Tag Archives: california birthday rule

Switching from Medicare Advantage to Medigap in California: What You Need to Know

Each year, many people in California decide to leave their Medicare Advantage (Part C) plan and return to Original Medicare (Part A and Part B) with a Medicare Supplement (Medigap) plan. Often, this happens when premiums, copays, or out-of-pocket costs increase, or when clients find their favorite doctors or hospitals are no longer in their plan’s network.

If you’ve ever wondered how to switch from Medicare Advantage to Medigap, it’s important to understand how the process works, and the potential challenges if you have existing health conditions.

You Can Switch Back to Original Medicare — But You’re Not Automatically Guaranteed Medigap Approval

You can drop your Medicare Advantage plan and go back to Original Medicare during certain times of the year, such as the Annual Election Period (AEP), which goes from October 15th through December 7th every year or during the Medicare Advantage Open Enrollment Period, which goes from January 1st through March 31st.

However, many people are surprised to learn that once they return to Original Medicare, they must apply separately for a Medicare Supplement plan, and approval is not guaranteed. In most cases, insurance companies can review your health history, which is called “medical underwriting,” and deny coverage if you have serious or chronic health conditions. That’s why timing and knowing the rules can make all the difference.

Medicare Guaranteed Issue Rights: The Hidden Opportunities

Here’s the good news… even if you have health problems, there are special Guaranteed Issue (GI) rights or situations that often let you enroll in a Medigap plan without health questions or underwriting.

These rights apply in specific situations and many beneficiaries don’t realize they qualify. Some are tied to Medicare Advantage plan changes, others to state-specific protections. In California, there are several lesser-known GI opportunities that can help people switch to Medigap coverage, even when they’ve been told “no” before.

I work with clients every year who thought they couldn’t qualify due to health issues and I’ve helped them get accepted for Medicare Supplement coverage using legitimate Guaranteed Issue options that most agents aren’t aware of or don’t mention to their clients.

Why Work with a Specialist Who Knows the California Rules

The Medicare rules in California are unique. Between the California Birthday Rule and other state-specific guaranteed issue protections, there are several ways to save money and secure coverage without medical underwriting.

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. My goal is simple. I want to help you find the best Medicare Supplement plan with the lowest premium and the most reliable coverage, year after year.

Let’s See What You Qualify For

If you’re considering leaving your Medicare Advantage plan or want to see if you qualify for a Guaranteed Issue Medicare Supplement, don’t wait until it’s too late.

There is no cost for my help. I’m paid by the insurance carriers, not my clients. I can review your situation, identify any Guaranteed Issue opportunities, and help you apply for the coverage that fits your needs and budget.

Contact me today to learn your options and see how much you could save on your Medicare Supplement plan.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars for the same exact plan and coverage! Please click here to read what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and 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

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

Choosing the Best Medicare Supplement Plan

If you are turning 65 or you are new to Medicare, it can be very confusing trying to figure out which Medicare Supplement plan (aka Medigap plan) is right for you. The purpose of this article is to answer your questions and to make the Medicare transition easier for you and a lot less stressful!

10 Standardized Medicare Supplement Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Medigap plan are identical regardless of what carrier you sign up with. For example, Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

Medigap Plans Are Standardized But Premiums Are Not Standardized

While the coverage and benefits for each of these plans are standardized, the monthly premiums are not standardized, and prices vary significantly between insurance carriers for the same identical plan and coverage. Other factors can affect the premiums such as your age, zip code, marital status, whether you use tobacco products, etc.

For example, in the 92024 zip code (Encinitas, CA), the Plan G rates for a 70 year old female range from $152 per month to $262 per month, which is a difference of $110 per month or $1,320 per year for the same identical plan and coverage! In California, rates usually go up every year as we get older. For this reason, it’s important to shop around every year to make sure you aren’t paying more than you should be! I periodically stay in touch with my clients, and I shop around for them every year around their birthday.

IMPORTANT: As an independent insurance agent, I work with the major insurance carriers, not one particular company. If you or someone you know has a Medigap plan, I’m happy to shop around for you, and there is no charge for my service!

The California Birthday Rule

In California, we have a law called the California Birthday Rule. This law applies to all California residents who already have a Medigap policy.

Under the birthday rule, you have an annual 90-day open enrollment period that begins 30 days before your birthday and ends 60 days after your birthday. During this period, you can switch to any other Medigap policy that has “equal or fewer” benefits.

