California Birthday Rule

Medicare in California

Not surprisingly, California is the most populous state in the United States! Between the large, well-known areas of Los Angeles, San Francisco, San Diego, and more, the amount of people who move to and live in California seems to be continuously growing. A large part of this population includes Medicare beneficiaries. Thankfully, California values Medicare beneficiaries and has put legislation in place to protect seniors who are enrolled in Medicare Supplement plans with an important state-specific rule.

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California Medicare Open Enrollment

California, like most other states in the US, grants open enrollment for Medicare Supplement plans to beneficiaries who are new to Medicare. Whether you are turning 65, or delayed your Medicare enrollment due to creditable health care coverage, when you enroll in Medicare Part B, you will be given 6 months to enroll in a Medigap plan without having to undergo medical underwriting or answer any health questions. 

medicare-open-enrollmentEssentially when your Part B date begins, which is always the first of the month, you enter a ticking time clock to enroll into a Medicare Supplement plan with no medical underwriting. This means that you cannot be denied coverage due to pre-existing conditions. Once that 6-month window ends, you will be subjected to medical underwriting, which means that an insurance carrier can deny you coverage based on your health or prescription history. For this reason, it is critical to enroll into a Medicare Supplement plan during your open enrollment window. 

Can I Change My Medigap Plan in California?

One of the most important reasons to enroll in a Medicare Supplement plan during your open enrollment window has to do with changing your plan in the future.

If you do not have a Medigap plan in California and you want to enroll in a plan past your open enrollment window, you must undergo medical underwriting. This means that the insurance carriers will assess your medical history including diagnoses, prescriptions, hospitalizations, height and weight, and other health-related factors. Then, the insurance carrier can decide whether to approve or deny you for a Medigap plan at their discretion. 

However, if you do have a Medigap plan in California, there is a rule in place that gives you the ability to change your Medicare Supplement plan once per year, without having to undergo medical underwriting. If you qualify for the California Birthday Rule, insurance carriers must accept you into their plan, regardless of your health history.

So, what is the California Birthday Rule?


California Birthday Rule

The California Birthday Rule is a Medicare Supplement rule specific to the state of California that allows Medicare beneficiaries enrolled in Medigap plans to change their plans without undergoing medical underwriting. This rule is fantastic, is it allows enrollees to be able to consistently shop plans and lower their premiums even if they have pre-existing conditions.

In order to utilize the California Birthday Rule, you must meet certain criteria:

Who Can Change?

In order to qualify for this rule, you must be currently enrolled in a Medicare Supplement plan. If you are enrolled in a Medicare Advantage plan or do not have any supplemental coverage, you will not qualify for the Birthday Rule. As long as you are enrolled in a Medigap plan A-N, you will qualify, but the plan you have will impact the moves you are able to make.

When Can I Change?

The best part about the Birthday Rule is that the name tells you exactly when you can make a move. It makes it hard to forget! In California, every year starting 30 days before your birthday and ending 30 days after your birthday, you can utilize this rule to change your plan. You are allotted a 60 day window to make the change, and the window happens every year at the same time.

What Changes Can I Make?

The Birthday Rule allows you to change your Medigap plan to one of equal or lesser coverage without any medical underwriting. To put it simply, you can change to a plan with equal benefits or a plan with lesser benefits, but you cannot change to a plan with higher benefits. If you want to increase your benefits, you would have to undergo medical underwriting. 

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