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How the California Birthday Rule Can Save You Hundreds on Your Medigap Plan — Every Year

Introduction

If you’re a Medicare Supplement (Medigap) policyholder living in California, there’s a little-known benefit that could save you hundreds (or even thousands) of dollars a year and many people don’t even know that it exists. It’s called the California Birthday Rule, and it gives you the right to switch your Medigap plan every year around your birthday, REGARDLESS OF YOUR HEALTH!

IMPORTANT: You can change your Medicare Supplement any time of the year, but if you do it around your birthday, it’s a lot easier because you don’t have to answer any health questions, there’s no medical underwriting, and YOU CAN’T BE TURNED DOWN FOR COVERAGE!

Medigap Plans Are Standardized

Nationwide, there are 10 standardized Medicare Supplement lettered plans to choose from, Plan A through Plan N. When I say “standardized,” that means that the coverage and benefits for every lettered plan are exactly the same regardless of what insurance carrier you sign up with. In other words, Plan G is Plan G, Plan N is Plan N, etc., regardless of what insurance carrier you are with. So it’s much easier to compare plans since every plan is exactly the same no matter which insurance carrier offers it.

NOTE: Technically, there are actually 12 standardized Medigap plans to choose from because there are high-deductible versions of Plan F and Plan G. In 2025, you will pay a $2,870 deductible before your coverage for either of these plans would begin.

As you can see, the only difference between Plan F and Plan G is the Medicare Part B deductible.

Which Medigap Plan is Best?

For those who are turning 65 or starting Medicare today, the best and most comprehensive Medigap plan is Plan G, which pays for everything except for the Medicare Part B deductible. The current annual Part B deductible (in 2025) is $257. That amount can change from year to year, but historically, it hasn’t changed by much.

Medicare Access and CHIP Reauthorization Act of 2015

Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap Plan C and Plan F were discontinued for new Medicare beneficiaries starting on January 1st, 2020. This legislation eliminated the availability of Medigap plans that cover the Medicare Part B deductible for individuals who became eligible for Medicare on or after that date. However, Plan C and Plan F are still available for people who were eligible for Medicare before 2020 or who already have one of those plans. They just aren’t available for those individuals that turned 65 or started Medicare on or after January 1st, 2020.

Let’s look at a common example of how switching under the Birthday Rule can save you money.

Why Plan G is More Popular Than Plan F

If you have a Plan F Medicare Supplement, you’re probably paying more than you need to. It’s usually much cheaper and more cost effective to switch to Plan G because both plans are identical in coverage except for the Medicare Part B deductible, which is $257 in 2025. Plan F covers that small deductible, while Plan G does not. That is the only difference between the two plans, yet the premiums for Plan F are usually significantly higher.

Even though Plan F covers that $257, it often costs $400–$1,000 more per year in premiums than Plan G, so in most cases, you’d save money by paying the lower monthly premium for Plan G and just covering that $257 deductible yourself.

IMPORTANT: If you can save more than $257 per year by switching from Plan F to Plan G, then Plan G is cheaper and more cost effective.

For example, if your Plan F premium is $250 per month and you can get Plan G for $200 per month, that’s a gross savings of $50 per month or $600 per year. If you pay the $257 on your own, your net savings will still be $343 per year ($600 – $257 = $343)! The Medicare Part B deductible is payable only one time per calendar year, so after you pay that small deductible, there is absolutely no difference between Plan F and Plan G for the remainder of the year!

NOTE: If you have Plan F and you switch to Plan G, if you’ve already met your $257 Part B deductible, you won’t pay it again until the following year since that small deductible is payable only one time per calendar year.

What Is the California Birthday Rule?

The California Birthday Rule is a special California state law that allows active Medigap policyholders in California to switch to a new Medigap plan with “equal or fewer” benefits every year around their birthday without medical underwriting during a 60-days following their birthday.

NOTE: In California, most carriers accept applications from 30 days before your birthday up to 60 days after your birthday, a 91-day window to switch Medigap plans without medical underwriting.

