California Medicare Supplement Birthday 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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When Would The New Policy Take Effect

Using the CA Birthday Rule, the new policy would take effect on the 1st of the month AFTER the birthday. So, with most companies, the price of the new policy would reflect your new age .

The application can be done the month before the birthday or the month after but the effective date always has to be after the birthday.

Quick Facts:

• Has to be done around your birthday each year
• Can only move to a plan of equal or lesser benefit
• Recently extended to 60 days after your birthday, .
• The effective date has to be after the birthday, so the new premium will reflect your new age.

What Is The California Birthday Rule For Medicare Supplements

The California Birthday Rule for Medicare Supplement may allow you to:

• Lower your monthly premium cost of your Medicare Supplement significantly if a lower rate is available for your same letter plan

• Move to any other carriers same letter plan without having to answer health questions

• Obtain the same Standardized benefits and the same choice of doctors

• You may be able to add additional benefits such as hearing and vision coverage

You must act within 60 days of your birthday to take advantage of these benefits.

It pays to shop rates for your plan. Since Medicare Supplements are Standardized you may be able to get the same plan benefits and choice of providers but with a lower monthly premium.

Watch our video about the California Birthday Rule by clicking here.

Our agents can help find the right Medicare Supplement for you.

Instead of calling dozens of carriers to shop rates, let our team shop Medicare Supplement Plans for you. We will provide you with competitive quotes, plan comparisons, and explanations of benefits. With our team, you wont be alone and can count on us being just a phone call or email away. No long holds to speak to a representative here we are happy to be of help!

1-916-346-4417

Birthdays have their privileges! Californias Birthday Rule for Medicare Supplement plans may allow you to make a change to another Medicare Supplement plan offered by another carrier to lock in a lower monthly premium while keeping strong coverage.

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How To Avoid Medical Underwriting

There are some instances when you may be able to avoid medical underwriting for a Medigap policy. One is if you have Medigap guaranteed issue rights. There are several situations when you could qualify for guaranteed issue Medicare Supplement coverage including :

• The Medicare Supplement Open Enrollment Period, which begins the day you are both age 65 and older AND enrolled in Medicare Parts A and B. It lasts for six months.
• If you lose your Medicare Advantage plan coverage because you move outside of the plan’s service area, the plan leaves the Medicare program, or it stops serving people in your area, you can apply for a Medigap policy starting 60 days before your MA coverage ends.
• If you have Original Medicare and secondary insurance, you may apply for a Medigap policy when your secondary coverage ends.
• If you join a Medicare Advantage plan in your first year of having Medicare and decide to switch back to Original Medicare within 12 months, you can apply for a Medigap policy 60 days before your plan’s scheduled end date and closing 63 days after coverage ends.

Additionally, some states offer greater consumer protections for Medigap customers called the Medigap birthday rule.

We Have Good News However

One of our premier insurance companies is, for a short time, allowing anyone with any type of Medicare Supplement to move to any of their plans no questions asked. This means there is no medical underwriting whatsoever. And you dont have to wait for your birthday to come around. Its happening now!

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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.

Next Steps For The Ca Birthday Rule

1) Check your bill to confirm the price of your current Medigap plan2) Check our instant online Medigap quotes to see competitive prices.3) Call Senior65 at 800-930-7956 before it has been 60 days from your birthday.

Senior65 will help you switch plans right over the phone. There is never a fee or hidden charge to work with Senior65.com. Since Medicare insurance pricing is regulated, no one can sell you the same plan for less than we can.

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When Did The New Birthday Rule Law Went Into Effect

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

What About Spousal Discounts

Yes, spousal discounts are available. This is a great opportunity to put spouses on the same plan and enjoy 7% off BOTH of your premiums. With the uniqueness of the Birthday Rule, its easy for spouses to get separated and on different plans in CA.

As this current change can be done at the same time with the same effective date, you and your spouse can get on the same plan at the same time. The discounts are available right away.

And this company also offers a free gym membership!

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The Basics Of Supplemental Insurance

For the Birthday Rule to affect you, you must have a supplemental insurance policy to Medicare, otherwise known as Medigap or Medicare Gap. Supplemental insurance helps cover some of the costs Original Medicare insurance does not.

If youre enrolled in an Original Medicare policy, Medicare will pay its share of the Medicare-approved health care costs first. Then, your supplemental insurance policy kicks in, paying the remaining portion that the policy covers. Examples of what Medigap policies cover include coinsurance, co-payments, deductibles and emergency foreign travel expenses.

