This week’s newsletter is Sponsored By: 2026 Medicare Enrollment State Pages eBook
Medicare enrollment statistics for all 50 states → State Pages eBook
Here is what you’ll find in this week’s newsletter!
Important links 🔗 - the best articles we found this week about the Medicare Market along with links to Jared’s recent LinkedIn posts.
Deep Dive 📚 - The Birthday Rule 🎂 June '26 Update on Medicare Supplement OE / GI Rules
Sponsor Snapshot 🚀 - brought to you by 2026 Medicare Enrollment State Pages eBook
It’s only a 5 minute read, but it will make you 10x smarter.
Here are IMPORTANT LINKS 🔗 for the week:
Medicare Patients Don’t Need More Information —They Need Someone to Act - (link)
Humana invests $83M in new Florida pharmacy distribution center - (link)
Medicare Advantage Out-of-Pocket Limits: Variation and Trends - (link)
ADA supports PARTNERS Act aimed at strengthening oversight of Medicare Advantage dental benefits - (link)
Patients with treatment-resistant depression are costing Medicare big - (link)
Health Outcomes of Socially Vulnerable Populations in Different Medicare Payment Arrangements - (link)
Elevance again avoids Medicare Advantage sanctions, but threat remains - (link)
Jared’s recent LinkedIn posts:
DEEP DIVE 📚
The Birthday Rule 🎂 June '26 Update on Medicare Supplement OE / GI Rules
Over the years, we have discussed the Medicare Supplement “Birthday Rule” numerous times:
Given what an important topic this is to the Medicare industry as a whole and the fact that there is no shortage of new activity, now is a good time to update!
Since our 3Q 2025 update, here is what has happened:
2 states (NM, WV) have added the Birthday Rule
1 state (MN) has added an annual enrollment period
3 states (MI, OH, PA) have a pending Birthday Rule
1 state (NJ) has a pending Unlimited Open Enrollment Rule
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Background
It is well known that consumers typically elect one of two main Medicare options:
Original Medicare + Medicare Supplement
Medicare Advantage (MA)
With MA continuing to dominate the market with over 50% of eligibles, we’ll start there.
MA has annual plans. Each year, policyholders can shop for a plan that is best for them. Essentially, MA presents policyholders with the annual right to change plans and avoid medical underwriting.
Unlike MA, which is regulated federally, Medicare Supplement policies are regulated at the state level. This means there is no nationwide equivalent to the annual plan change opportunity in MA.
However, several states have made the decision to implement rules that attempt to mimic this annual right to switch. While there have been various approaches implemented, the most popular is the Birthday Rule, which allows Medicare Supplement policyholders to change their policy to a new carrier each year around their birthday without being subjected to medical underwriting.
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MMI Plus Subscribers:
Check out the Med Supp OE-GI Guide—created by Telos Actuarial—to easily track each state’s unique Open Enrollment and Guaranteed Issue rules.
👉Download your copy today on the MMI Plus Resources page.
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Tracking Pending Rules
There are currently 4 states with pending rules summarized in the table below.
State | Birthday | New Plan | New Plan | Proposed | Annual |
NJ | Any Carrier | Any | Unknown | Continuous | |
MI | X | Any Carrier | Same Plan Only | Unknown | 60 days |
OH | x | Any Carrier | Same Plan Only | Unknown | 60 days |
PA | x | Any Carrier | Same Plan (or variation) Only | 1/1/2027 | 60 days |
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The following map illustrates the various types of Open Enrollment / Guaranteed Issue rules adopted by states.
Another interesting view is of these rules over time. Several of the innovator states have had these rules since as early as 2009.
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Impacts
When states elect to introduce Birthday Rules or other special enrollment rules, it means that carriers currently in those markets did not price their products according to the risk associated with those rules. Therefore, carriers need to make decisions about how to account for that additional risk to remain profitable in the state. There are several ways that carriers can achieve this:
Increase premium rates to reflect the expansion of non-underwritten business;
Decrease agent commissions to offset the likely increase in loss ratio due to taking on more non-underwritten business; or
Close the block of business in the state to new business sales.
In reviewing data for states that implemented Birthday Rules between 2022 and 2024, the following were observed:
Average Plan G rate increases for open blocks of business in the 3 years following rule implementation cumulatively ranged from 1.7%-4.9% higher than a nationwide baseline of states without special rules; and
In the 3 years following rule implementation, these states averaged a 38% reduction in the number of carriers offering a Medicare Supplement product. For comparison the nationwide baseline of states without special rules showed a 29% decrease in the number of carriers offering a Medicare Supplement product.
When considering these elements together, it is possible that eventually these states with special enrollment rules could be faced with having only a handful of participating carriers with elevated premium rates.
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Conclusion
When it comes to birthdays, there are pros and cons, and the Medicare Supplement rules associated with birthdays are no exception.
For the policyholders, it gives them the opportunity to shop for a lower premium rate, possibly an alternate plan, or both.
However, the trade off appears to be a reduced number of carriers to choose a product from and the likelihood of higher premium rates.
It is clear that more states are going to consider implementing these types of rules. It will be critical moving forward that regulators and industry work together to ensure that the rules implemented do not significantly harm either policyholders or carriers, so that Medicare Supplement markets remain robust.
What type of adjustments do you think would be beneficial to the existing style of Birthday Rules?
SPONSOR SNAPSHOT 🚀: 2026 Medicare Enrollment State Pages eBook
In Medicare, each state is its own unique market.
We share Medicare enrollment statistics for all 50 states in colorful data visuals. Includes enrollment data for the following:
Medicare Advantage
Medicare Supplement
Top Carriers in each state
Market Penetration
And much more!
We hope this eBook will help you wrap your arm around the Medicare market, both nationally and locally, assess your competition, train your team, and make strategic decisions.
Telos Actuarial → Medicare Enrollment State Pages
What MMI + Subscribers read this week…
Insurance Regulatory Insights June 2026 - Four new laws to take effect 👉 (link)
2026 Medicare Enrollment State Pages eBook - (link)
Non-Commissionable Plans - 2026 - Repository of 2026 Non-Commissionable Plans (link)
May ‘26 MA/MAPD and PDP enrollment data - May enrollment data has been loaded. Here are a few observations. (link)
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