Quick answers
- Does Oregon have a Medigap birthday rule?
- Yes. OAR 836-052-0143 lets anyone with a Medigap policy switch to another policy with the same or fewer benefits, without health questions, from 30 days before to 30 days after their birthday each year.
- When is my Medigap open enrollment period?
- The 6 months that start the first month you're enrolled in Part B. During it, a company must sell you any Medigap policy it offers in Oregon, regardless of your health (OAR 836-052-0138).
- Can I buy Medigap in Oregon if I'm under 65?
- Yes. If you have Medicare because of a disability, Oregon companies must offer you every policy they sell during your 6-month open enrollment, at a premium no higher than they charge people who are 65.
- Can I switch from Medicare Advantage to Medigap in Oregon?
- Without health questions only with a guaranteed-issue right, such as your plan leaving your county or the 12-month trial right. Oregon's birthday rule is only for people who already have Medigap.
- How long do I have to return a new Medigap policy?
- 30 days from delivery for a full premium refund if you aren't satisfied for any reason (OAR 836-052-0160).
What is Medigap?
Medigap, also called Medicare Supplement Insurance, is a policy sold by private insurance companies to people with Original Medicare (Part A and Part B). Medicare pays its share first, and your Medigap policy pays some or all of what is left, such as the Part A hospital deductible, the Part B coinsurance and skilled nursing coinsurance.
- Medigap works only with Original Medicare. You can't use it with a Medicare Advantage plan.
- There are no networks: it pays its share wherever you get Medicare-covered care in the U.S. from a provider who accepts Medicare, with no referrals.
- 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 Oregon are licensed and regulated by the Oregon Division of Financial Regulation (DFR), but each plan letter's benefits are set by federal law. DFR told the 2025 Legislature that about 175,000 Oregonians have Medigap and that 21 companies offer Plans A and G.
What are Oregon's Medigap rules?
Oregon's Medigap law is ORS 743.680 to 743.689, and the rules are in Oregon Administrative Rules chapter 836, division 52, enforced by DFR. Here is what they mean for you:
Birthday rule every year
Anyone with a Medigap policy can switch to a policy with the same or lesser benefits, from any company, without health questions, from 30 days before to 30 days after their birthday (OAR 836-052-0143, in its current form since January 1, 2023).
Every policy for people under 65
During the 6-month open enrollment that starts with Part B, companies must offer every Medigap policy they sell "without regard to age," so people under 65 with Medicare because of a disability can buy any plan the company offers, at a premium no higher than it charges people who are 65 (OAR 836-052-0138).
A second window at 65
If you got Part B before 65, you get another 6-month Medigap open enrollment when you turn 65 (OAR 836-052-0138(5)(b)).
Moving to Oregon with a disability
If you have Medicare because of a disability and move to Oregon from a state that doesn't require Medigap for people under 65, you have 63 days from establishing Oregon residency to buy a policy without health questions (OAR 836-052-0138(5)(c)).
Broader guaranteed issue
When you have a guaranteed-issue right, Oregon lets you buy Plan A, B, D, G, K, L, M or N (and C or F if eligible before 2020) from any company, a wider list than the federal minimum (OAR 836-052-0142).
30 days to return it
Every Oregon Medigap policy must say you can return it within 30 days of delivery and get your premium back if you aren't satisfied for any reason (OAR 836-052-0160). If you're replacing a policy, keep the old one until you decide.
How does Oregon's birthday rule work?
Oregon is one of a small number of states with a yearly Medigap switching right. A 2025 bill that would have added a separate yearly open enrollment window for everyone (SB 1181) did not pass, so the birthday rule is the yearly option.
- Know your window. It opens 30 days before your birthday and closes 30 days after it, about 61 days in all (OAR 836-052-0143). Apply within the window.
- Check that you qualify. You must have a Medigap policy now. The rule doesn't apply to policies issued before January 1, 1990, and it doesn't help people in Medicare Advantage.
