How does California’s Medigap Birthday Rule work?

California allows Medicare Supplemental plan members to switch on their birthday

by Ray Wilson+ on Jan 02, 2018 | 36 Comments

California’s Medicare Supplemental Insurance law (AKA “Birthday Rule”) allows Medigap members to switch to a different insurance plan or provider during the 30 days following the member’s birthday. Members who take advantage of this new switching law cannot be turned down for the new plan because of a pre-existing condition.

This article was updated on Jan 2, 2018 to reflect new information

To take advantage of this rule, you must:

1) Live in California
2) Have an active Medigap plan
3) Switch to a Medigap plan with same or lesser benefits
4) Be within 30 days of your birthday

Why is the Birthday Rule Important

In states without the Birthday rule, if your Medigap price dramatically increases you would either have to pay the new higher price or apply for a new plan and could be turned down for pre-existing conditions. In California, however, you can switch to a competitor within 30 days of your birthday and you are guaranteed to be approved. This protects you and gives you options.

CA residents should always check out Medigap prices as their birthday approaches. The best way to get a quote is to click on the Medigap Quote button below. If you find the same plan for less with a different provider or just want to get on a less expensive plan, we can help you switch. For questions, call the number at the top of the page. To learn more, visit our medigap overview page

Anthem Blue Cross new Innovative F states that you can switch from it to traditional F (or G, N etc) during your birthday month but you cannot move from a traditional F to innovative F without health review.

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Reader Comments and Questions

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By Jim on June 10, 2019

I have plan G in California. I have paid the part B deductible for 2019. If I change carriers exercising the birthday rule in 2019, moving directly from plan G to another plan G, do I have to pay the part B deductible for 2019 again with my new carrier? My current carrier no longer supports Silver Sneakers, where an alternative carrier does.

Jim,
Once you pay your Part B deductible for the year, you don't have to pay for it again even if you switched Medigap plans. We are Birthday Rule Specialists!!! Please give us a call. We can help you switch to your new plan that includes Silver Sneakers right over the phone.
-Eric from Senior65.com


By Linda on March 11, 2019

From what I've read, under the California birthday rule, for 2019, you can (without undergoing underwriting - ie with guaranteed issue/acceptance) do the following:

Have plan F with insurance company X and switch to plan F with insurance company Y. (ie shop premiums among companies for the same plan). Could you please verify this? (EDITORS NOTE: Yes! you can switch companies to equal or lessor plans during the CA birthday rule. ) But, from what I've read, starting in 2020 there is a difference of opinion - leading to confusion - about the above.
Some say there will be no change. This will be still be available. Others say this will no longer be possible. In other words, you will no longer be able to shop premiums among insurance companies for plan F. To keep an F you would have to stay with the insurance company you have on 12/31/19. And, should premiums for F start to really go up, the only recourse to control premiums would be to switch to a G (or other) either with that company or another company. Could you clear this up and find out what the real rules will be for 2020 and later?

Hello Linda,
We know there is a lot of confusion about 2020. This is why we wrote this article that explains what is happening to plan F after 2020. This is our best understanding of the new rules. If you are already a Medicare beneficiary before 2020, you should be able to switch from Plan F to Plan F between companies using the California Birthday Rule going forward. Only "newly eligible" beneficiaries will not be able to enroll in Plan F, High F and C after 2020.

If premiums should go up, you should have the opportunity to switch to another plan during the birthday rule.

We would love to help you enroll or switch plans so please give us a call.
-Michelle from Senior65.com


By Lyn on March 07, 2019

As I understand it Anthem Blue Cross' new Innovative F allows you switch from it to traditional F (or G, N etc) during your birthday month but you cannot move from a traditional F to innovative F without health review. If I sign up for Innovative F in 2019 (as a new medicare enrollee), can I switch to plan F during or after 2020 using the California Birthday Rule? It's unclear whether I can make this downgrade after 2020. Thanks

Hello Lyn,
Using the CA Birthday Rule you should be able to switch from Innovative F to Plan F even after 2020.

If you are not already working with us, we would love to help you enroll and/or switch if you decide to. Give us a call!