For example, if you have Plan G with Carrier A, you can switch to Plan G with Carrier B, regardless of your health and without answering any health questions. There is no medical underwriting and you cannot be turned down for coverage! If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G.

If you have Plan N, you can switch to Plan N with another carrier, but you cannot switch to Plan G because Plan G has more benefits than Plan N, etc.

NOTE: You can change your Medigap plan any time of the year, but if you do so outside of your 90-day annual open enrollment period under the California Birthday Rule, you will have to answer health questions and be medically underwritten, and you can be turned down for certain health conditions.

The Three Best Medicare Supplement Plans

Although there are 10 standardized Medigap plans to choose from, Plan F, Plan G, and Plan N are the three best and most popular plans.

As you can see from the chart, Plan F provides the most comprehensive coverage. Plan G is identical to Plan F except it does not cover the Medicare Part B deductible. Plan N also does not cover the Part B deductible and there are co-payments for doctor visits, emergency room visits, and it does not cover Part B excess charges. Please continue reading for more detailed information.

Plan G Medicare Supplement

For those who are turning 65 on or after January 1st, 2020, Plan G is the best plan today because your only out-of-pocket (OOP) expense is the Medicare Part B deductible, which is currently $226 for all of 2023.

NOTE: That small deductible can change from year to year, but historically, it hasn’t changed significantly. In fact, the Part B deductible decreased from $233 in 2022 to $226 in 2023.

The Part B deductible zeros out every January and starts all over again. Once you meet that small annual deductible, you won’t have any other OOP costs for the remainder of the calendar for any Medicare-approved doctors visits, surgeries, hospitalizations, etc.

Plan F Medicare Supplement

Prior to January 1st, 2020, Plan F was considered to be the best Medicare Supplement plan because there were no deductibles, co-payments, or OOP costs. The only difference between Plan F and Plan G is the Medicare Part B deductible. Plan F pays for that small deductible, and Plan G doesn’t. That is the only difference between the two plans!

NOTE: For those individuals that had Plan F prior to January 1st, 2020, they can still keep their plan and switch to Plan F with other insurance carriers if they want, but Plan F isn’t available for individuals who started Medicare on or after January 1st 2020 because of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Although Plan F covers the Medicare Part B deductible and Plan G doesn’t, the premiums for Plan F are significantly more than the premiums for Plan G, which is why most people with Plan F have switched to Plan G.

Most People With Plan F Have Switched to Plan G

Most people who had Plan F have switched to Plan G because in most cases, the premiums for Plan G are significantly less, and even if you have to pay the $226 Part B deductible, you still end up saving money by switching to Plan G!

For example, if someone has Plan F and their premium is $250 per month and they can get Plan G for $180 per month, that’s a gross savings of $70 per month or $840 per year! If you subtract the $226 Medicare Part B deductible, that’s still a net savings of $614 per year!

NOTE: If you have Plan F and you want to switch to Plan G, if you have already met your $226 Medicare Part B deductible for this year, you would not have to pay it again until the following year since the Part B deductible is payable only one time per calendar year.

Medicare Supplement Plan N

Plan N isn’t as popular as Plan G because there are more OOP costs, but the premiums are usually a little lower, but not significantly lower than the Plan G premiums. If you are in relatively good health and rarely go to the doctor, you may want to consider Plan N if you want lower monthly premiums and you are willing to incur more OOP costs. However, Plan G is a better option if you’re willing to pay slightly higher premiums for much better coverage than Plan N.

NOTE: If you are not in the best of health and you go to the doctor often, Plan N is not a good choice as you are required to pay co-payments for every office visit, and with all those payments, Plan G would normally be more cost effective.

With Plan N, you are responsible for paying the annual $226 Medicare Part B deductible (like you are with Plan G). You must also pay co-payments of up to $20 per doctor visit and co-payments of up to $50 for emergency room visits. However, if you are admitted to the hospital, the emergency room co-payment is waived.

Another difference between Plan N and Plan G is that Plan G covers the Medicare Part B “excess charges” and Plan N doesn’t. If your doctor doesn’t accept “Assignment” (the amount Medicare agrees to pay for a service), they may charge you up to an additional 15% of the bill. This fee is known as an excess charge.

Between Plan N and Plan G, I would recommend Plan G if the premiums aren’t significantly different and it’s not a financial burden to pay the Plan G premiums.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California.

As an independent agent, I work with the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday to find them the best Medigap rates. Please click here to see some of my client testimonials.

