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How Does the California Birthday Rule Work?

California Medicare PlansHow Does the California Birthday Rule Work?

Some say that in California we just like to do things differently, I say Better. California has a unique provision known as the California birthday rule that allows folks who currently have a California Medicare Supplement, also referred to as Medigap,  to enroll with a different insurance company for 30 days following their birthday.  This open enrollment period was specific to CA residents but Oregon just adopted this rule and it goes into effect January 1st.

How does it work exactly?

  • To take advantage of this provision you need to already have a Medicare Supplement in place.
  • This is basically a 30 day time period starting with your birthday. You are allowed to apply up to 30 days before your birthday and only 30 days after your birthday. The new supplement will need to take effect on your birthday or within the 30 days immediately following your birthday.
  • This provision does not change the fact that if you apply for a different supplement outside of your “birthday rule”  enrollment window, you would still need to go through underwriting to qualify medically. With the “birthday rule”  you do not need to go through medical underwriting since you are considered “guarantee issue”.
  • You can switch to another plan that has either equal or less coverage. So if you have Plan F you can switch to any plan with any company. If you have one of the plans with less coverage, you would have to stay with that plan or one with less coverage. Sometimes the savings can make it well worth switching to a new insurer.
  • Once you’ve made the switch there are a few insurers who will let you “move up” in coverage without medical underwriting and that’s something we help folks with everyday. Kind of neat way to get Plan F after all!

If this explanation of the California Birthday rule was a little confusing or if you just want help reviewing your options, please feel free  to call us at 1-888-806-3299. We are happy to help.

By  Dave Wilson

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