-Michelle from Senior65.com


By John on February 24, 2019

I've been considering changing to a G plan from my F plan anyway, premiums increasing by $160 this coming year. I'm 67 and my birthday is in March. I was reading about the changes next year and I was afraid that I'd be stuck in my F plan or if I changed plans now that my premiums would sky rocket because of my preexisting conditions. This CA birthday rule period is a godsend. The day after my birthday, I'll be ready to make the switch to a G plan. With the F plan's dwindling pool of participants and continual aging of F planners; isn't it important for anyone who can, especially those people with preexisting conditions, to get out of their F plans now or face substantial premium rate hikes for the remainder of their F plan coverage.

Hello John,
You explained the situation very well. While we don't know exactly what will happen to prices in the future, your logic for switching to G makes sense. We agree the birthday rule is great! We wish it was available for switching Medigap in every state.

When you are ready to switch to G, please give us a call as we would love to help you at no additional cost.

-Michelle from Senior65.com


By Scott on February 16, 2019

I am a resident of California will be 67 in December 2019. I now have a United Healthcare Medicare Advantage (MA) Plan. I wish to get a Medicare Supplement Plan - without going through underwriting. An Anthem phone operator told me very confidently tonight that if I apply for the Anthem Supplement Plan N, I would not have to go through underwriting. Then following California's Birthday Rule, I would be able in December 2019 to enroll in, say, Plan F or whatever Anthem Supplement Plan I wished. Can that be correct?

Scott,
That advice does not match our understanding of how Medigap enrollment or the CA birthday rule works.
A) Insurance companies do not typically guarantee approval for just plan N. The provider you mentioned confirmed that one would have to go through underwriting to be approved on plan N.

B) Once on Plan N you could NOT switch to a plan F using the Birthday rule. With the birthday rule, you have to switch to a plan that is of equal or lessor benefits. F is not considered less than N so you couldn't use that rule (there are some insurance companies that will allow you to upgrade during certain promotions but that is not part of the birthday rule-call to learn details on this).

If you goal is to move from MA to Medicare Supplement Plan without going through underwriting, the two best ways would be:
1) Apply for Medigap during your first year of MA using the trail right option.
2) See if you qualify for special enrollment such as moving out of your service area.

Please don't hesitate to give us a call to discuss your specific case. And why not call us? We never charge a fee and our customers are guaranteed to pay the lowest rate allowed by law...and frankly we are very good at what we do.

-Chris from Senior65.com


By Donna on February 14, 2019

I know in CA you can change a medigap plan to another plan in your birthday month, but I am receiving conflicting information as to whether I can keep my same plan F but switch to a company with lower rates. Can I keep Plan F but change companies? If I can keep plan F and change companies, will I still be able to do that after plan F is closed to new enrollees in 2020 and beyond?

Donna,
You can definitely keep Plan F but change insurance companies. We have helped many of our clients do exactly that. If you would like help with this process, just give us a call. We can handle it right over the phone.

The way we have interpreted the new law, current Plan F member should still be able to use the Birthday rule to switch to another Plan F even after 2020.

Hope that helps and give us a call if you want to switch to a lower priced F.
-Michelle from Senior65.com


By Craig on February 06, 2019

Does the CA birthday rule also apply to Medicare RX plans?

Craig,
The birthday rule only applies to Medicare Supplement (AKA Medigap) plans.

You can switch your RX during Medicares AEP open enrollment
-Eric from Senior65.com


By Anne on February 06, 2019

I just switched my h;usband's Medigap policy to a company with a lower premium using the CA Birthday Rule. If I also applied now rather than waiting until my birthday month at the end of the year and for any reason was denied or the terms were higher, can I reapply for automatic acceptance at the end of the year?. Even at the issuing company's lower normal rate (if for any reason they levied a higher premium in the middle of the year)? I have no medical conditions and my only meds are HRT so I'm not overly concerned but I'd like some reassurance before attempting this change.

Hello Anne,
You should have no problem using the Birthday Rule at the end of the year even if you get turned down before. If you do get turn down, your monthly premium will be based on the prices set at the time of your new application.

We have helped 100's of clients switch plans using the birthday rule at no additional cost. Please consider working with us should you want to reapply during your birthday month.