- Pick a policy with the same or lesser benefits. "Same or lesser" is defined by a chart on DFR's website. You can stay with your company or choose another one. A policy with more benefits can be bought only if the company accepts you after health questions.
- Apply before you cancel. Keep your current policy until the new one is approved and in force, so you're never without coverage. You then have 30 days to return the new policy for a refund.
- Get help if you're refused. The new company can't deny you, put conditions on your policy, or price it based on your health or claims. If that happens, call DFR's consumer advocates at 1-888-877-4894.
Use our birthday rule timing calculator to find your window, and see does Oregon have a Medigap birthday rule?
Correction: some websites, including earlier versions of this page, said Oregon has no birthday rule, or that the window starts on your birthday. Oregon's rule has applied since January 1, 2013, and under its current version (effective January 1, 2023) the window starts 30 days before the birthday.
When should I buy? Your Medigap open enrollment period
Your Medigap open enrollment period lasts 6 months and starts the first day of the first month you're enrolled in Part B (OAR 836-052-0138). It happens once, plus a second time at 65 if you got Part B earlier. During it, any company selling Medigap in Oregon must sell you any policy it offers and can't charge you more because of your health. If you had at least 6 months of creditable coverage before, there's no waiting period for pre-existing conditions; with less, the wait (up to 6 months) is shortened by the months of coverage you had. If Social Security approves your Part B retroactively after an appeal, the 6 months start the month after you're notified.
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 in Oregon. Outside open enrollment, the birthday rule and guaranteed-issue rights, Oregon companies can use medical underwriting and may turn you down.
When else can I buy Medigap without health questions?
Federal law and Oregon's rule (OAR 836-052-0142) guarantee you can buy a policy, with no health questions and no pre-existing condition exclusion, in situations like these. You need to send proof of the date your other coverage ended with your application.
- 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, K, L, M or N from any company, or C or F if you were eligible for Medicare before January 1, 2020.
- Your employer or union coverage that pays after Medicare ends, or a Medicaid (OHP) or other plan that supplemented Medicare ends.
- Trial rights: you joined a Medicare Advantage plan (or, at 65 or older, PACE) within 6 months after your Part B started, or dropped a Medigap policy to try Medicare Advantage for the first time, and you leave within the first 12 months. If you dropped Medigap, you can usually get your old policy back from the same company.
- Your Medigap company goes bankrupt, ends your coverage, or misled you.
Windows: generally up to 63 days after your coverage ends. If you leave a plan voluntarily, you can apply as early as 60 days before and up to 63 days after the date coverage ends.
Plans ending for 2027: some companies stop offering Medicare Advantage plans in some Oregon counties for 2027, and Grant, Harney, Lake, Umatilla and Union counties have no Medicare Advantage plan open to everyone. If your plan is ending, you have a Medigap guaranteed-issue right for 63 days after it ends, and a Special Enrollment Period through February 28, 2027. Keep your non-renewal letter: the Medigap company will ask for it. See Oregon 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, how they set rates and service. Every plan pays Part A coinsurance and hospital costs for 365 extra days after Medicare benefits are used up, and 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 ($8,000 and $4,000 in 2026). 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 ($2,950 in 2026). 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 assignment may bill. The 2026 Part A deductible these plans help with is $1,736, and the 2026 Part B deductible is $283; CMS publishes 2027 amounts each fall.
How are Medigap premiums priced in Oregon?
Benefits are the same from company to company for the same plan letter, but prices are not. Oregon allows Medigap companies to price by attained age, so premiums rise as you get older, and some use other methods, such as issue-age rating. Premiums also usually change every year, and companies file their rates with DFR. Before you buy, ask the company how the policy is priced and how its rates have changed. For people under 65 who buy during open enrollment, Oregon's rule limits the premium to what the company charges a 65-year-old (OAR 836-052-0138(4)).
To see Medigap policies sold where you live, see plans for your ZIP code.
Medigap or Medicare Advantage?