If you have any questions, please don’t hesitate to contact me. If you have any friends that are turning 65 or that have Medicare Supplements, I’m happy to shop around for them, and there is no charge for my service!!! Also, please feel free to forward this blog on to anyone who may be interested!

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

How to Sign Up for Original Medicare (Part A and Part B)

Signing up for Medicare can seem like a confusing and daunting task, but it’s really not that bad. This article will hopefully answer any questions you have and make the Medicare maze easy to navigate.

What is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Who is Eligible For Medicare?

You are generally eligible for Medicare if you are 65 or older, a U.S. citizen or permanent legal resident, and have lived in the U.S. for at least five year

What Are the Four Parts of Medicare?

Medicare is composed of four parts:

  • Part A (Hospital insurance)
  • Part B (Medical insurance)
  • Part C (Medicare Advantage plans)
  • Part D (Prescription drug plans)

NOTE: Medicare Parts A and B are also referred to as “Original Medicare.”

What Does Medicare Part A Cover?

Part A covers things like inpatient hospital stays, home health care and some skilled nursing facility care.

What Does Medicare Part B Cover?

Part B covers things like doctor visits, outpatient services, X-rays and lab tests, and preventive screenings.

What Does Medicare Part C Cover?

Part C is also known as Medicare Advantage (MA). An MA plan is a Medicare-approved plan from a private company that offers an alternative (replacement) to Original Medicare (see note below) for your health and drug coverage. These “bundled” plans include Part A, Part B, and often Part D. In most cases, you must only use doctors who are in the plan’s network. Most MA plans are HMO’s and are restrictive and limit your options to what doctors, specialist, hospitals, and care facilities you can go to.

IMPORTANT: A much better option to Part C, in my opinion, is a Medicare Supplement plan, also known as “Medigap” because it picks up the gap in coverage not covered by Medicare. With a Medigap plan, there are NO networks, and you have much greater freedom of choice as to which doctors, specialists, care facilities, etc. that you go to. You can go to any doctor, specialist, care facility, etc. ANYWHERE in the US as long as they accept Medicare, and most do, about 93%.

What Does Medicare Part D Cover?

Part D covers the cost of prescription drugs (including many recommended shots or vaccines).

The Medicare Initial Enrollment Period (IEP)

If you are turning 65 and are eligible for Medicare, you can sign up for Original Medicare, aka Medicare Part A (Hospital insurance) and Part B (Medical insurance) during your Initial Enrollment Period (IEP), which typically starts three months before the month of your 65th birthday and ends three months after your birth month. For example, if your birthday is June 23rd, your IEP would begin on March 1st and end on September 30th of that year.

NOTE: Medicare normally begins on the 1st of the month of your 65th birthday. If you want your coverage to start then, you need to sign up for Medicare during the 3 months before the month of your birthday. Otherwise, your Medicare won’t start until sometime after your birthday month.

For most people, their Medicare normally begins on the 1st of the month of their 65th birthday. However, if your birthday is on the 1st of the month, your Medicare would begin on the 1st of the previous month. For example, if your birthday is June 1st, your Medicare would normally begin on May 1st.

NOTE: If your birthday is on the 1st of the month, your IEP begins and ends one month earlier as well. For example, if you turn 65 on June 1st, your IEP would begin on February 1st and end on August 31st.

Some People Are Automatically Enrolled in Medicare When They Turn 65 and Some Are Not

If you are currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will normally be automatically enrolled in Medicare, and you’ll receive your Medicare card in the mail before your 65th birthday. You’ll still have an IEP, and during this seven-month window, you can still make Medicare coverage decisions such as signing up for a Medicare Supplement and a Prescription Drug Plan (PDP).

IMPORTANT: If you are not currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you’ll have to sign up for Medicare on your own. If that’s the case, be sure to write down your IEP dates on your calendar before you turn 65.

Three Ways to Sign Up for Medicare

There are the three different ways to sign up for Medicare:

  • You can apply for Medicare online at the Social Security Administration’s website (https://secure.ssa.gov/iClaim/rib).
  • You can call Social Security toll-free number at 1-800-772-1213 and sign up on the phone.
  • You can visit your local Social Security office.

I know that it doesn’t seem intuitive that you would contact Social Security to sign up for Medicare, but you do! When you apply for Medicare, you will need to provide personal and financial information including your name, Social Security number, birth date, income, etc.

After you apply for Medicare, you will receive a confirmation notice in the mail indicating whether your application has been approved, etc. If you have any questions or concerns about the Medicare enrollment process, you can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).