-Chris from Senior65.com


By stan on July 14, 2018

my birth date was 4/4/53 in march - my paperwork was cleared with auto pay yet the insurance company has canceled me for lack of payment. The agent I used keeps telling me he will straighten it out but it seams to get worse. Can I sign up with someone new?

Stan,
You have 6 months from your part B effective date to enroll in a Medigap plan without health review. This means you can also sign up with someone new (like us!) during this time and they have to accept your coverage.

If you fall outside this 6 month innital enrollment window, you can still reinroll but you may have to fill out health questions before approval.

Give us a call and we would be glad to help you. There is never a fee to work with us and we guaranteed the lowest prices allowed by law.
-Eric from Senior65.com


By Dan on June 24, 2018

My mother is 85 and is in very good health for her age. She lives alone without any help or care, but has very mild Parkinson’s. She currently has a Medicare Advantage Plan (MA) with BCBS, parts A and B. She wants to switch back to basic Medicare and add a Medicare Supplement and stand-alone Medicare Part D (Rx) Plan. This way she can see any doctor that accepts Medicare without a referral and the supplement insrance would pay claims after Medicare pays them. Can she make this change during the “birthday rule” period?

Dan,
She can switch from MA to a Medigap plan but the birthday rule would not apply. The birthday rule is designed from switching from one Medigap plan to another.
She could only switch during certain times of the year. The best time to do this is during the initial enrollment period of Oct 15-Dec 7. She would have to submit a Medigap application and answer some health related questions before approval.

We have helped many clients switch from Medicare Advantage to Medigap so please give us a call to discuss your options.
Best,
-Chris from Senior65.com


By Tony Lauria on June 04, 2018

Does the birthday rule/law apply to all supplemental medicare plans in CA? Meaning, it covers plans from any company; AARP United, Blue Cross, State Farm, etc.

Tony,
Yes. All CA plans fall under the birthday rule. Please give us a call if you would like help switching. There is no charge for our services.
-Eric from Senior65.com


By Peter on April 17, 2018

My wife started on Medicare 2 years ago and selected Plan F with Anthem Blue Cross in California. It is within 30 days of her birthday and she would like to use the “birthday rule” to switch to Plan G. We called Blue Cross but they say she cannot switch from Plan F to Plan G. Are they correct?

Peter,
Based on the information you shared this is NOT correct. Please contact us and we can help you switch your wife's plan from F to G. There is no charge or hidden fee to work with our Senior65.com team.
-Eric at Senior65.com


By Nancy on October 29, 2017

I am 70 y.o. and want to come off small group policy. I have had Part B for two years and do not qualify for guaranteed acceptance. Does the birthday rule apply to me or no because my current coverage is not a medigap plan?

Nancy,
The birthday rule only applies to those that currently have a Medigap plan. While you technically do not qualify for a guaranteed issued plan since you have had Part B for more than 6 months, we have been able to get most of our clients who have recently ended group coverage approved without medical review.

Please give us a call to discuss your options
-Chris from Senior65.com


By Sarah on June 10, 2017

If someone who is under 65 and on Medicare due a disability, they can switch to any supplement when they turn 65 regardless of their residence state? In other words, they get a new open enrollment period with guaranteed issue when the turn 65. Is that correct?

Sarah,
In most states, you are correct. However, in some states, like NY which has year round guaranteed issuance, they do not get a second Medigap initial enrollment period. What this means is if a person were to miss their initial enrollment period, they are still guaranteed enrollment in NY, but their preexisting conditions may have a 6 month waiting period. Other states may have other qualifications. For your specific state call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Eric from https://www.senior65.com/


By Don on May 05, 2017

I have been on a Medicare Advantage plan for at least 3 years. Can I switch to a supplemental plan if I have a pre-existing condition (prostate cancer). I've been told no but are there any workarounds? I'm in California, age 70.

Don,
Most likely you will not be able to join a Medigap plan because you have cancer. The only work arounds would be if you had creditable coverage through work, it was your first year of Medicare Advantage, or if you have another qualifying event. If you believe you have a qualifying event, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Ari8 on May 04, 2017

New to California. Does this mean I can no longer change during Medicares annual open enrollment period? Or can I change both then and in my birthday period?

