The California Birthday Rule for Medigap

By Nancy DellaVecchia
eMedicareSupplements Contributor

Although Medicare is a federal program, some states have regulations regarding its administration. California has a unique supplement law known as the birthday rule that allows residents to enroll for Medicare supplements with a different insurance company for 30 days following their birthday. The new Medigap plan must offer either the same benefits or fewer benefits, and companies are not allowed to deny new applicants for health reasons.

No Impact On Medicare Benefits

The law only applies to Medigap supplemental insurance, not to Medicare, which has an annual election period from November 15 to Decemeber 31 and a general enrollment period from January 1 to March 31. Since Medigap insurance involves private insurance companies, it is hoped that the law will stimulate competition and lower premium rates on Medigap policies.

The birthday rule allows seniors to take advantage of lower prices on the same Medigap insurance coverage. Medigap offers a number of standardized policies, but the prices on these policies vary from company to company and state to state. The purpose of Medigap insurance is to cover all or most of the costs not covered by Medicare, including co-payments and deductibles.

Open Enrollment

The best time to purchase Medigap insurance is during the open enrollment period, which occurs during the first six months of being enrolled in Medicare Part B or the first six months after leaving the group plan offered by an employer. At this time, seniors are guaranteed access to Medicare supplements under guaranteed issue rights.

Seniors who choose a Medicare Advantage Plan may not be eligible for Medigap insurance later, and Medicare Advantage Plans are not included in the birthday law.

Changing Medigap Policies

Seniors may choose to change Medigap policies at any time, but they may have to undergo a physical examination. They may also have to answer health questions on the insurance application, and their application may be denied if they have pre-existing health conditions like diabetes, Parkinson's disease, Alzheimer's disease or other conditions.

Under California law, seniors who wish to change policies cannot be denied Medigap insurance in the 30 days following their birthdays.

Saving Money

In order to take full advantage of California's birthday rule, seniors should begin checking the costs of Medicare supplement insurance policies before their birthdays. If they wish to switch to a new policy, the policy must be the same as the policy the senior has or offer fewer benefits.

Comparing quotes from different Medicare supplement insurers can result in monthly savings on health insurance premiums. Contact one of our trained specialists today if you are interested in taking advantage of the California birthday rule and saving money on your Medicare supplement premiums.