Ultimate Guide to the California Medicare Supplement Birthday Rule Guarantee 

What is the California Medicare Supplement Birthday Rule also called the California Medicare Supplement Birthday Open Enrollment?

This rule allows a Medicare beneficiary with Parts A and B of Medicare that also has a current Medicare Supplement to replace that Medicare Supplement with equal or lesser benefits guaranteed.  

Why is this important?  

All Medicare Supplements get rate increases and generally, they happen every year.  This allows you to shop for a lower rate with a different carrier and your acceptance is guaranteed.  You are also guaranteed to get the best available rate regardless of your health. The purpose of this law is to allow protections for someone with a Medicare Supplement to shop all of the available companies to look for a lower premium.

When does my California Birthday Rule Open Enrollment start and end?

The California Birthday Rule Open Enrollment starts on your birthday and lasts for 60 days beyond your birthday.  

Is this available in all states?

What makes this unique is the insurance companies are not allowed to ask you any medical underwriting questions.  This law is only available in California and Oregon, however, Missouri also has a similar rule but is based on when the anniversary date of the policy.   In other states that don’t have this rule, when you want to change your Medicare Supplement you have to be medically underwritten. Meaning the insurance company can ask you a series of health questions to see if you qualify for their company.  If you don’t qualify, they have the right to deny you coverage, or if you do qualify and have certain health conditions, they have the right to charge you more premium every month. What happens in other states, if you have certain medical conditions, the likelihood of a different Medicare Supplement company accepting you is very limited.  This means you are stuck with Medicare Supplement you have and you have to accept whatever rate increases they impose on their members.

I thought I could only change during the Annual Enrollment Period (AEP) from October 15 to December 7?

It is a common misconception that you can only change your Medicare Supplement during the Annual Enrollment Period (AEP) from October 15th to December 7th.  You can change your Medicare Supplement anytime during the year you want. However, you will likely have to answer a series of health underwriting questions to qualify.  California and Oregon are the only states that will allow you to change your Medicare Supplement guaranteed around your birthday. It is also misunderstood that you can change your Medicare Supplement during the Annual Enrollment Period (AEP) guaranteed issue, meaning the insurance company you apply to must accept you no matter what your health conditions are.  This annual enrollment period from October 15 to December 7 has nothing to do what-so-ever with Medicare Supplements. The enrollment period is only in regards to Medicare Advantage Part C or stand-alone prescription drug plans also known as Part D of Medicare.  

Can the insurance companies deny me coverage or raise my premiums?

Here in California with the Medicare Supplement Birthday Rule, the insurance companies are not allowed to deny you coverage or raise the premium if you have unfavorable health when you apply to their company during this birthday rule open enrollment time.  Remember this open enrollment time applies to people that already have a Medicare Supplement. I have people who ask if they can enroll in a Medicare Supplement guaranteed issue during a time around their birthday if they don’t already a Medicare Supplement.  Unless you are turning 65, losing your group health insurance coverage or under a few other instances the answer is, “no.” If you don’t have a Medicare Supplement and would like to get one and you are outside of an open enrollment like turning 65 or you have lost group coverage, or your Medicare Part B is newly effective then you must answer health underwriting questions to qualify and all the companies have different questions.

The Medicare Supplement Birthday Rule is important here in California because you know once a year around your birthday, you have the right to change your Medicare Supplement and look for a less expensive rate.  You know during this time the insurance companies cannot ask you any health question as a condition of qualification. There is nothing the insurance companies can do to deny you and must offer you their lowest rate.  We have switched people that are currently battling cancer, just had a stroke or heart attack and have helped a few people that were in the hospital lower their Medicare Supplement premium guaranteed and they were given the same rate as the person that is healthy as a horse.  They must accept you.

What about preexisting conditions?

The new company you choose must also cover any preexisting conditions.  

Will my current doctors, hospitals, and other providers accept my new Medicare Supplement?

Just like the Medicare Supplement you have now there are no networks.  The rules for acceptance are exactly the same as every Medicare Supplement company. 

California Medicare Supplement Birthday Rule Law:

https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=10192.11.

An individual shall be entitled to an annual open enrollment period lasting 60 days or more, commencing with the individual’s birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage. During this open enrollment period, an issuer that falls under this paragraph shall not deny or condition the issuance or effectiveness of Medicare supplement coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract. An issuer shall notify a policyholder of their rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period, and on any notice related to a benefit modification or premium adjustment. 

This is your once per year pass to shop all of the carrier’s rates to make sure you are getting the best possible rate.

Will the Medicare Supplement I switch to be different than I have now?

We know the medical benefits from Medicare Supplements are standardized.  Meaning the letter plan that you have now like Plan F, G, and N, but it doesn’t matter what letter plan you have.  If you have a Plan F with one carrier you know the medical benefits are the exact same with another carrier. The only difference is the price you pay and if the company offers any value-added benefits, sometimes being called innovative benefits.  These innovative benefits can include benefits like gym memberships, vision insurance, hearing insurance, over the counter pharmacy benefits and more. For more info about California carriers offering innovative or value-added benefits please see the description below this video for a link to my video about this subject.  The same goes for Plan G, Plan N or whatever plan letter Medicare Supplement you have. In addition, carriers that are offering these innovative benefits must offer them as part of the California Birthday Rule as well. So by using the California Birthday Rule, you can qualify for a Medicare Supplement that has even more benefits than you currently have now and may do so guaranteed.        

How do I find out what rates are the best for me?

Rates are different for different plans and different companies and different areas of California.  To get a free price quote from all of the companies and plans simply fill out the form provided on this page. This is my website so you know it is secure and any information you enter will only come to me and will not be shared with any other parties.   We will provide you with a comparison on your current Medicare Supplement, and see if we can save you hundreds of dollars a year for the exact same coverage you have now and maybe add some benefits as well.