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California Birthday Rule For Medicare Supplements

Additional Medicare Coverage Options In California

California Medicare Supplement Plans & the Birthday Rule (2021)

Medicare Supplements are not the only coverage you will need when enrolled in Medicare in California. In addition to your Medicare Supplement Plan, its important to review prescription drug coverage and ancillary coverage to ensure all your needs are covered.

Medicare Part D plans help cover the cost of prescription drugs for beneficiaries. Alongside Medicare Part D, there are dental, vision, hearing, and critical illness plans available to round out your health care coverage in California.

Some Enrollees May Qualify For Medigap Special Enrollment

You may qualify for a special Medigap enrollment period if you have guaranteed issue rights. In these cases, insurance companies cannot charge you more based on your medical conditions, put a waiting period on your coverage, and deny you coverage.

The Centers for Medicare and Medicaid has established a list of seven situations that require insurance companies to allow you to sign up for or change a Medigap plan without medical underwriting. This list of events is somewhat limited, but you may have even more options depending on what state you live in.

As of 2022, eleven states offer guaranteed issue rights that go above and beyond what the federal government does .

What Is An Equal Or Lessor Benefit Plan In 2021

This is a good question because the rules regarding equal plans have changed. The birthday rule law requires you to only switch to a lettered plan that has the same or less benefits than your current plan.

By this logic those with Medigap Plan F could switch to Medigap plan G, because G offers less benefits than Plan F . If you wanted to go from a G to and F you cannot make the birthday rule switch. That hasnt changed.

In the past, however, you were previously unable to switch from Plan F to an Innovative Medigap F , as insurance providers stated they were not equal. That has changed.

The CA legislator has now clarified that all lettered plans are considered equal, meaning you can now switch from a standard F to an Innovative F using the birthday rule. If you are not sure which plans you can switch to using the birthday rule, please give us a call at 800-930-7956.

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Why Is This Important

All Medicare Supplements get rate increases and generally, they happen every year. This allows you to shop for a lower rate with a different carrier and your acceptance is guaranteed. You are also guaranteed to get the best available rate regardless of your health. The purpose of this law is to allow protections for someone with a Medicare Supplement to shop all of the available companies to look for a lower premium.

Medicare Spending In California

California Medicare Supplement Plans

In 2018, Original Medicares average per-beneficiary spending in California was $9,868, based on data standardized to eliminate regional differences in payment rates .

Nationwide, average per beneficiary Original Medicare spending was $10,096 per enrollee, so Medicare spending in California was about 2 percent below the national average. Per-beneficiary Original Medicare spending was highest in Louisiana, at $11,932, and lowest in Hawaii, at just $6,971.

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Medicare Supplements California Birthday Rule: Another Reason To Celebrate

We discussed in an earlier post why it is important to compare your Medicare Supplement plan at least once every other year to make sure you are getting the best price for your Medigap Plan, but for some this may be a problem. Most Medicare Supplement plans are subject to underwriting so for those with serious health conditions such as heart disease, COPD, or a recent history of internal cancer, it may not be as easy to switch as you must get approved for the new plan. There are a few exceptions to having to go through underwriting such as when a person is turning 65 years old and a few others that may apply. A great advantage to living in our great state, California, is you can switch your Medicare Supplement Plan each year around your birthday without having to go through underwriting thanks to the California Birthday Rule.

In order to qualify for the California birthday rule you must sign up for your new plan on your birthday or within 30 days past your birthday . You must also sign up for a plan that is the same letter plan you have now or a letter plan that covers less. So for instance, if you have plan F, you can sign up for another plan F or you can downgrade your plan to a plan that covers less than plan F. If you have plan N, you will not be able to upgrade your plan to a plan that is more comprehensive but you can switch to another plan N or to a plan that covers less than plan N.


I Thought I Could Only Change During The Annual Enrollment Period From October 15 To December 7

It is a common misconception that you can only change your Medicare Supplement during the Annual Enrollment Period from October 15th to December 7th. You can change your Medicare Supplement anytime during the year you want. However, you will likely have to answer a series of health underwriting questions to qualify. California and Oregon are the only states that will allow you to change your Medicare Supplement guaranteed around your birthday. It is also misunderstood that you can change your Medicare Supplement during the Annual Enrollment Period guaranteed issue, meaning the insurance company you apply to must accept you no matter what your health conditions are. This annual enrollment period from October 15 to December 7 has nothing to do what-so-ever with Medicare Supplements. The enrollment period is only in regards to Medicare Advantage Part C or stand-alone prescription drug plans also known as Part D of Medicare.

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Find The Best Medicare Insurance Information

The Association maintains the only national online directory that exclusively lists Medicare Insurance agents.

