If you already have a Medicare Supplement (Medigap) plan in California, your birthday may give you an opportunity to shop for a lower premium without having to go through medical underwriting.
The California Medicare Supplement Birthday Rule provides qualifying Medicare Supplement policyholders an annual open enrollment period lasting 60 days or more, beginning on their birthday. During this period, you can apply for another Medicare Supplement policy that offers equal or lesser benefits than your current coverage without being denied or charged differently because of your health.
This can be especially valuable if the premium on your current Medicare Supplement plan has increased.
What Is the California Medicare Supplement Birthday Rule?
Normally, after your initial Medicare Supplement Open Enrollment Period has ended, an insurance company may be allowed to ask health questions and use medical underwriting when you apply for a new Medicare Supplement policy.
California provides an important additional protection.
If you already have qualifying Medicare Supplement coverage, the Birthday Rule gives you an opportunity each year to compare other Medicare Supplement policies around your birthday without your health becoming the determining factor in whether you can change coverage. This means someone who has developed health problems since originally purchasing a Medicare Supplement plan may still have an opportunity to change companies.
How Long Is the California Birthday Rule?
California law provides an annual Medicare Supplement open enrollment period lasting 60 days or more commencing with your birthday. This is important because you may still see older information online referring to a 30-day California Birthday Rule.
California expanded the Birthday Rule window, so the current period is at least 60 days beginning on your birthday.
I recommend starting the comparison process before your birthday so you have plenty of time to review rates and understand your options.
Do I Have to Answer Health Questions During the Birthday Rule?
The purpose of the California Birthday Rule is to allow qualifying Medicare Supplement policyholders to change coverage without their health status preventing the change. During the applicable Birthday Rule open enrollment period, an insurer cannot deny or condition the issuance of qualifying Medicare Supplement coverage or discriminate in pricing because of your:
Health status
Claims history
Receipt of healthcare
Medical condition
You must already be covered under another qualifying Medicare Supplement policy or contract when using this protection.
Can I Change Medicare Supplement Insurance Companies?
Yes! In fact, this is one of the biggest reasons the California Birthday Rule can be so valuable. Medicare Supplement plans are standardized, which means the core benefits of a particular lettered plan are generally the same regardless of which insurance company sells the policy.
For example, the standardized medical benefits of Plan G from Company A are the same as the standardized Plan G benefits from Company B.
The premiums, however, can be different.
That means someone paying a high premium for Plan G may be able to use the Birthday Rule to move to another company’s Plan G at a lower premium while maintaining the same standardized Medigap benefits.
Can I Go From Plan G to Another Plan G?
Yes, assuming you otherwise qualify for California’s Birthday Rule. Moving from Plan G to Plan G is one of the most straightforward examples because the new policy provides the same standardized benefits. This can make the Birthday Rule particularly useful for someone who likes Plan G but is unhappy with a premium increase from their current insurance company.
You aren’t necessarily changing your Medicare coverage strategy. You may simply be shopping the same standardized plan with another insurance company.
Can I Switch From Plan G to Plan N?
Potentially, yes. California’s Birthday Rule permits a qualifying person to purchase Medicare Supplement coverage that offers equal or lesser benefits than the previous coverage.
Plan N has less coverage than Plan G in certain areas, including office and emergency room copays and Medicare Part B excess charges. For someone currently enrolled in Plan G, Plan N may therefore be an option to consider during the Birthday Rule period. Whether switching makes financial sense is a separate question.
Plan N may have a lower premium, but you should understand the additional potential out-of-pocket costs before making the change.
If you’re considering this option, you can also read my Medicare Plan G vs. Plan N in California comparison for a more detailed explanation of the differences.
Can I Switch From Plan N to Plan G Using the Birthday Rule?
This is where the equal-or-lesser-benefits rule becomes important. The Birthday Rule should not be interpreted as an annual opportunity to move into any Medicare Supplement plan you want. Because Plan G provides benefits that Plan N does not, moving from Plan N to Plan G generally represents an increase in benefits.
Therefore, you should not assume that the California Birthday Rule gives you guaranteed acceptance from Plan N into Plan G.
Depending on the circumstances, an application for increased benefits may be subject to the insurance company’s normal underwriting requirements unless you have another guaranteed-issue right. This is one reason it’s important to understand both your current plan and the plan you’re considering before submitting an application.
Does the California Birthday Rule Apply to Medicare Advantage?
No. The California Medicare Supplement Birthday Rule applies to Medicare Supplement (Medigap) coverage.
It is not an annual opportunity to switch from Medicare Advantage to a Medicare Supplement plan without underwriting. Medicare Advantage has its own enrollment and disenrollment periods, and moving from Medicare Advantage to Medigap can involve different eligibility and guaranteed-issue rules.
If you’re currently enrolled in Medicare Advantage and are considering Original Medicare with a Medicare Supplement, it’s important to review your specific circumstances before making any changes.
Does the Birthday Rule Change My Medicare Part D Plan?
No. Your Medicare Supplement and Medicare Part D prescription drug plan are separate policies. Using the California Birthday Rule to change Medicare Supplement companies does not automatically change your Part D prescription drug coverage.
Part D plans should generally be reviewed separately during the appropriate Medicare enrollment period because premiums, formularies, drug costs and pharmacy networks can change from year to year.
Why Would Someone Use the California Birthday Rule?
The most common reason is simple: Their Medicare Supplement premium has gone up.
