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California Medicare Supplement "Birthday Rule"

For those on Medicare and enrolled on a Medicare Supplement Plan, the California Insurance Code provides a provision for annual Medicare Supplement changes. This provision is commonly referred to as the "Birthday Rule".

Under California Insurance Code 10192.11 (h) 1, the following is available in regard to Medicare Supplement Plans in California:

"(h) (1) An individual shall be entitled to an annual open
enrollment period lasting 30 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, no issuer that falls under this provision shall
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 his or her rights under this subdivision at least 30 and no more
than 60 days before the beginning of the open enrollment period."

So, a California Medicare Beneficiary enrolled in a Medicare Supplement plan will have 30 days from his/her birthday to change to a like or less Medicare Supplement plan with any available issuer with no medical underwriting on a Guaranteed-Issue basis.

Like or Lesser is very important in this regard. If a beneficiary is on Plan F for example, then any available Supplement including another Plan F would be allowed under the Birthday Rule. A similar beneficiary on Plan N would have some limitations as to which Supplement he/she could move to under the Birthday Rule as certain Supplements (including Plan F) would be considered an upgrade in coverage and not 'like or lesser' coverage. An independent agent can be a great assistant in helping you understand your Medicare Supplement plan change options under the "Birthday Rule".


As always, for information on specific health insurance products and programs, please visit my health insurance web site at the link above.


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