Utah · Medigap birthday rule and Medicare Advantage
Does Utah's Birthday Rule Apply to Medicare Advantage?
No. Utah's birthday rule is a door between two Medigap plans at the same company. It is not a door into Medigap, and it has nothing to say about Medicare Advantage. If you are weighing an Advantage plan this fall and counting on your birthday to bring you back, read the statute's first sentence before you enroll.
The bottom line
- The rule is Medigap-to-Medigap only. Utah Code §31A-22-620(3)(g) protects "an enrollee that is enrolled in one of the issuer's Medicare supplement insurance plans." A Medicare Advantage member is not one.
- Three tests, all required: you already hold a Medigap policy, the new plan is "offered by the issuer" you are with now, and it is "a comparable or lower tier plan." The window is 60 days from your birthday.
- You cannot hold both. Medicare.gov: "It's illegal for someone to sell you a Medigap policy if you have a Medicare Advantage Plan."
- From Advantage to Medigap, the rights are federal and specific: the 12 months trial rights, a plan leaving Medicare or your county, or a move out of the service area. Otherwise Medicare.gov says "there's no federal guarantee that an insurance company will sell you a Medigap policy."
- Before October 15 – December 7: dropping a Medigap policy for an Advantage plan is a decision the birthday rule will not undo.
I hear a version of this every September, from Logan to St. George: "I'll try the Advantage plan for a year or two. If I don't like it, Utah has that birthday thing, so I can always go back." It is a reasonable thing to believe. The rule is new, the name is friendly, and most of what is written about it online stops at "Utah has one." The statute itself is three sentences long, though, and the people it protects are named in the first of them. Here is what it says, who it leaves out, and what the real routes from Medicare Advantage to a Medigap policy look like.
What the statute actually says
H.B. 258 passed in the 2025 General Session and took effect May 7, 2025. It added one subsection to Utah Code §31A-22-620. In full:
"(g)(i) Each year, beginning on an enrollee's birthday and ending 60 days later, an issuer shall allow an enrollee that is enrolled in one of the issuer's Medicare supplement insurance plans to choose a different Medicare supplement insurance plan that is: (A) offered by the issuer; and (B) considered a comparable or lower tier plan than the enrollee's current plan. (ii) An issuer may not deny enrollment based on medical underwriting when an enrollee selects a plan in accordance with Subsection (3)(g)(i)."
Read it as a checklist. The person protected is "an enrollee that is enrolled in one of the issuer's Medicare supplement insurance plans." The plan they may choose is one "offered by the issuer," meaning the same company. And it must be "comparable or lower tier" than what they have. Meet all three, and the company "may not deny enrollment based on medical underwriting." Miss any one, and the subsection simply does not apply. Our earlier post on changing a Medicare supplement plan in Utah works through the switches that do qualify. This one is about the people who do not.
Who the birthday rule reaches, and who it doesn't
| Your situation | Birthday rule? | Why |
|---|---|---|
| On a Medigap policy, want a different plan letter from the same company | Yes | This is the case the statute was written for: "enrolled in one of the issuer's Medicare supplement insurance plans," choosing a plan "offered by the issuer" that is "comparable or lower tier." No medical underwriting for 60 days from your birthday. |
| On a Medigap policy, want to move to a different company | No | The new plan must be offered by your current issuer. A different company may underwrite you. |
| On a Medigap policy, want a richer plan than you have | No | The new plan must be comparable or lower tier. Moving up is an ordinary application. |
| On Medicare Advantage, want a Medigap policy | No | You are not enrolled in any issuer's Medicare supplement plan, so the first test fails. Your route is one of the federal rights below, or an underwritten application. |
| On Medicare Advantage, want a different Advantage plan | No | The statute regulates Medicare supplement insurance only. Advantage changes follow Medicare's calendar: October 15 – December 7, and January 1 – March 31 for one change. |
| Dropped Medigap for Advantage years ago, want the old policy back | No | Once the policy is cancelled you are no longer an enrollee of that issuer. The federal trial right covers only the first 12 months. |
Source: Utah Code §31A-22-620(3)(g), as amended by H.B. 258 (2025). The verdicts are our reading of the statute's text; the Utah Insurance Department is the authority on how it is applied.