Our article, A Guide To Medicare Gap Insurance, explains more about what you should know if youre thinking about purchasing a Medigap policy. But, in relation to the Birthday Rule, you should know that the best time to purchase Medigap policies is during your open enrollment period.

This begins the month you turn 65 and enroll in Medicare Part B. There are no restrictions other than your age, even if you experience health problems. If you wait until after your open enrollment period, or decide to change your Medigap policy later, it can cost you more. Or worse, insurance companies that provide supplemental insurance can deny you altogether.

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 â anytime. Can your current agent say that? Have they even called to discuss the Birthday Rule with you?

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#birthday Rule Medicare Guaranteed Issue Rulesto Change To Plan A F G Or N

An individual shall be entitled to an annual open enrollment period lasting 60 days or more, commencing with the individuals birthday, during which time that person may purchase any Medicare supplement coverage that offers benefits equal to or lesser than those provided by the previous coverage. 1358.11. * SB 407 Effective 7.1.2020?

Blue Cross Innovative F or G or Blue Shield Plan F or G Extra, count the same as F or G and dont require underwriting. CA Health Care Advocates*

The application may be submitted 90 days in advance, for Blue Cross, but the effective date would be for the month after the clients birthday unless their birth date was on the 1st. CA Health Care Advocates * excerpt of email from BC 6.2.2020

shall not deny

• nor discriminate in the pricing of coverage, because of health status,
• claims experience,
• receipt of health care, or
• medical condition of the individual

Blue Shield Birthday Rule Chart

Typical Guidelines for all Insurance Companies

California Birthday Rule FAQs

Dont wait to wait for your birthday? Try Blue Shields and other companies Underwriting Holiday and/or Just go ahead & Answer Health Questions

Do NOT confuse the birthday rule with Medicare Advantage * AEP Annual Election Period October 15th to December 7th for the next January 1st. They are two totally separate things!!!

Cost Of Medicare Supplement Plans In California

Each persons Medicare Supplement premium is unique to them and depends on several factors. In California, plan letter, carrier, age, and tobacco use status can all work together to determine premium price. Thus, it is not possible to receive an accurate premium quote without speaking with a licensed agent.

Below, we provide sample Medigap premium rates for male and female beneficiaries, ages 65 and 75 in a California ZIP Code. None of the sample rates are for tobacco users.

* If on Original Medicare before 01/01/2020

Medicare Supplement carriers in California use the issue age or attained age Medigap pricing method to determine monthly premium rates. As you can see above, it often behooves you to enroll in Medigap when you are younger.

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Are Birthday Rules Likely In More States

Life is not predictable and your medical needs may change over time. What you can afford may change too. You deserve the opportunity to find an affordable plan that works for you.

While Medigap is an excellent option for people on Original Medicare, some policyholders may feel that they are locked into Medigap plans with high rates. Guaranteed issue rights can help, but the situations outlined by CMS are limited to very specific situations that apply to relatively few policyholders.

These states are being proactive for your health. As more of them enact these birthday rules, more Medicare beneficiaries will have the opportunity to shop around for plans. This will increase the market competition for Medigap plans in those states and could hopefully drive down rates.

Keep an eye out for more birthday rules in the future.

Tanya Feke M.D. is a licensed, board-certified family physician. As a practicing primary care physician and an urgent care physician for nearly ten years, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization review and medical necessity compliance. She currently works as a physician advisor at R1 RCM, Inc., where she performs case reviews for hospitals nationwide.

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.

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What Medigap Plans Dont Cover

• Private-duty nursing

* Medicare Enrollment Dashboard. Centers for Medicare & Medicaid Services , November 2019. The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

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.

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What Is The Birthday Rule For Medicare

The Birthday Rule is a very important requirement to know if you have a Medigap policy or are approaching the age when you are eligible for Medicare.

Although Medicare is a federal program, in the state of California , Medigap enrollees have the benefit of a state law that allows you to change your Medicare supplement insurance with no medical underwriting, as long as this is done within 30 days before or after your birthday.

Known as the Birthday Rule, this law carries many benefits for Medicare policy holders, and is especially important to understand for those who have signed up for Medigap policies.

Below, well outline:

• What Medicare supplemental insurance is
• How the Birthday Rule impacts Medigap
• Why its important for those who have Medigap policies
• What help is available to assist you with any questions about Medigap and the Birthday Rule

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.

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Getting Help Using Your Birthday Rule

Do you have a birthday coming up, and feel like help is needed navigating the birthday rules for your state? We have experienced licensed insurance agents that specialize in Medicare who can assist.

Give us a call or fill out the online request form. We can review your options and help you determine if using your birthday rule is right for you.