CALIFORNIA BIRTHDAY RULE MEDIGAP
You can thank California Senate Bill 407 if you want to read the fine print. It's like curling up with a good book & a cup of hot tea by the fireplace.
But how does it work?
What if you are enrolled on an innovative or extra Medicare Supplement plan? What are the rules?? Does the California Birthday Rule work still?
We know you have many questions and we will get to all of them! Feel free to jump ahead to any section below:
How does California's Medigap Birthday Rule Work?
Since it allows California residents to switch plans to an equal or lower benefit Medicare Supplement plan it creates a competitive marketplace between the insurance carriers.
It stops the California Medigap insurance carriers from charging you whatever they want.
If you are enrolled on a California Medicare Supplement plan and received a large rate increase you have some protection.
This is rate increase price protection!
Can you be denied because of a pre-existing condition? No! Not during this free special enrollment period each year provided the plan change is not an upgrade in benefits.
The new version of the law took effect July 1st 2020, increasing the time period from 30 days to 60 days.
Remember the days of double digit percentage premium rate increases?
Rates have increased steadily for the last twenty years, but when the Affordable Care Act was enacted in 2014 rates jumped through the roof and increased overall 100% over the next 4 years.
Unless you received a subsidy tax credit discount based on household income your premium rates on average doubled.
With Medicare Supplements in California you have protection.
The Birthday Rule now allows an existing enrollee of a California Medicare Supplement plan to switch to another Medicare Supplement plan of equal or lesser coverage.
"Innovative" & "Extra" Medicare Supplement plans which include additional benefits such as hearing aid & vision coverage are considered equal now as well according to the new 60 day rule starting July 1st 2020.
So, for example if you are enrolled in a standard G Supplement plan and would like to switch to the G "Extra" Supplement plan to the hearing aid or vision coverage you can do so now starting on 60 days from your upcoming birthday.
Or, you could change from your G Medigap Supplement plan to another insurance carrier to receive a lower premium but the same plan & benefits.
You could also simply reduce premium cost by downgrading your G Supplement plan to say N Supplement plan but keep your same insurance carrier if you are happy with them.
Here's a chart which shows the heirarchy of Medicare Supplements so you can get a sense of what plans you can downgrade to.
A lot of people are really stressed when they contact us with Medicare questions, particularly if they are turning 65 and new to Medicare.
This is because they are overwhelmed with information, confused about the plan choices, and afraid of making the wrong decision.
Let's say beyond confusion or pricing issues you add to it a customer service, claims, or billing concern with your Medicare Supplement insurance carrier.
But this moment of confusion is simply the moment before you learn something!
You have a way out!
This takes the stress and pressure out of the decision.
Sometimes we get questions like "What if I've got type 2 diabetes for 15 years?" Or, "I've been taking 3 medications for high blood pressure and cholesterol. Are those approved and covered?"
If you have health issues or pre-existing conditions your plan change is still guaranteed provided you apply within the 60 day window after your birthday.
You can still apply to make changes in ANY month during the year on a Medicare Supplement plan, but it's possible the plan is declined if you are trying to get stronger coverage or better rates due to medical underwriting.
As an independent insurance agency, we work with all the major insurance carriers.
The cost to you is nothing! We receive a commission from the insurance carrier but your rates are the same.
Contact us to get the same plan for less at a different insurance carrier, or to find help with changing the plan entirely at your current insurance carrier.
Effective date of plan change will be after the application is submitted, not retroactively effective back to your birthday.
Toll free is 1-866-486-6551 or email is firstname.lastname@example.org.