Its 100% free and 100% private.

You enter no personal information to access the listing which is Zip Code based.

See a listing of agents. Decide who you wish to connect with. Then call or email them for assistance.

Is This Available In All States

California Medicare Supplement Plans | Medigap Plans in CA | CA Birthday Rule Explained

What makes this unique is the insurance companies are not allowed to ask you any medical underwriting questions. This law is only available in California and Oregon, however, Missouri also has a similar rule but is based on when the anniversary date of the policy. In other states that dont have this rule, when you want to change your Medicare Supplement you have to be medically underwritten. Meaning the insurance company can ask you a series of health questions to see if you qualify for their company. If you dont qualify, they have the right to deny you coverage, or if you do qualify and have certain health conditions, they have the right to charge you more premium every month. What happens in other states, if you have certain medical conditions, the likelihood of a different Medicare Supplement company accepting you is very limited. This means you are stuck with Medicare Supplement you have and you have to accept whatever rate increases they impose on their members.

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What Is The California Birthday Rule

This rule is unique to California and specifically deals with Medicare Supplement plans.The rule states that residents of California have an opportunity, every year, to change their Medicare Supplement plan without ANY Underwriting requirement.This simply means that the insurance companies cannot deny your request to change companies or plans if you follow this state rule.

How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In California

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare such as long-term care.

Our guide to financial assistance for Medicare enrollees in California includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

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The California Birthday Rule

If you already have Medigap insurance, you have 60 days of open enrollment following your birthday each year when you can buy a new Medigap policy without a medical screening or a new waiting period. The new policy must have the same or lesser benefits as your old policy. To avoid confusion, the new law specifies which of the new Plans are equal to the old Plans.Want to change to a different Medigap plan for a lower premium? In California and have a Medigap plan, you can! Our state law allows you an opportunity to buy certain plans without a health screening each year starting on your birthday for at least 60 days. This window used to be 30 days, but, thanks to the passage of SB 407 in 2019, this Medigap Birthday Rule has been extended to 60 days as of January 1, 2020.

How does it work?

If you already have a Medigap plan, you can choose a plan from any company but are limited to one that has the same or fewer benefits than your current plan. For example, if you already have Plan G, you may switch to another Plan G, but not to a Plan F.To qualify for the Birthday rule you must:

  • Live in California

Why The Birthday Rule Is Important

Medicare Birthday Rule

Although you can change your Medigap plan at any point in the year , if you attempt to make a change thats not in the timeframe of the Birthday Rule, you will have to qualify medically for the policy.

That means if you have health conditions, you may be denied by an insurance company that offers Medigap policies. Under the Birthday Rule, you are guaranteed acceptance even if you would normally be disqualified because of a health condition.

The Birthday Rule also is important because it helps stimulate competition among the private insurance companies that offer supplement insurance. Competition can lower premiums, and give Medigap policy owners an opportunity to find something more affordable with the same level of coverage.

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What Is The Medigap Birthday Rule

The birthday rule is the nickname for a law that allows those who are already on a Medigap plan to switch to another plan without medical underwriting. In CA, they have created an annual window of 60 days after your birthday to switch plans hence the name birthday rule.

Most states do not have a birthday rule or anything similar. In other states, those with Medigap plans who want to switch to a better-priced competitor have to fill out an application and answer questions about their current health condition to be approved.

Yes, even in California, Medicare insurance providers can turn you down for certain pre-existing conditions if you try to switch outside the birthday-rule period.

What Help Is Available

One of the biggest benefits of working with a licensed insurance agent is that your agent will continue to advocate for you and provide you with service even after you initially sign up for a Medicare policy and any Medigap policies.

This becomes especially important when your birthday comes each year and you have the opportunity to re-evaluate how much you pay for your supplemental insurance policies and the coverage they provide.

Because agents work with several different insurance carriers, they can provide you with options and several price points to consider. In doing this, their advice and services are free to you because they receive a commission paid by the insurance company.

A licensed insurance agent who is an expert in Medicare coverage can help you navigate the confusing nature of Medicare, make sure you dont miss important deadlines, and ensure that if you do decide to change supplemental policies, that you still get the coverage you need to meet your specific needs.

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Idaho Illinois And Nevada

The new Idaho birthday rule is set to take effect March 1 2022. It will create a 63-day plan switching period beginning on the policyholders birthday. The new policy must offer the same level of benefits as the existing coverage or a lower level of benefits. The Medigap policy user can either switch insurers or change to a new Medigap policy from the same issuer. Idaho will switch to a community rating system for Medigap enrollees, meaning that premium rates will no longer be based on the age of the applicant.

