What is California’s Medigap Birthday Rule?

California residents with active Medicare Supplement plans, also known as Medigap plans, have the unique opportunity to switch between certain plans annually without the need for medical underwriting. This opportunity is called the California Medigap Birthday Rule and when used, it ensures the policyholders will be accepted.

Because there is no open enrollment period each year, Medigap policyholders can switch between plans at any time. But, if you switch plans without using the California Medigap Birthday Rule you will be required to go through the medical underwriting procedure which can decline your application for a pre-existing medical condition. If you are past your Medigap open enrollment period when you first turned 65 and were enrolled in Part B, you can be turned down or charged more for a Medigap policy.

The California Medigap Birthday Rule
While the birthday rule has been in effect in California for several years, CA Senate Bill 407 expanded the annual switching time frame between Medigap plans from 30 to 60 days after a recipient’s birthday. The only restriction when using the birthday rule is that the switch must be to a plan with equal or lesser benefits. The new rule became effective on July 1, 2020.

How to Use the California Medigap Birthday Rule
To successfully switch between plans when using the California Medigap Birthday Rule, you must:
• Be a California resident
• Be a participant with an active Medigap insurance plan
• Submit an application within the 60-day grace period from your birthday with proof of having an active Medigap plan
• Ensure that you are switching to a Medigap insurance plan with equal or lesser benefits

What does Equal or Lesser Mean
California has 10 different lettered Medicare Supplement Plans: A, B, C, D, F, G, K, L, M, and N. While each lettered plan has a combination of different benefits, all plans must cover 4 basic benefits with the additional 5 benefits offered under other plans. Plan F is the only plan that includes all 9 benefits.

Keep in mind, Plan C and Plan F are no longer offered to new enrollees as of January 1, 2020. If you were already enrolled in one of these discontinued plans at that time, you were able to keep your coverage. Unfortunately, you may not be able to switch between these plans during your California Medigap Birthday Rule enrollment period. It will be based on plans available in your state, so it’s important to take the time to research and compare policies available.

You can check with your insurance provider to compare the benefits offered with each Medigap plan, and to determine which plan is right for you. When you apply the Birthday Rule to switch between equal or lesser plans, you will be accepted into the approved plan and not have to worry about being disqualified due to pre-existing health conditions.

Who Qualifies for California Medigap Birthday Rule
The birthday rule is valid for seniors aged 65 and older who currently have an active Medigap plan. While each state has its own rules for offering Medigap plans to individuals under the age of 65, the supplemental insurance may be available for individuals with end-stage renal disease and for those under the age of 65 who are disabled.

Major Benefit of the California Medigap Birthday Rule
When you have an active Medigap plan that does not meet your health needs, using the California Medigap Birthday Rule gives you the opportunity to switch to a plan with equal or lesser benefits without going through the medical underwriting process. This is especially beneficial if your health situation has changed and you now have a pre-existing condition that could result in you being disqualified for a plan. Watch the calendar and let your birthday be the time when you give yourself the gift of a plan switch without the possibility of being turned down or charged more for coverage.