Medigap has no network, which matters in rural Oregon, where the nearest specialist may be hours away, and in the five counties with no Medicare Advantage plan open to everyone for 2027. It also matters for people who spend part of the year in another state. Medicare Advantage plans use networks and service areas, include a yearly out-of-pocket limit, and usually include drug coverage. Oregon'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 Original Medicare vs. Medicare Advantage in Oregon and see Medicare Advantage in Oregon.
Where can I get help with Medigap in Oregon?
- Oregon Division of Financial Regulation, consumer advocates: 1-888-877-4894 or DFR.InsuranceHelp@oregon.gov. DFR licenses Medigap companies and agents, reviews rate filings and handles complaints, including a company refusing a birthday-rule change you qualify for.
- 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 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 Oregon.
Related questions
- Does Oregon have a Medigap birthday rule?
- Can I get Medigap under 65 in Oregon?
- When can I buy Medigap in Oregon?
- What Medigap plans are sold in Oregon?
Sources
- Oregon Secretary of State — OAR 836-052-0143, Annual Opportunity to Select Another Medicare Supplement Policy or Certificate
- Oregon Secretary of State — OAR 836-052-0138, Open Enrollment
- Oregon Secretary of State — OAR 836-052-0142, Guaranteed Issue for Eligible Persons
- Oregon Secretary of State — OAR 836-052-0160, Required Disclosure Provisions (30-day return)
- Oregon Division of Financial Regulation — Oregon Medicare Supplement Insurance Overview, 2025 legislative presentation
- Oregon Legislature — SB 1181 (2025), measure history
- Oregon Division of Financial Regulation — Contact us (consumer advocates)
- 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
Can I change Medigap companies with the Oregon birthday rule?
Yes. During the window from 30 days before to 30 days after your birthday, you can cancel your Medigap policy and buy one with the same or lesser benefits from your current company or a different one. The new company can't deny you, put conditions on the policy or charge you more because of your health (OAR 836-052-0143). It doesn't apply to policies issued before January 1, 1990.
Can a Medicare supplement deny me for a pre-existing condition in Oregon?
Not during your 6-month Medigap open enrollment period, the birthday window, or a guaranteed-issue period. In open enrollment, a company can delay coverage of a pre-existing condition for up to 6 months only if you had less than 6 months of earlier creditable coverage. Outside those times, Oregon companies can review your health and may turn you down.
Can I still buy Medigap Plan F in Oregon?
Only if you were eligible for Medicare before January 1, 2020. Federal law stopped the sale of Plans C and F, which pay the Part B deductible, to people who became eligible on or after that date. Plan G has the same benefits as Plan F except the Part B deductible.
What are Medigap guaranteed issue rights?
They are situations when a company must sell you certain Medigap policies without health questions, such as when your Medicare Advantage plan leaves your area, your employer coverage that pays after Medicare ends, or you leave Medicare Advantage within a 12-month trial period. In Oregon you generally have 63 days after the coverage ends, and you can buy Plan A, B, D, G, K, L, M or N (C or F if eligible before 2020) from any company (OAR 836-052-0142).
Does Medigap cover prescription drugs?
No. Medigap policies sold today don't include drug coverage, so most people with Medigap also join a stand-alone Part D plan. Medigap does help with your share of drugs covered under Part B, such as infusions given in a doctor's office.
Can I keep my Oregon Medigap if I move to another state?
Yes. Medigap policies are guaranteed renewable, so you can keep your policy if you move, as long as you pay the premium, though the premium may change. If you want a different policy after you move, you may need to answer health questions unless you have a guaranteed-issue right or your new state has its own switching rule.
Does Medigap cover me when I travel outside the U.S.?
Plans C, D, F, G, M and N pay 80% of medically necessary emergency care during the first 60 days of a trip outside the U.S., after a $250 yearly deductible, up to a $50,000 lifetime limit. Plans A, B, K and L don't include it.
Where do I complain about a Medigap company or agent in Oregon?
Contact the Oregon Division of Financial Regulation's consumer advocates at 1-888-877-4894 or DFR.InsuranceHelp@oregon.gov. DFR licenses insurance companies and agents in Oregon and enforces the state's Medigap rules, including the birthday rule.
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