Ari8,
The Annual Election Period is only for switching/joining a Medicare Advantage or Part D drug plan OR for returning to Original Medicare, it is NOT for switching/joining a Medigap plan. If you do not have a Special Enrollment Period in CA, the only time you can switch your Medigap plan without going through medical underwriting is during the birthday rule. If you need help switching your California Medigap plan call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Sam on January 25, 2017

Based on the birthday rule, the provider cannot turn down my application but can the provider charge more because of present health problem?

Sam,
Good news! Nope! As long you switch your Medigap plan during the CA Birthday Rule to equal or lesser benefits your new plan cannot charge more for a preexisting condition. If you need help finding a plan call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Fred on December 14, 2016

what other States in the country have this same Birthday rule as California?

Fred,
Great question! While there is only one other state that offers the Medigap Birthday Rule: Oregon; Missouri has the Anniversary Rule. But not to worry if you don't live in one of those states! We consider ourselves the Medigap switching experts. If you need help switching your Medigap plan please call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Judy on December 05, 2016

Can this "birthday rule" be applied every year going forward in that 30 day window around my birthday? Could I switch to the best priced plan of equal or lesser value each year going forward or is there a limitation as to how many times this rule can be applied?

Judy,
You can use the California Medigap Birthday Rule every year! If you need help finding the best deal in your area call our Senior65 team of licensed independent insurance agents at 800-930-7956.
-Eric from https://www.senior65.com/


By Nancy Mantell on December 03, 2016

I am 69 and have Medicare Parts A and B, but no supplement. If within 30 days of my birthday, can I apply for a Supplement at Guarantee issue or do I have to be underwritten?

Nancy,
Without a current Medigap policy you do not qualify for the Medigap Birthday Rule. Therefore, you will need to go through medical underwriting. Don't worry some companies are easier than others. We can help. Call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Sandra Valdez on November 05, 2016

I have been on original medicare since 2000 due to disability and have always used my medicare as a secondary insurance because my husband carried me on his plan. I no longer will be using his insurance plan and my Medicare will now be primary. Being 57 can I get plan F medigap plan in California? If I can what is the premium? Does plan F really cover anything Medicare doesn't?

Sandra,
You can apply for a Medigap plan under 65 in CA, but you can be denied, and if you're not denied you will be charged more than if you were over 65. The premium will depend on your zip code and your medical records.
-Michelle from https://www.senior65.com/


By Jean Gallagher on October 13, 2016

We live in California. My husband's birthday is October 22. I want to change him from Plan F with one company to Plan G with another company. If I apply in November, within 30 days of his birthday, can I have the effective date of the new plan be December 1st.?

Jean,
Absolutely, your husband can start on December 1, if he applies within in 30 days of his Oct 22nd birthday. If you need help switching from Plan F to Medigap Plan G during California's Birthday Rule, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By carol on October 08, 2016

my birthday is in jan.and 6 months after i started medicare in california my plan f went up. i thought it would stay one rate for a year. how can it go up after 6 months

Carol,
Each Medigap company may increase their rate at different times of the year. Some companies increase twice a year, some increase once, and on a rare occasion the price stays the same, or even is decreased. If you would like to look into a different Medigap plan, please contact one of our licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Deborah on September 29, 2016

Hello..Due to a disability, I have been on Medicare since Oct 2012. I am 53 yrs old. I will be moving to Cali soon and was wondering if there is a residency time period before being able to apply for Supplemental Medigap Ins. Thank you.

Deborah,
You can apply as soon as you get to California,as long as you have proof of residency (ie. lease, cable bill, utility bill). If you need help applying for a Medicare Supplement plan, call one of our Senior65 licensed independent agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Betti gregory on June 03, 2016

Does this rule apply to part d?

Betti,
The Medigap Birthday Rule only applies to Medigap plans. However, you can change your Part D during Medicare's Annual Election period. If you need help finding a Medigap or Part D plan, please call one of our Senior65 licensed independent agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Gabriela on April 20, 2016

does the birthday rule apply to someone who is under 65 and on medicare due to disability?

Gabriela,
The California Medigap Birthday Rule should apply to anyone in CA who is enrolled in a Medigap plan. For further help, please speak to one of our licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Roberto on April 01, 2016

Which Medigap plans can I switch to?

