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How Does California’s Medigap Birthday Rule Work?

How Does California’s Medigap Birthday Rule Work?
California’s Medicare Supplement Insurance law, also known as the "Medigap Birthday Rule", allows members of Medigap plans to switch to a different Medigap insurance plan or carrier during the 30 days following their birthday without going through medical underwriting or meaning they cannot be turned down or charged a higher premium due to pre-existing conditions.

Why Is The Medigap Birthday Rule Important?

Imagine you lived in a state without the Birthday rule, and your Medigap premium drastically increased. Your options would be to either pay the new, higher premium, or apply for a new plan, but realize you could be declined for a pre-existing condition. However, in California, you would have the opportunity to switch to a different plan or carrier within 30 days of your birthday. Plus, there is no underwriting and are guaranteed to be approved.

Birthday Rule Requirements

There are a few requirements in order to take advantage of the Medigap Birthday Rule. You must:

  • Reside in California.
  • Have an active Medigap plan.
  • Be within 30 day window following your birthday.
  • Switch to a plan with the same or lesser benefits as your old plan.

What You Can't Do

The Medigap Birthday Rule does not apply to people who have Medicare Advantage plans (MA) or stand-alone Prescription Drug plans (PDP) and want to switch to a different MA or PDP plan. The rule also does not apply to people looking to switch from an MA plan to Medigap Plan. The Birthday rule only applies to current Medgiap policy holders looking to switch to a different Medigap policy.

Know Your Plan (The 5 P's For Insurance)

Prior Planning Promotes Predictability & Protection

Remember, Medigap plans are regulated by the government. The plans benefits are not different from carrier to carrier, but the premium may be. So California residents should always compare Medigap plan prices as their birthday approaches. To learn more about Medigap Plans, look at our Medigap Plan Comparison Chart.