Medicare Answers: Policy Extension Requirements in a Birthday Rule State

  • Originally published May 14, 2013 , last updated December 23, 2014
  • Medicare
Medicare Answers: Policy Extension Requirements in a Birthday Rule State

If you have a Medicare question you’d like answered, you can leave it in the comments section below, or you can e-mail it to

This week’s question deals with policy extension requirements in a birthday rule state.

Cal asks,

I work for a small insurance agency specializing in Medicare insurance. We run most of our Medicare Supplement policies through Senior Market Sales. We saw your post from about a year ago regarding extensions and exclusions. Are there some states that require policy extensions when the client is in the midst of a hospital or nursing home stay? With the new birthday rule in Oregon we are faced with this likely scenario. In the state of Oregon if the extension is not a requirement, what would you recommend for a policy replacement?


I looked at several different companies contract provisions for “extension of benefits.” I also found that Oregon is no different from many other states that do not have the new “Birthday Rule.” Here is how the policy reads:

If you incur expense for a continuous loss which began while this policy was in force, coverage for such loss will continue beyond the date insurance ends. This extension of coverage is:
(a) Subject to your continuous total disability; and
(b) Limited to the duration of the Medicare Benefit Period or, if none is applicable, payment of the maximum benefits.

Benefits are payable during this extension on the same basis as if coverage had not ended. However, coverage is extended only for those covered Sicknesses or Injuries causing the continuous loss. Receipt of Medicare Part D outpatient prescription drug benefits will not be considered in determining a continuous loss.

Thank You,