Most states don’t have a birthday rule, and if you develop a serious health condition, you could be stuck with your current health insurer and Medigap plan. But thanks to the California Birthday Rule, you have a guaranteed open enrollment period every year to shop around and save money on your premiums without worrying about being stuck or declined.

What Does Equal or Fewer Mean?

Again, under the birthday rule, you can switch to any Medigap plan that offers “equal or fewer” benefits than your current plan. In other words, you can switch from your current Medigap plan to any other Medigap plan that offers benefits that are the same or less comprehensive than what you currently have.

For example:

  • You cannot upgrade to a plan with more benefits (such as Plan N to Plan G).
  • You can switch to a plan with the same level of benefits (such as Plan G to another Plan G with a different carrier).
  • You can downgrade to a plan with fewer benefits (such as Plan F to Plan G, Plan G to Plan N, etc.).

This rule exists to prevent people from waiting until they are sick to “upgrade” to more generous coverage. However, it does give you freedom to shop around for lower prices on the same or lesser coverage without worrying about health questions or being declined.

Examples of “Equal or Fewer”

  • If you have Plan F, you can switch to Plan F with a different insurance carrier or to Plan G, Plan N, etc.
  • If you have Plan G, you can switch to Plan G with another insurance carrier or to Plan N, etc.
  • If you have Plan N, you can switch to Plan N with a different insurance carrier or to Plan A, etc.

Even if you’re not sure whether your current plan is the best deal, you can always switch to the same plan with a different insurance carrier during your birthday rule window, often saving hundreds and sometimes thousands of dollars per year without changing any of your benefits.

What States Have a Medigap Birthday Rule?

Today, more states are slowly adding their own birthday rules. Here is a current list of states that have a Medicare birthday rule:

  • California
  • Illinois
  • Idaho
  • Kentucky
  • Louisiana
  • Maryland
  • Nevada
  • Oklahoma
  • Oregon
  • Utah
  • Virginia
  • Wyoming

States with Year-Round Guaranteed Issue or Open Enrollment Rights

These states don’t have a Medicare birthday rule, but they offer year-round guaranteed issue or open enrollment periods without underwriting:

  • Connecticut
  • Maine
  • Missouri
  • New York
  • Washington

Do Most People Use the Birthday Rule?

Surprisingly, no! Many people don’t know this rule exists and they stay on overpriced Medigap plans for years thinking they’re stuck because of health issues, etc. If you take advantage of the birthday rule each year, you can keep your premiums under control and avoid being overcharged.

Rates Vary Significantly Between Insurance Carriers

As mentioned before, Medigap plans are “standardized” meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits for every Plan G, etc. are exactly the same regardless of what insurance carrier you are with. However, the rates between insurance carriers are not standardized. Every insurance carrier charges their own rates.

For example, right now in the 92024 zip code (San Diego), the Plan G rates for a 70 year old single female range from $217.78 to $319.79 per month! That’s a difference of $102.01 per month or $1,224.12 per year for the same identical plan and coverage!

NOTE: Several years ago, one of my clients, a husband and wife, moved to San Diego from Los Angeles. They were paying $809.00 per month for Plan G with United American, and I got them Plan G with Mutual of Omaha for $367.01 per month, which was a savings of $441.99 per month or $5,303.88 per year for the save identical plan and coverage! Rates are based primarily on age and zip code, and they are constantly changing. It‘s critically important to shop around every year!

How to Apply and Save Money!

To take advantage of the California birthday rule, you must do the following:

  • Live in California
  • Have an active Medigap plan
  • Switch to a Medigap plan with “equal or fewer” benefits
  • Apply during the 30 days before up to 60 days after your birthday
  • Email me at Ron@RonLewisInsurance.com or call me at 760.525.5769 (cell) or 866.718.1600 (toll-free) for a free quote or to switch plans

It only takes a few minutes to apply and there is never a charge for my service!

Conclusion

If you currently have a Medigap plan, you can change your plan every year around your birthday, REGARDLESS OF YOUR HEALTH! If you apply during your annual 60-day open enrollment period under the California Birthday Rule, YOU CANNOT BE TURNED DOWN FOR COVERAGE!