A Medicare Advantage member fails the first test, and it is not a close call. Medicare Advantage and Medigap are different kinds of coverage under different law. An Advantage plan replaces Original Medicare as the way you get your benefits. A Medigap policy sits on top of Original Medicare and pays its gaps. Medicare.gov's Medigap tool puts the wall between them in one line: "It's illegal for someone to sell you a Medigap policy if you have a Medicare Advantage Plan." Nobody in an Advantage plan is "enrolled in one of the issuer's Medicare supplement insurance plans," even when the same company's name is on the card.
That matters to a lot of Utahns. The CMS landscape file for 2026 lists 280 Medicare Advantage drug-plan offerings across 28 Utah counties. For every member of every one of those plans, the birthday rule is a law about somebody else.
The routes that do exist from Medicare Advantage to Medigap
The rights an Advantage member has are federal, and Medicare.gov lists them situation by situation. They are narrower than the birthday rule, but inside them they are stronger: the company cannot turn you down or charge you more for your health.
| If this is you | What Medicare.gov says | Type |
|---|---|---|
| You joined Medicare Advantage when first eligible at 65 and want out within 12 months | Medicare.gov: drop the plan, return to Original Medicare, and "you'll have special rights to buy a Medigap policy for a limited time." | Trial right |
| You dropped a Medigap policy to try Medicare Advantage for the first time, and it has been less than 12 months | Medicare.gov: "You can buy the Medigap policy you had before you joined the Medicare Advantage Plan, if the same insurance company you had before still sells it." If not, certain lettered plans from any company. | Trial right |
| Your Advantage plan is leaving Medicare or will stop covering your county | Apply from 60 days before coverage ends to no more than 63 days after. "You only have this right if you switch to Original Medicare (rather than joining another Medicare Advantage Plan)." | Guaranteed issue |
| You move out of your plan's service area | Same 60 days-before, 63 days-after application window, again only if you go to Original Medicare. | Guaranteed issue |
| None of the above | Medicare.gov: "there's no federal guarantee that an insurance company will sell you a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems." | Underwriting |
Sources: Medicare.gov, When can I buy a Medigap policy?; Medicare.gov, Special Enrollment Periods. Plans C and F are available only to people who were eligible for Medicare before January 1, 2020.
The two trial rights are the ones people confuse with the birthday rule, because they also sound like a free return trip. They are, once. Medicare.gov's Special Enrollment page describes the first: "I joined a Medicare Advantage Plan when I was first eligible for Medicare at 65, and within the first year of joining, I decided to switch to Original Medicare." The chance "lasts for 12 months after you join the Medicare Advantage Plan for the first time." The second is for someone who gave up a Medigap policy to try Advantage for the first time. In both cases the clock is 12 months, it applies to your first time in an Advantage plan, and it does not reset on your birthday.
The last row of the table is where most people actually are. Someone who has been in an Advantage plan for three years, whose plan is continuing, who has not moved, is "outside of your Medigap Open Enrollment Period, so there's no federal guarantee that an insurance company will sell you a Medigap policy." Medicare.gov then suggests checking "with your State Insurance Department about what rights you might have under state law." In Utah, for this person, the answer is that the birthday rule is not one of them.
Thinking about moving between Medigap and Medicare Advantage in Utah?
Bring your Medicare card, your current plan or policy card, and the date you first joined. We will work out whether a trial right or guaranteed-issue right is open to you, what an underwritten application would involve if not, and in what order to file things so you are never left uncovered. Free, no pressure, from our Moab office serving all of Utah. We do not offer every plan available in your area, and we will say so when Medicare.gov or 1-800-MEDICARE is the better next call.
Book a coverage review →Leaving Medicare Advantage is easy. Landing on Medigap is the hard part.
Two separate questions get folded into one. The first is whether you can leave your Advantage plan, and the answer is yes, twice a year. Medicare.gov's Open Enrollment runs October 15 – December 7, with changes effective January 1. The Medicare Advantage Open Enrollment Period runs January 1 – March 31 for people already in an Advantage plan, and lets you "drop your Medicare Advantage Plan and return to Original Medicare." Our post on switching back to Original Medicare in Utah covers the mechanics.
