California Birthday Rule

California Birthday Rule

California’s Medigap Birthday Rule

If you’ve chosen to get your Medicare benefits through Original Medicare, you may have considered purchasing a Medigap, or Medicare Supplement, plan to help pay for some of the out-of-pocket costs that are not included in Part A and Part B. When you first turn 65 and have enrolled in Medicare Part B, you have the option of purchasing any Medigap policy sold in your state. In fact, you have a 6-month Medigap enrollment period that gives you a guaranteed issue right to buy any plan without medical underwriting. You can’t be charged a higher premium or turned down for a policy because of a pre-existing condition you may have.

If you purchased a policy when you were first eligible, but would like to make a change, can you switch Medigap plans? If you live in California, you have some options. Medigap’s Birthday Rule is the result of a California law that allows Medigap enrollees to change to another plan without a health screening, but there are certain restrictions.

What is Medigap’s Birthday Rule?

If you live in California, you will have a chance to switch to another Medigap policy starting on your birthday. As of January 1, 2020, the Medigap Birthday Rule will allow you to make a change during the 60 days following your birthday each year. You can’t be charged more or turned down for coverage because of pre-existing medical conditions during this 60-day period, but there are restrictions on which plans you can choose. You are only allowed to switch to a lettered plan with the same or fewer benefits as you already have. For instance, if you are currently enrolled in Plan G, you can switch to another Plan G, or choose a plan with fewer benefits, such as Plan A.

Why make a change? Another company might offer additional benefits for the same lettered plan you already have. Compare Medigap policies before making any changes to explore the options available and find the coverage that is right for you.