As an independent insurance agent specializing in Medicare Supplements, I work with all the major insurance carriers, not just one. (A “captive” insurance agent can only represent one insurance carrier.) I will do the shopping for you and find you the best rates, not just this year, but I shop around for all my clients every year around their birthday! The monthly premiums are exactly the same whether you let me do the shopping for you to save you money on your premiums or if you contact an insurance carrier directly! Please visit Client Testimonials to read what some of my clients have to say about me.

Call, text, or email me today, and I’ll help you review your options in just a few minutes with no pressure or obligation. Let me help you save hundreds, or even thousands of dollars, on the exact same Medigap plan you already have. Won’t that be a nice birthday present?

If you liked this blog and found it informative, please click the “Like” button, and please send me your questions, comments, or feedback! And please feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

The California Birthday Rule

If you are a California resident and you have a Medicare Supplement, aka a “Medigap” plan, I have good news for you! Under a law called the California Birthday Rule, you have 60 days of “open enrollment” following your birthday each year when you can change your Medigap plan, REGARDLESS OF YOUR HEALTH. During this period, there are no health questions to answer, no medical underwriting or waiting periods, and YOU CANNOT BE TURNED DOWN FOR COVERAGE! To qualify, the new plan must have “equal or fewer” benefits as your current policy.

For example, if you have Plan G, you can switch to Plan G with any other insurance carrier or you could switch to Plan N since Plan N has fewer benefits than Plan G. You just can’t switch from Plan N to Plan G, etc. under the birthday rule because Plan N has fewer benefits than Plan G.

NOTE: In California, most insurance carriers will let you apply during the 30 days before your birthday up to 60 days after your birthday, so in reality, you have a 90-day open enrollment period each year.

You can change your Medigap plan any time of the year, but if you do so around your birthday, it’s a lot easier because you don’t have to answer any health questions on the application and you can’t be turned down for coverage.

The Annual Election Period

There is another open enrollment period called the Annual Election Period (AEP) that goes from October 15th through December 7th every year. This open enrollment period has nothing to do with Medigap plans. It’s only for people with Medicare Advantage (MA) plans and/or Prescription Drug Plans (PDPs). If someone has an MA plan or a PDP, the AEP is the time to shop around and change those plans. The new coverage would begin on January 1st of the following year.

During the AEP, you can always switch from a Medigap plan to an MA plan, but there is no guarantee that you can switch from an MA plan to a Medigap plan. If someone has an MA plan, they are guaranteed the right to switch back to Original Medicare, which is Medicare Part A (Hospital insurance) and Part B (Medical insurance). However, they are not guaranteed the right to get a Medigap plan unless they are in a special enrollment period (SEP) that allows them to do so.

For example, if someone had an MA plan for the first time and they have had it for less than one year, they would be in a SEP, and they could still get a Medigap plan. Otherwise, they would have to answer health questions, be medically underwritten, and they could be turned down for certain types of health conditions.

NOTE: Medicare Part A and Part B cover approximately 80% of medical and hospital costs, so most people will get a Medigap plan to pick up most of the remaining 20% of the costs that are not covered by Medicare.

Most States Don’t Have a Birthday Rule

Most states don’t have a birthday rule, so the California Birthday Rule is definitely very beneficial for California residents because if your health should change, or if your rates go up significantly, or if you are not happy with your plan or insurance carrier, etc., you can always change to a different plan or insurance carrier, REGARDLESS OF YOUR HEALTH, every year around your birthday. In contrast, for those living in a state without a birthday rule, you could be stuck with your current Medigap plan, insurance carrier, high monthly premium, etc.

NOTE: Some states have recently added their own version of a birthday rule such as Idaho, Illinois, Louisiana, Maryland, Nevada, and Oregon. Besides the birthday rule, other states offer guaranteed issue protections for changing Medigap plans including Connecticut, Maine, Massachusetts, Missouri, New York, Rhode Island, and Washington. Each of these states have their own rules and requirements for changing Medigap plans, which are beyond the scope of this article.

When is the Best Time to Apply For New Coverage Under the California Birthday Rule?

