Key Takeaways
- California is a Medigap Birthday Rule state - policyholders can change plans during their birthday month
- California requires a 6-month open enrollment period for Medicare Supplement starting at age 65
- Guaranteed issue rights apply when losing other coverage or during open enrollment
- California prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
California Medicare Supplement (Medigap) Regulations
California has adopted unique protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance, including the famous "Birthday Rule."
The Birthday Rule
California is one of only a few states with a Birthday Rule for Medigap:
How It Works
- During your birthday month (the 30 days following your birthday)
- You can switch to any Medigap plan
- From any insurance company
- Without health underwriting
- Cannot be denied or charged more due to health conditions
Rules and Limitations
| Rule | Requirement |
|---|---|
| Timing | Your birth month (30-day window) |
| Plan Options | Same or lesser benefits only |
| Premium | Based on age, not health |
| Insurer | Can switch companies |
| Frequency | Once per year |
Exam Tip: The Birthday Rule is California-specific and frequently tested. Remember: same or lesser coverage, during birthday month, no health underwriting.
Example
If your birthday is March 15:
- Birthday month window: March 1-30
- Can switch from Plan F to Plan G, N, or any plan with same or lesser benefits
- Cannot switch to a plan with MORE benefits
- New premium based on attained age, not health
Open Enrollment Period
California provides a 6-month open enrollment period for Medicare Supplement:
When It Begins
The 6-month period starts:
- First day of the month you are 65 or older AND
- Enrolled in Medicare Part B
Protections During Open Enrollment
- Guaranteed issue - Must be accepted regardless of health
- No pre-existing condition exclusions
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan A through N
Guaranteed Issue Rights
Beyond open enrollment, California provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer coverage | Can purchase Medigap within 63 days |
| Leaving Medicare Advantage | Can return to Medigap within 63 days |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Losing Medicaid | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
Standardized Plans
California requires Medigap plans to be standardized:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 only) |
| Plan G | Like F without Part B deductible |
| Plan K | 50% cost sharing, out-of-pocket max |
| Plan L | 75% cost sharing, out-of-pocket max |
| Plan M | 50% Part A deductible |
| Plan N | Cost sharing, copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Rate Regulation
California has specific Medigap rate rules:
- Attained age rating permitted (premiums increase with age)
- Issue age rating also permitted
- Community rating not required
- Rate increases must be filed with CDI
What is the California Birthday Rule for Medicare Supplement insurance?
How long is the open enrollment period for Medicare Supplement in California?