The second question is whether a Medigap company will take you once you are there, and neither of those periods answers it. They are Medicare's windows, for Medicare's plans. A Medigap policy is a private insurance contract, and without a guaranteed-issue right the company may ask about your health before it agrees. People who miss this end up in the worst of the three positions: out of the Advantage plan, into Original Medicare with its 20% coinsurance and no yearly limit, and declined for the supplement that was supposed to cover it.
The order of operations prevents that. If you will need to pass underwriting, apply for the Medigap policy first, with a requested start date that matches the day your Advantage coverage would end. Wait for the company's written approval. Only then file the change that takes you out of the Advantage plan. If the answer is no, you have lost nothing and you are still covered. If you qualify under one of the federal rights in the table, the sequence is more forgiving, but Medicare.gov's reminder still applies: "Medigap coverage can't start until your Medicare Advantage Plan coverage ends."
The decision this fall: the rule will not bring you back
The direction that worries me most in September is the other one. A Utahn with a Medigap policy sees the fall advertising, notices that many Advantage plans carry a $0 plan premium, and reasons that the birthday rule makes the experiment safe. It does not. A $0 premium is the plan's premium; you still pay your Part B premium, and the plan's copays and network come with it. More to the point, the moment the Medigap policy is cancelled you stop being "an enrollee that is enrolled in one of the issuer's Medicare supplement insurance plans." Next birthday, the statute has nothing to attach to.
What you do have, if this is your first time in an Advantage plan, is the federal trial right: 12 months to change your mind and, in Medicare.gov's words, "buy the Medigap policy you had before you joined the Medicare Advantage Plan, if the same insurance company you had before still sells it." That is a real safety net, and it is one year long. After it, a return to Medigap depends on your health on the day you apply. For a 67-year-old in good health that may be no obstacle at all. For someone who has since picked up a diagnosis, it can be the whole question.
None of this makes Medicare Advantage the wrong choice. For many people it fits well, and we help Utahns enroll in those plans every fall. It makes it a choice to take with open eyes. In rural Utah the practical considerations pile on: in Grand County, where our Moab office sits, CDC PLACES puts high blood pressure at 33.3% of adults (2023), and specialty care often means a drive to Grand Junction or the Wasatch Front, which is a network question before it is anything else. Our post on Utah hospital networks is the companion to this one.
What the birthday rule is good for
It would be unfair to the rule to leave it there. For the people it reaches, it fixed a real problem. Before May 2025 a Utahn on a Medigap policy whose health had changed could find themselves locked into that plan letter, because any switch meant new health questions. Now, once a year, they can step to a comparable or lower tier plan with the same company, with no health questions, which is one way to bring a premium down without giving up the structure of Original Medicare plus a supplement. If you hold a Medigap policy today, that window is yours every year, starting on your birthday, for 60 days. Keeping the policy is what keeps the window.
How we know all this: the Medicare On Main Data Desk frames every article with public data — here, Utah Code §31A-22-620(3)(g) as amended by H.B. 258 (2025 General Session, Chapter 376) and effective May 7, 2025, quoted in full from the Utah Legislature's current version of the section; Medicare.gov's Medigap buying tool for the prohibition on selling a Medigap policy to a Medicare Advantage member, the 60 days-before / 63 days-after guaranteed-issue application window, the right to return to a prior Medigap policy, and the statement that outside those rights there is "no federal guarantee"; Medicare.gov's Special Enrollment Periods page for the 12 months trial right; Medicare.gov's Open Enrollment and joining-a-plan pages for the October 15 – December 7 and January 1 – March 31 periods; the CMS CY2026 Medicare Advantage / Part D Landscape file for Utah's 280 MA-PD offerings across 28 counties; and CDC PLACES county data (2023) for Grand County. The table of who the rule reaches is our reading of the statute's text, not a ruling; the Utah Insurance Department administers it. Premiums and underwriting standards are set by each insurance company — we quote none. This is education, not advice; confirm your plan, costs, and eligibility with a licensed agent, the Utah Insurance Department, or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
Does the Utah birthday rule apply to Medicare Advantage plans?