Someone may be completely satisfied with their Medicare Supplement benefits but unhappy with what they’re paying. Instead of simply accepting the increase, the Birthday Rule creates an annual opportunity to see whether another insurance company offers qualifying coverage at a more attractive rate.
Other reasons someone might compare plans include:
Multiple premium increases over time
Losing a household discount
Wanting to change insurance companies
Comparing Plan G with Plan N
Wanting to reduce monthly Medicare Supplement expenses
A Real-World Example
I’ve seen the California Birthday Rule make a substantial difference for clients. In one case, I helped someone who was paying considerably more than necessary for their Medicare Supplement Plan F. We compared other Plan F options available to them and were able to move them to another insurance company while keeping the same standardized Plan F benefits.
The difference was approximately $110 per month.
That’s more than $1,300 per year in premium savings.
Obviously, everyone’s situation and available rates are different, and savings aren’t guaranteed. But it’s a good example of why I think Medicare Supplement policyholders should review their rates periodically rather than automatically accepting every premium increase.
Another Simple Example
Suppose you’re paying:
Plan G with your current company: $225 per month Another insurance company offers qualifying Plan G coverage at:
$180 per month
That’s a difference of:
$45 per month
or:
$540 per year
Because both are standardized Plan G policies, the core Medicare Supplement benefits are the same. That doesn’t automatically mean the $180 policy is the right choice. I also like to consider the insurance company, available discounts, pricing and other relevant factors.
But a $540 annual difference is certainly worth looking at.
Are All Plan G Policies the Same?
The standardized Medicare Supplement benefits of Plan G are the same regardless of the insurance company offering the policy. However, the companies themselves aren’t identical.
They can differ in areas such as:
Monthly premium
Household discounts
Historical rate increases
Customer service
Financial strength
Enrollment experience
Additional non-Medigap services or perks
This is why I don’t recommend choosing a Medicare Supplement company based solely on the lowest premium. Price is important, but it isn’t the only consideration.
When Should I Start Comparing Medicare Supplement Rates?
I recommend contacting me before your birthday. Even though the Birthday Rule period begins with your birthday, starting early gives us time to:
Review your current Medicare Supplement plan.
Confirm your current premium.
Compare rates from other insurance companies.
Determine which plans may qualify under the Birthday Rule.
Discuss whether changing companies actually makes sense.
If your current rate is already competitive, staying exactly where you are may be the best decision. The goal isn’t to switch every year. The goal is to check every year.
Do I Have to Change Medicare Supplement Plans Every Birthday?
Absolutely not. The Birthday Rule gives you an opportunity, not an obligation. If you like your insurance company and your premium remains competitive, there may be no reason to change anything.
I don’t believe in switching someone’s coverage just for the sake of switching. Instead, I use the Birthday Rule as an annual opportunity to ask:
“Is what I’m paying still competitive for the coverage I have?” If the answer is yes, great. If the answer is no, then we can look at alternatives.
Frequently Asked Questions
What is the California Medicare Supplement Birthday Rule?
The California Birthday Rule gives qualifying people who already have Medicare Supplement coverage an annual open enrollment period beginning on their birthday to purchase another Medicare Supplement policy with equal or lesser benefits without health-based underwriting affecting their eligibility or pricing.
How many days do I have under the California Birthday Rule?
California law provides an annual open enrollment period lasting 60 days or more commencing with your birthday.
Can an insurance company deny me because of my health?
For a qualifying application made under the Birthday Rule, the insurer cannot deny or condition issuance or discriminate in pricing because of health status, claims experience, receipt of healthcare or medical condition.
Can I keep the same Medicare Supplement plan but change companies?
Yes. This is a common use of the Birthday Rule. For example, someone with Plan G may compare Plan G rates from other insurance companies.
Can I change from Plan G to Plan N?
Potentially. Because the Birthday Rule permits equal or lesser benefits, moving from Plan G to Plan N may be an available option for someone who otherwise qualifies.
Can I change from Plan N to Plan G without underwriting?
Don’t assume so. Plan G provides benefits beyond Plan N, so this generally would not fit the equal-or-lesser-benefits limitation of the Birthday Rule. Other guaranteed-issue rights could apply depending on the situation.
Does my birthday let me leave Medicare Advantage and get Plan G without underwriting?
No. The California Medicare Supplement Birthday Rule should not be confused with Medicare Advantage enrollment rules. Different guaranteed-issue protections may apply in certain circumstances, but simply having a birthday does not create an unrestricted right to move from Medicare Advantage into Medigap.
Want Me to Check Your Medicare Supplement Rate?
If you already have a Medicare Supplement plan in California and your birthday is approaching, I’d be happy to compare your current premium with other options. I’m Steve Korts, an independent Medicare broker serving San Diego County and North County San Diego.
I work with multiple Medicare Supplement insurance companies, which allows me to compare rates rather than representing only one company. If your current coverage and premium are already a good fit, I’ll tell you.
If there’s an opportunity to potentially lower your premium while maintaining qualifying Medicare Supplement coverage, we can review that together. Contact me before your birthday for a Medicare Supplement rate review.
There is no additional cost to you for my services when enrolling in a Medicare plan I represent.
This information is intended for educational purposes and is not a complete description of California Medicare Supplement laws or insurance policy terms. Eligibility, guaranteed-issue rights and available plans depend on your individual circumstances. Medicare Supplement rules can change. Contact the California Department of Insurance, the insurance company, Medicare, or a licensed insurance agent for additional information.