California Medicare Supplement Guaranteed Issue Birthday Rule

California Medicare Supplement Guaranteed Issue Birthday Rule

California offers a Medicare Supplement Guaranteed Issue Birthday Rule which allows Medicare beneficiaries living in the state of California a yearly opportunity to compare Medicare Supplement (also known as “Medigap”) Plan prices and switch insurance companies if they find a more affordable plan. There are certain rules that apply, however.  The Medicare beneficiary must keep the same plan type or choose one with lesser benefits. For example, if a Medicare beneficiary has a Plan F then he or she can switch to any Medicare Supplement Plan A – N, except for an Innovative Plan F.  The Medicare beneficiary cannot switch to a Medicare Supplement Innovative Plan F because it offers more benefits than any other plan and the rule is they can keep the same plan type or choose one with lesser benefits.  This yearly opportunity for California Medicare beneficiaries is entitled the Medicare Supplement Guaranteed Issue Birthday Rule.  This specific enrollment period applies only to Medicare Supplement plans and has no effect on original Medicare or other Medicare insurance, such as Medicare Advantage Plans or Prescription Drug Plans.

What does the Medicare Supplement Guaranteed Issue Birthday Rule Mean?

The California Medicare Supplement Guaranteed Issue Birthday Rule means that every year a Medicare beneficiary will have the opportunity to shop and compare Medicare Supplement plans among the numerous insurance companies and purchase a plan with guaranteed issue rights.  These guaranteed issue rights means the Medicare beneficiary does not have to go through underwriting, or qualify for acceptance in the plan.  Therefore, preexisting conditions or age are not considered because the policy is guaranteed issue.  The Medicare Supplement Guaranteed Issue Birthday Rule does not eliminate the opportunity to change plans at any other time throughout the year but simply adds a bonus period of guaranteed issue.  The Medicare beneficiary can still shop and compare rates and Medicare Supplement Plans at any time and change plans at any time; however, outside of a guaranteed issue or special enrollment period, he or she will have to go through underwriting.

How does the Medicare Supplement Guaranteed Issue Birthday Rule Work?

This Medicare Supplement Guaranteed Issue Birthday Rule allows Medicare beneficiaries that have been locked into Medicare Supplement Plans with large annual increases and who were not able to switch Medicare Supplement Plans or insurance companies due to not being able to pass underwriting due to current or preexisting conditions an opportunity to change Medicare Supplement Plans and/or insurance carriers with guaranteed issue rights.  The following explains how the Medicare Supplement Guaranteed Issue Birthday Rule works:

  • The Medicare beneficiary’s opportunity to compare prices and change Medicare Supplement plans begins on his or her birthday and ends 30 days later.
  • The change is guaranteed, regardless of your health. New coverage begins on the first of the month following the application date (so a January 23rd application date results in a February 1st effective date).
  • This rule does not apply to Medicare supplement policies issued before January 1, 1990.
  • People with an employer-sponsored standardized Medicare Supplement policy can use the time around their birthday to switch to a non-employer sponsored supplement as long as the new plan does not have additional benefits. Keep in mind that if you leave your employee sponsored plan you may not be able to go back if the employer plan rules do not allow it.
  • Medicare SELECT Supplement plans are considered equal to the same plan type it is modifying.

California Medicare Supplement Guaranteed Issue Birthday Rule is a Great Opportunity to Save Money

The California Medicare Supplement Guaranteed Issue Birthday Rule is a great opportunity for Medicare beneficiaries to shop and compare and change plans to an insurance company offer the same Medicare Supplement Plan, or a Medicare Supplement Plan with lesser benefits, and get a more affordable monthly premium.  Contact Medicare Pathways to review your options and assist you in determining which plans you are eligible to change to, as well as find you a lower monthly premium even if you are looking to stay with the same plan.  A Medicare Pathways Benefit Specialist will not only help you find a more affordable premium, but will assist you in enrolling in the plan.  You can call 1-966-466-9118 to speak with a Benefit Specialist, or you can Request a Quote, complete a small, simple form, and a Benefit Specialist will contact you.

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Medicare Pathways:  1-866-466-9118