In Illinois, a new birthday rule will take effect Jan. 1, 2022. The Illinois rule will let Medigap users ages 65 through 75 have annual Medigap open enrollment periods lasting 45 days after their birthday anniversaries. The new policy must offer the same level of benefits as the existing coverage or a lower level of benefits.

In Nevada, a new birthday rule will take effect Jan. 1, 2022, and provide 60-day plan switching periods starting on the first day of a Medigap users birthday month. Eligible consumers can buy new coverage, with the same or lesser benefits, from either their existing carriers or new carriers, without medical underwriting. A consumer cannot use the new rules to get policies with extra, innovative benefits, such as dental insurance, vision insurance, hearing benefits or gym memberships, officials say.

When Did The New Birthday Rule Law Went Into Effect

California Medicare Plans – Medicare Birthday Rule Explained

The CA birthday rule began on July 1, 2020. The period allows for 60 days after your birthday to switch to certain Medigap plans.

To qualify for the Birthday rule you must:

  • Live in California
  • Have a Medigap plan in force
  • Switch to a plan with equal or lesser benefits
  • Act before 60 days have passed since your birthday

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How Medicare Part D Prescription Drug Plans Differ Between States

Medicare Part D prescription drug plans are private insurance plans that work with Original Medicare to help cover the costs of your prescription medicine. Many Medicare Advantage plans also provide prescription drug coverage.

Plan prices and plan availability varies from state to state, but all states are required to have open enrollment in Medicare Part D plans at the same time as open enrollment for Original Medicare October 15 to December 7 every year.

The availability of Medicare Part D plans vary from state to state. The number of plans available in any state in 2019 ranged from 22 choices in Alaska to 30 choices in California, Pennsylvania and West Virginia, according to the Kaiser Family Foundation.

Medicare In California: Resources For Medicare Beneficiaries And Their Caregivers

Need help with Medicare enrollment in California, or have questions about Medicare eligibility in California?

  • HICAP, Californias Health Insurance Counseling and Advocacy Program, is a helpful resource. Access their website or call 1-800-434-0222.

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What You Need To Know

  • The Illinois and Nevada rules take effect in January, and the Idaho rules take effect in March.
  • California and Oregon already had birthday rules.
  • Connecticut, Maine, Missouri, New York state and Washington state have other types of Medigap plan-switching rules.

Three states Idaho, Illinois and Nevada are adding rules that could help unhappy Medicare supplement insurance users change policies without going through medical underwriting.

The new state birthday rules will give people who already have Medicare supplement insurance policies, or Medigap policies, a chance to switch Medigap policies for a few weeks every year, around the time of their birthday anniversaries.

Jesse Slome, the director of the American Association for Medicare Supplement Insurance, put out an alert about the new state birthday rules. He emphasized, in a comment included in the alert, that Medigap users who want to switch policies should talk to insurance agents who regularly sell Medicare plans.

This is probably one of the least-known opportunities available to seniors, Slome said.

Getting professional advice is important, because each state has different rules, and understanding and meeting a states requirements is critically important, Slome said.

Why Is The Birthday Rule Important

California Medicare Supplement Plans

In states without the Birthday rule, if your Medigap price dramatically increases, you would either have to pay the new higher price or apply for a new plan and risk being turned down for pre-existing conditions. In California, however, you can switch and you are guaranteed to be approved. This protects you and gives you options.

CA residents should always check out Medigap prices as their birthday approaches. The best way to get prices is to get an instant Medigap Quote here. If you find the same plan for less with a different provider or just want to get on a less expensive plan, we can help you switch. To learn more, call us or visit our Medigap Overview page.

Please Note: Switching using the Birthday Rule can also be done in Oregon. Contact us for more info.

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Why Can We Do It Better

We are a customer-focused independent insurance agency that specializes in Medicare and the options to supplement it. We have relationships with dozens of insurance companies, allowing us to meet your specific needs at the best price possible. Our company has been serving clients across the country for almost 70 years and would like to earn your trust and business. Call us or fill the form out below today!

We will take all the time needed to review your current coverage with you and make suggestions on better priced options. The same coverage in most cases, but possibly priced better. If you have been on the same plan for 2 or more years, its time to look around.

With almost 70 years of experience and having worked with people on Medicare since it started in 1966, we consider ourselves experts in this area. We have helped thousands of seniors over the years make the best decisions for their Medicare Coverage. We have fully licensed, educated and caring agents to help discuss options with you.

We believe in educating the client about the products and options available. We have full time customer service on staff who are ready and able to handle any questions or concerns that may arise – anytime. Can your current agent say that? Have they even called to discuss the Birthday Rule with you?

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