Medigap Policies: California Birthday Rule Change
Want to change to a different Medigap Insurance Carrier as your pricing is starting to feel out of control?
In the state of California they have a special rule called the Birthday Rule which allows you an opportunity to buy certain Medigap plans without a health screening each year starting on your birthday for a 60 day period. This window used to be 30 days, but, thanks to the passage of SB 407 (Monning) in 2019, this Medigap “Birthday Rule” has been extended to 60 days as of January 1, 2020.
How Does the Birthday Rule Work?
If you already have a Medigap Plan G with Carrier A, you can choose a new Plan G from a different Medicare Supplement Insurance Carrier at a lower cost. Please keep in mind, in order for it to be guaranteed issue you are required to pick a plan that is the same letter plan (Plan F to Plan F) or a lower letter plan (Plan F to Plan G) that offers a lower level of coverage than your current plan.
For example, if you already have Plan G, you may switch to another Plan G, but not to a Plan F. If you wanted to increase your coverage (picking a that offered greater benefits) you would need to go through full underwriting. In this case you can switch outside of the birthday rule window.
Another change that also happened as part of this new law, Medicare Insurance Carriers that offered two types of the same Plans under the same letter plan (Plan G vs Plan G Innovate) these “Innovate Plans” are not allowed to require additional underwriting even though they are offering additional benefits under their plan. The Innovate plans offered additional plan benefits such as Vision, Dental, hearing and so on.
This means that, for example, if you have Medigap Plan F with company X and want to switch to Medigap Plan F with company Y that has also added some innovative benefits to their Plan F, you by law must be allowed to make that switch. (please note that if you buy one of those plans with extra benefits, you should see a separate line item for the cost of those extra benefits on your Medigap insurance premium bill.)
How do I take advantage of the Medicare Birthday Rule
In order to take advantage of this rule, you must already be enrolled into a Medicare Supplement plan.
The time frame to exercise the “Birthday Rule” is 30 days leading up to your birthday and 30 days following your birthday.
We recommend that you begin the process during the 30 days prior to your birthday to ensure a smooth transition. Please keep in the mind, the new Medigap policy can only take effect on your birthday or in the 30 days after your birthday.
Can I move from a Medicare Advantage plan to a Medigap plan using the Birthday Rule?
This is a common question we receive all the time. Unfortunately, the birthday rule does not apply if you are on a Medicare Advantage Plan.
If you are on a Medicare Advantage plan and you are not happy because of the Network restriction and limited access to Doctors, you would be required to go through full medical underwriting to get into a Medigap plan.
Medical underwriting can be easy or difficult to get through depending on your current health conditions you are experiencing. We highly recommend if you want to switch to Original Medicare with a Medigap plan do so while you are healthy and not wait until you get sick. We are here to help you get through the underwriting process so please give us a call and a Medigap Insurance Agent can help find a plan and insurance carrier that offers a competitive price.
Integrity Now Insurance Brokers