Birthday Prior to 1955

If your birthday is prior to 1955, then the federal Guaranteed Issue rule means that you can enroll in Plan F without underwriting. Plan G, however, is not available on a guaranteed basis, but if you can pass underwriting, it’s available.

This isn’t all bad for the reasons that I have known, and shared in the video.

To quickly review,
Plan F = Plan G + Part B Deductible + “Other stuff”.
In reality, it can be the case that Plan F premium is LOWER than Plan G + Part B deductible (!!!). This shouldn’t happen in the “real world,” because there is no doubt that the administrative cost/hassle of dealing with the Part B deductible, the “Other Stuff,” is NOT ZERO.

That means only those that never go to the doctor will find Plan G superior, because the absolute price is lower. That said, if that is the case, you never go to the doctor because you are Miss Perfect, then why are you not in $0 Medicare Advantage, and save the $2000/year? For Miss Perfect, that “tax” seems high, but ultimately, up to the consumer. I take orders for a living over here (“still or sparkling”).


Illinois has introduced a twist on the birthday rule. Switching Plan F to Plan G now possible, but you need to stay within the same carrier (so meh). Plan G to Plan N possible, but the Part B Excess charge would become uncovered, you know my thoughts on this.


Nevada has introduced the birthday rule. You can switch carriers and plans (the new plan cannot be stronger than the old). The period lasts 61 days, beginning on the 1st of your birthday month. This joins other states with this format of the birthday rule.

Not New, But Interesting: New York

New York has very, very interesting options and challenges for Medicare beneficiaries.

  • Medigap Open Enrollment is 100% unrestricted. Don’t be overjoyed, the cost of Medigap is much higher than in other states. This makes entire sense. Jae is cherry-picking into Medigap when there is a health situation that demands it, and the carriers know that I am knocking at the door (I’m here, and you, Mr Carrier, are about to lose $, and possibly a lot. The carriers have already adjusted, in advance. How? Higher premiums, ding.

  • Part B Excess in not allowed in New York State. Hmm. You would be stunned to know the % of people that do not know this.

  • By the way, calling 800-Medicare can result in erroneous information given to you, where Eddie S in Staten Island attempted to tell me “Medicare told me that….” Unfortunately for Eddie, he believed the incorrect information. Ugh.

  • Clear negative: Medicare Advantage acceptance is very fragmented. And many healthcare providers (still) do not understand that PPOs will pay them, as long as the healthcare provider accepts the federal Medicare card.

  • Moving from NY State to another state? A combination of the prior bullet points, correctly executed, is providing priceless options for our clients.

They Aren’t My Rules

No has called me to ask me for how the rules “should” work. However, it is 100% my job to use the rules, as written, for the client’s best interest, irrespective of health or financial situation.

In order to do this, I need to:

  1. Understand the math and logic of how insurance is priced. This requires an understanding of how options pricing works, in the base case, and then how federal and state regulations affect the price.

  2. Understand the forces that insurance carriers face in a very competitive marketplace, where the population is 100% certain to increase (62MM and counting).

  3. Relate this to people from different financial, health, attitudinal backgrounds, so they can get to the most-fitting conclusion for themselves.

If you want my apology for the perhaps annoying, overbearing way and manner in which I present this, HERE IT IS.

If you want my apology for having the background and experience in providing it, y’all know the answer to that one, right?