 2020. Apply as early as 60 days before your plan coverage ends and no later than 63 days after it ends.
- Your employer or union coverage that pays after Medicare ends. You have 63 days.
- Trial right: you joined a Medicare Advantage plan when you were first eligible for Medicare at 65, or dropped a Medigap policy to try one for the first time, and you leave within the first 12 months.
- Your Medigap company goes bankrupt or misleads you.
If you are under 65 with a disability, the guaranteed policy under Oklahoma's rule is the standardized plan the company offers to disabled applicants, at a premium no higher than its lowest rate for people 65 and older. Keep the letter showing when your other coverage ends; the Medigap company will ask for it.
Plans ending for 2027: for 2027, seven Oklahoma counties (Beaver, Cimarron, Ellis, Harmon, Harper, Roger Mills and Texas) have no Medicare Advantage plan open to everyone, and some plans elsewhere are ending. If your plan won't be offered in your county in 2027, you likely have this guaranteed right. See Oklahoma plans ending in 2027.
What do the Medigap plan letters cover?
Medigap policies are standardized by federal law and named by letter. A Plan G from one company has the same benefits as a Plan G from any other; companies differ on price, rating method and service. Every plan pays Part A coinsurance and hospital costs for an extra 365 days after Medicare benefits are used up, plus at least part of the Part B coinsurance, the first 3 pints of blood and hospice coinsurance.
| Plan | Part A deductible | Part B deductible | Part B excess charges | Skilled nursing coinsurance | Foreign travel emergency |
|---|---|---|---|---|---|
| A | No | No | No | No | No |
| B | Yes | No | No | No | No |
| C* | Yes | Yes | No | Yes | 80% |
| D | Yes | No | No | Yes | 80% |
| F* | Yes | Yes | Yes | Yes | 80% |
| G | Yes | No | Yes | Yes | 80% |
| K | 50% | No | No | 50% | No |
| L | 75% | No | No | 75% | No |
| M | 50% | No | No | Yes | 80% |
| N | Yes | No | No | Yes | 80% |
- *Plans C and F can't be sold to people who became eligible for Medicare on or after January 1, 2020. If you were eligible before then, you may still buy them.
- Plans K and L pay 50% and 75% of most costs and have a yearly out-of-pocket limit: $8,360 for Plan K and $4,180 for Plan L in 2027. After you reach it, the plan pays 100% of covered services for the rest of the year.
- Plan N pays the Part B coinsurance except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission.
- High-deductible Plan G has the same benefits as Plan G after you pay a yearly deductible of $3,050 in 2027. High-deductible Plan F exists for people eligible before 2020.
- Foreign travel emergency coverage pays 80% of emergency care outside the U.S. during the first 60 days of each trip, after a $250 yearly deductible, up to a $50,000 lifetime limit.
- Part B excess charges are amounts, up to 15% above the Medicare-approved amount, that doctors who don't accept Medicare's payment as full payment may bill.
Medigap or Medicare Advantage?
Medigap has no network: it pays its share wherever you get Medicare-covered care in the U.S. from a provider who accepts Medicare. That matters in rural Oklahoma, where the nearest specialist may be in Oklahoma City, Tulsa, Wichita Falls or Fort Smith, and in the Panhandle counties with no Medicare Advantage plan open to everyone for 2027. Medicare Advantage plans use networks and service areas, include a yearly out-of-pocket limit, and usually include drug coverage. Oklahoma's birthday rule makes changing between Medigap policies easier, but it doesn't make moving from Medicare Advantage back to Medigap easier. Compare the two on Medigap vs. Medicare Advantage in Oklahoma and see Medicare Advantage in Oklahoma.
Where can I get help with Medigap in Oklahoma?
- Oklahoma Insurance Department: 1-800-522-0071. OID licenses Medigap companies and agents, reviews rate filings and handles complaints, including a company or agent refusing a birthday-rule change. You can also file a complaint online.
- Medicare: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and the federal guide Choosing a Medigap Policy at Medicare.gov.
To see Medigap policies sold where you live, see plans for your ZIP code. To compare Medigap policies from the companies they work with, or to check what your birthday window allows, you can request a call from a licensed insurance agent. You can also meet licensed insurance agents in Oklahoma.
Sources
- Oklahoma Insurance Department — New Medicare Supplement Open Enrollment FAQs (birthday rule, switching chart, pricing factors)
- Oklahoma Insurance Department — Bulletin No. 10-2023 (Revised), New Medicare Supplement Enrollment Requirements, effective September 1, 2023
- Oklahoma Insurance Department — Special Notice to Medicare Supplement Carriers (February 27, 2024)
- Okla. Admin. Code § 365:10-5-129, Open enrollment (via Cornell LII)
- Okla. Admin. Code § 365:10-5-129.1, Guaranteed issue for eligible persons (via Cornell LII)
- Oklahoma Statutes, 36 O.S. § 3611.1, Medicare supplement policies (return and refund, subsection G)
- Oklahoma Insurance Department — File an online complaint
- Medicare.gov — When can I buy Medigap?
- Medicare.gov — Compare Medigap plan benefits
- CMS — Out-of-pocket limits for Medigap Plans K and L, 2027
- CMS — Deductible for Medigap high-deductible options, 2027
- CMS — Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
Every question in this guide
Frequently asked questions
How does Oklahoma's Medigap birthday rule work?
Each year, Medigap companies in Oklahoma must give current policyholders a 60-day open enrollment period that starts on their birthday. During it you can buy a Medigap policy with the same or fewer benefits than the one you have, from your company or a different one, and the new company can't use medical underwriting or a pre-existing condition waiting period. You must have had no break in Medigap coverage longer than 90 days. The rule is OAC 365:10-5-129(f), effective September 1, 2023.
Can I switch from Plan G to Plan N under the birthday rule?
Yes. The Oklahoma Insurance Department's chart says a Plan G policyholder can move to Plan A, B, D, G, K, L, M or N, or to high-deductible Plan F or G, during the birthday window without health questions. Moving to a plan with more benefits, such as Plan F, is allowed only if the company accepts you after underwriting.
Can I use the birthday rule to leave Medicare Advantage for Medigap?
No. The Oklahoma Insurance Department says Medicare Advantage members aren't eligible for the birthday rule. To move from Medicare Advantage to Medigap without health questions you need a guaranteed-issue right, such as your plan leaving your county or your 12-month trial right. Otherwise the Medigap company can review your health and may turn you down.
Can I buy a Medigap policy in Oklahoma if I'm under 65?
Yes, if you have Medicare because of a disability. Oklahoma's rule requires every Medigap company to offer at least one of the standardized plans to you during the 6 months after you first enroll in Part B, and the premium can't be more than the company's lowest rate for that plan for people 65 and older (OAC 365:10-5-129(d)). When you turn 65 you get a new open enrollment period with any plan the company sells.
Where do I complain about a Medigap company or agent in Oklahoma?
Contact the Oklahoma Insurance Department at 1-800-522-0071 or file a complaint online at oid.ok.gov. The department licenses insurance companies and agents, reviews Medigap rate filings, and says to contact it if a company or agent refuses a birthday-rule change you qualify for.
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