Does North Carolina have a Medigap birthday rule?

What North Carolina law says

Some states require Medigap companies to let current policyholders switch each year, often in a window around their birthday or policy anniversary, without health questions. North Carolina does not. Its Medigap statute, G.S. 58-54-1 to 58-54-50, sets minimum standards for policies, disclosure, pricing and people under 65, but gives no yearly switching right. The working rule, 11 NCAC 12 .0843, adopts the national NAIC model regulation and adds no state switching window.

In North Carolina, a company must accept you regardless of your health only in these cases:

• Medigap open enrollment: the 6 months starting the first month you are both 65 or older and enrolled in Part B. It happens once.
• The under-65 disability window: if you have Medicare because of a disability, the 6 months after you first enroll in Part B, for at least Plan A (and Plan D or G if the company sells them to people 65 and older) under G.S. 58-54-45.
• Guaranteed issue: specific events, such as your Medicare Advantage plan leaving your area or employer coverage that pays after Medicare ending.

What this means for you

1. Choose carefully at 65. Your Medigap open enrollment is the one time any company must sell you any policy it offers, at a price not based on your health.
2. Ask how a policy is priced. Without a birthday rule, you may stay with one company for years, so its rating method and rate history matter. See how Medigap rates work in North Carolina.
3. Know your guaranteed-issue rights. If your Medicare Advantage plan is ending for 2027, you may be able to buy Medigap with no health questions. See North Carolina plans ending in 2027.
4. If you want to switch later, apply before you cancel. Keep your current policy until a new company approves you. You get 30 days after delivery to return the new policy for a refund (G.S. 58-54-30).

To compare Medigap policies from the companies they work with, you can request a call from a licensed insurance agent. More in our guide to Medigap in North Carolina.

Related questions

Sources

• N.C. General Assembly — G.S. Chapter 58, Article 54, Medicare Supplement Insurance Minimum Standards
• N.C. Office of Administrative Hearings — 11 NCAC 12 (rule .0843, Medicare supplement)
• Medicare.gov — Can I change my Medigap policy?
• Medicare.gov — Get ready to buy (Medigap open enrollment)

More questions in this guide

• Are Medigap rates based on age in North Carolina?
• Can I get Medigap under 65 in North Carolina?
• Can I get a Medicare Supplement with pre-existing conditions in North Carolina?
• Can I switch Medigap plans in North Carolina?
• Medigap Plan G vs. Plan N in North Carolina
• What happens to my Medigap if I move out of North Carolina?
• When can I buy a Medicare Supplement plan in North Carolina?

Part of the guide: Medigap (Medicare Supplement) in North Carolina · All questions

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