No. Utah Code §31A-22-620(3)(g) applies to "an enrollee that is enrolled in one of the issuer's Medicare supplement insurance plans," and lets that person "choose a different Medicare supplement insurance plan" from the same issuer. A Medicare Advantage member is not enrolled in a Medicare supplement plan, so the rule does not reach them, and it does nothing to change Advantage plans either. Those follow Medicare's own calendar: October 15 – December 7 each fall, plus one change during January 1 – March 31 for people already in an Advantage plan.
Can I switch from Medicare Advantage to Medigap in Utah without underwriting?
Only if a federal guaranteed-issue right applies. Medicare.gov lists them: leaving Advantage within 12 months of joining it for the first time, a plan that is leaving Medicare or your county, moving out of the plan's service area, or a plan that misled you. For the plan-ending and moving cases the application window runs from 60 days before coverage ends to no more than 63 days after. Outside those situations Medicare.gov says "there's no federal guarantee that an insurance company will sell you a Medigap policy," and Utah's birthday rule does not fill that gap.
What is the Medigap birthday rule in Utah?
It is an annual window created by H.B. 258 in 2025 and effective May 7, 2025. Each year, "beginning on an enrollee's birthday and ending 60 days later," a Medicare supplement company must let its own enrollee move to another of its plans that is "comparable or lower tier" than the current one, and "may not deny enrollment based on medical underwriting." It has three tests: you already hold a Medigap policy, the new plan is from the same company, and the new plan is equal or lesser in benefits.
Can I be denied a Medigap policy in Utah?
Yes, outside the protected windows. Inside your one-time six-month Medigap Open Enrollment Period, inside a federal guaranteed-issue right, or inside a qualifying birthday-rule switch, a company cannot turn you down for health reasons. At any other time the application can include health questions, and Medicare.gov warns that a policy "may cost more due to past or present health problems," if one is offered at all. Medicare.gov also suggests checking "with your State Insurance Department about what rights you might have under state law."
If I drop my Medigap policy for Medicare Advantage, can I get it back on my birthday?
Not through the birthday rule. Once the Medigap policy is cancelled you are no longer "enrolled in one of the issuer's Medicare supplement insurance plans," which is the statute's first requirement. The protection that does exist is federal and short: if this is your first time in a Medicare Advantage plan, Medicare.gov says you can return within 12 months and "buy the Medigap policy you had before you joined the Medicare Advantage Plan, if the same insurance company you had before still sells it." After that year, coming back generally means underwriting.
When can I leave a Medicare Advantage plan in Utah?
Leaving is the easy half. You can return to Original Medicare during Open Enrollment, October 15 – December 7, for a January 1 start, or during the Medicare Advantage Open Enrollment Period, January 1 – March 31, with the change effective the first of the following month. Neither period gives you a right to a Medigap policy. If you need to pass underwriting, apply for the Medigap policy first and cancel the Advantage plan only after the company has approved you, so that you are never in Original Medicare with nothing behind it.
Sources
- Utah Code §31A-22-620 — Medicare Supplement Insurance Minimum Standards Act (effective May 7, 2025) — Subsection (3)(g), the 60 days birthday window and its three tests.
- Utah H.B. 258 (2025 General Session) — Medicare Supplement Insurance Amendments — the 2025 bill that created it.
- Utah Insurance Department — Medicare, Medigap and Medicare Advantage — the state regulator for Medigap questions.
- Medicare.gov — When can I buy a Medigap policy? — "It's illegal for someone to sell you a Medigap policy if you have a Medicare Advantage Plan"; the guaranteed-issue situations; "no federal guarantee."
- Medicare.gov — Special Enrollment Periods — the 12 months trial right.
- Medicare.gov — Open Enrollment (October 15 – December 7) — October 15 – December 7.
- Medicare.gov — Joining a plan (enrollment periods) — January 1 – March 31, "only if you're already in a Medicare Advantage Plan."
- CMS CY2026 Medicare Advantage / Part D Landscape — Utah's 280 MA-PD offerings across 28 counties for 2026.
- CDC PLACES: Local Data for Better Health, County 2023 — Grand County high blood pressure prevalence.