Roberto,
You can switch your Medigap plan to any other plan of equal or lesser benefits during your birth month. Here is a chart of Medigap plans you can switch to during the Birthday Rule For further help, call one of our licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By sharan on March 23, 2016

Not clear why I need Medigap. I am 65 and have decent financials. Also in good health. It seems to me all they are paying are the 20% doctor bills or the copay. Do they cover anything else, such x-rays and blood tests? What about mammogram and colonoscopy? If I go to the doctor four times a year only, does it make sense for me to have this insurance?

Sharan,
Medigap covers way more than just your Part B 20% coinsurance. Depending on the plan you choose, it can cover your Part A and B deductibles, copayments, and your Part A coinsurance, for such things as scheduled blood work, x-rays, colonoscopies, and mammograms. For help finding a Medigap plan, please call one of our licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By ela on January 20, 2016

BDR: If I have an Advantage Plus with KP and wish to move to Plan F... may I do that?

Ela,
While the Medigap Birthday Rule does not apply to Medicare Advantage plans, you can apply for a Medigap Plan F. You likely will need to apply during the Medicare Advantage disenrollment period (Jan 1 thru Feb 14th). Remember do NOT disenroll from your MA plan until you are approved by Medigap (you most likely period you will need to answer medical questions, and can be denied). Please contact us at 800-930-7956, and we to help you find a Medicare Supplement plan in your area that has more accessibility to Medicare beneficiaries applying after their initial enrollment.
-Chris from https://www.senior65.com/


By Michael on January 10, 2016

I live in Massachusetts where I have medicare and medicaid. I am 70 years old. I am moving to San Diego California, I would like to buy medigap insurance. Do I have to undergo underwriting? Thanks

Michael,
If you no longer qualify for Medicaid, you may have a Special Enrollment period for Medigap that would not require medical underwriting. Please call 800-930-7956 for more assistance.
-Michelle from https://www.senior65.com/


By paulette on January 10, 2016

what If I move out of California to another state, can I still use the birthday rule?

Paulette,
Unfortunately, no. You would still need to continue to live in California to use the Medigap Birthday Rule.
-Chris from https://www.senior65.com/


By Michael on December 18, 2015

Saw your answer about not being able to switch from the High Deductible Plan F plan to the traditional Plan F plan under the birthday rule. How about switching from the High Deductible Plan F to any other of the plans? Since Plan C and G are pretty close to Plan F, would those be good alternatives to the traditional Plan F or is the High Deductible the lowest plan that there is so you cannot switch to any other plan from it?

Michael,
The California Medicare Supplement Birthday Rule allows to switch to a plan of equal or lesser benefits. So, if you have Medigap High F you would only be able to switch to another High F plan from another company, but remember that your deductible may restart if it's midyear. Remember, you can apply to a traditional Plan F, you'll just need to answer medical questions.
-Jacima from https://www.senior65.com/


By Jim on October 31, 2015

California allows switching Medigap plan for 30 days after my birthday regardless of pre-existing conditions. But can they refuse to cover pre-existing conditions for 6 months?

Jim,
Great question! If you switch your CA Medigap plan during the 30 day Birthday Rule period to a plan of equal or lesser value, then you cannot be asked medical questions, nor can waiting periods be applied. Hope this helps!
-Amy from https://www.senior65.com/


By Bill on October 25, 2015

Where can I find a list of all the companies that offer Medigap policies in my zip code together with the current monthly premium charged by each company

Bill,
If you go to our Medigap quote, Please call us at 800-930-7956. Hope this helps!
-Chris from https://www.senior65.com/


By Happy on September 10, 2015

If I have a High deductible F plan can I switch to regular F during the birthday rule?

Happy,
Unfortunately, you can't switch to a traditional Medigap Plan F from Medigap High F, without answering medical questions. You can switch from one High F plan to another, though. Hope this helps.
-Chris from https://www.senior65.com/


By Robert Lishan on September 02, 2015

I'm 67 have Medicare & Medicaid. Hopefully I will be going off Medicaid by year end. Can I get a Medigap policy then?

Robert,
Thank you for your question. To answer your question, you might be able to enroll in Medigap. However, since you have a very specific situation, we suggest that you call us at 800-930-7956.
-Eric from https://www.senior65.com/



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