In California, the “Birthday Rule” is a regulation that allows Medicare beneficiaries to change their Medicare Supplement (Medigap) plans on or around their birthday each year. Typically from their birthday and moving forward 60 days. This rule provides an opportunity for individuals to switch to a different Medigap plan with equal or lesser coverage without undergoing medical underwriting.
Here are the key points to understand about California’s Birthday Rule:
- The Birthday Rule applies to individuals who currently have a Medigap plan and want to switch to another Medigap plan with the same or lesser coverage. Also with the same or different company.
- The rule allows beneficiaries to make a one-time change to a new Medigap plan during the 60-day period that begins on their birthday. This means that you have a 60-day window starting from your birthday to apply for a new Medigap plan.
- The new Medigap plan you select must have the same or lesser coverage than your current plan. For example, if you have a Plan F, you can switch to any other Plan F or choose a plan with lesser coverage like Plan G or Plan N.
- During the Birthday Rule period, insurance companies must accept your application for the new Medigap plan regardless of any pre-existing conditions. They cannot deny you coverage or charge you higher premiums based on your health status.
- You must continue paying the premiums for both your old and new Medigap plans until your old plan is terminated. Typically there is no overlapping or gap in coverage.
- The Birthday Rule does not apply if you are switching from a Medigap plan to a Medicare Advantage plan or if you want to add a Medigap plan for the first time. It only applies to switching between Medigap plans.
Remember that the specific details and requirements of the Birthday Rule may change over time, so feel free to call or email anytime with questions.