In California, Medigap rates are based primarily on your age and zip code. Other factors that can affect the rate is if you use tobacco products and whether you live alone or with someone else in the household. Under the California Birthday Rule, most insurance carriers base their rates on your age after your birthday, but a couple carriers base their rates on your age on the date your application is submitted and signed. This one year age difference can make a big difference in the rate so for this reason, I normally recommend checking Medigap rates during the 30 days before your birthday each year.

Under the birthday rule, the new effective date is usually the 1st of the month following your birthday. For example, if your birthday is June 3rd, the new effective date would normally be July 1st, etc.

IMPORTANT: I shop around for my clients every year around their birthday to take advantage of the California Birthday Rule. If you aren’t a client of mine, and you would like for me to shop for you too, please let me know. As an independent agent, I work with all the major insurance carriers, and there’s no charge for my service!

10 Standardized Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from with lettered names, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Plan F, Plan G, Plan N, etc. are exactly the same no matter what carrier you are with. In other words, Plan G with Anthem Blue Cross is exactly the same as Plan G with Blue Shield of California, etc. Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

As of January 1st, 2020, Medigap plans purchased by individuals who are turning 65 or who are new to Medicare can no longer cover the Part B deductible, which is currently $240 in 2024. (That amount can change from year to year.) Because of this, Plan C and Plan F aren’t available to people who are new to Medicare on or after January 1st, 2020.

NOTE: If you turned 65 before January 1st 2020 or you were eligible for Medicare before then, you can still get Plan F and Plan C. Those plans just aren’t available for those individuals who turned 65 after January 1st, 2020, etc.

Medigap Plans Are Standardized but Medigap Premiums Are Not Standardized

Although the coverage and benefits for all Medigap plans are standardized, the premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to another for the same identical plan and coverage.

For example, for a 72 year old female living in Encinitas, CA in the 92024 zip code, Plan G rates currently range from $178 to $280 per month for the same exact plan and coverage! That’s a difference of $102 per month or $1,224 per year! Since the monthly premiums vary significantly between insurance carriers, it’s important to shop around periodically.

The Application Process

Today, almost all Medigap insurance carriers in California use online applications that the agent completes. I work with clients throughout California and in several different states, so it’s not necessary to meet in person. The application process is simple, and it usually takes less than 15 minutes to complete.

In addition to the application, under the California Birthday Rule, most insurance carriers require some kind of proof that you currently have a Medigap plan. A copy of your Medicare Supplement card or a recent bill showing which plan you currently have (Plan G, etc.) is sufficient. Once the application has been submitted, the entire application process normally takes a couple of days to a week to complete since there is no medical underwriting. Underwritten applications usually take longer. After you are approved, you should contact your current Medigap insurance carrier to let them know that you will be canceling your old policy when your new policy begins.

CAUTION – Some Insurance Carriers Are Better Than Others!

In addition to finding an insurance carrier with competitive rates, you also have to be careful to choose a good insurance carrier because not all carriers are the same. Although the coverage and benefits for Medicare Supplement plans are standardized and the same, not all insurance carriers are the same; some are better than others!

For example, some insurance carriers will give you a 12-month rate lock and some don’t. Some have better financial ratings than others. Some will give you up to a 12% household discount if you live with someone else in your household, and some don’t. Some have much better customer service than others. Some have call centers in the US and some are overseas. Some provide free gym memberships and some don’t, etc. Price is important, but there are also other factors to consider when choosing a Medigap plan.

For More Information

As an independent insurance agent, I work with the major insurance carriers in California, Nevada, Arizona, and Washington state. I’m not limited to one particular insurance carrier. I shop around for my clients, every year, to find them the best rates, and I’m happy to shop for you too!

If you have any questions about the California Birthday Rule, etc. or if you would like a free, no-obligation Medicare Supplement quote, please don’t hesitate to let me know. There is no charge for my services as I am compensated by the insurance carriers, not my clients!

My contact information is below, and please click here to check out what my clients have to say about me. If you feel that the information in this blog would be helpful to a friend or family member, please feel free to pass it on and please feel free to add your comments below!

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com