Do I Need to Enroll in Medicare If I’m Working After Age 65

For most people, Medicare Part A (Hospital insurance) is free because you or your spouse paid Medicare taxes long enough while working, generally at least 10 years. However, Part B (Medical insurance) is not free. There is a monthly premium for Part B, which is currently $164.90 each month for most people (or higher depending on your income).

You’ll pay a higher monthly premium for Part B if your modified adjusted gross income (MAGI), as reported on your IRS tax return from 2 years ago, is more than $97,000 in 2023 if you file an individual tax return or are married and file separately, or $194,000 if you are married and file a joint tax return. Please click here for more detailed information about the Part B premiums. Social Security will tell you if you have to pay a higher premium because of your income.

NOTE: If you are planning to continue working past age 65, you may be able to delay enrolling in Medicare Part B and avoid paying the Medicare Part B monthly premium. Since Medicare Part A is usually free, most people sign up for it even if they are working.

If you have “creditable” health coverage from your employer or are covered under a spouse’s employer plan, you may qualify for a Special Enrollment Period (SEP), and be able to delay enrolling in Part B without a penalty.

Medicare defines “creditable coverage” as coverage that is at least as good as what Medicare provides.

Here are some situations that will affect when you should begin your Medicare coverage:

  • If an employer has 20 or more employees, you can generally choose to delay Medicare enrollment, drop your employer coverage for Medicare, or have both Medicare and employer coverage.
  • If an employer has fewer than 20 employees, you will generally need to enroll in Medicare during your IEP.
  • If you have health coverage through a spouse’s employer, what you can do will depend on the employer’s rules. You may be able to delay signing up for Medicare or you may need to enroll at age 65.

IMPORTANT: When you are turning 65, if you aren’t sure if your employer plan provides creditable coverage, you should call Social Security to verify. Otherwise, you could end up paying a penalty.

What If I’m Coming Off An Employer Group Plan?

If you qualified to delay Medicare because you had creditable coverage from an employer, there is an 8-month Special Enrollment Period (SEP) for enrolling in Medicare Parts A and B.

IMPORTANT: Be careful because this SEP can be tricky. Although you have the entire 8 months to get Medicare Parts A & B, you only get the first 2 months to enroll in Part C or Part D without penalty. If you enroll after the two-month period, you’ll face late enrollment penalties for Part D (regardless of whether you end up with a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage).

What If I Don’t Enroll in Medicare On Time?

If you don’t sign up for Medicare Part A, Part B, or Part D on time, you will pay late enrollment penalties for life so make sure to sign up for Medicare coverage during your IEP unless you have other creditable coverage that’s comparable in value to Medicare, such as from an employer. Please click here for more detailed information.

It’s a good idea to start researching your Medicare options a few months before your 65th birthday to make sure you have enough time to enroll and choose the plan that’s right for you.

Original Medicare Will Not Cover All of Your Costs!

Original Medicare (Part A and Part B) does not cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket (OOP) costs including co-payments, coinsurance, and deductibles. Medicare usually pays approximately 80% of allowable charges for covered services.

The Part A Deductible and Co-payments

If you’re a hospital inpatient, Medicare Part A generally covers your care for a limited time. A deductible or copay generally applies.

NOTE: The Part A deductible isn’t an annual deductible, it’s a “benefit period” deductible meaning there can be multiple Part A benefit periods and deductibles per calendar year. In 2023, the Part A deductible per benefit period is $1,600.

The Part A benefit period begins the day you go into a hospital or skilled nursing facility and ends when you have been out for 60 consecutive days in a row. It’s possible to have multiple benefit periods in a calendar year, and without a Medicare Supplement, you would have to pay the full deductible amount for each benefit period!

Most Medicare Supplements pay for all the Part A deductibles, co-payments, etc. With a Plan G Medicare Supplement, your only out-of-pocket cost for the entire year is the Part B deductible, which is currently $226 in 2023.

In 2023, after you pay the $1,600 Part A deductible for each benefit period, there are no hospital co-payments for the first 60 days, but there are co-payments if you are in a hospital for longer than 61 days. Most Medicare Supplements will cover all of these costs.

The Medicare Part B Deductible

In 2023, the Medicare Part B calendar year deductible is $226. Unlike Part A, the Part B deductible is payable only one time per calendar year.

What is the Maximum Out-of-Pocket Expense Limit Under Original Medicare?

Original Medicare (Part A and Part B) have no out-of-pocket maximum amount.

NOTE: A Plan G Medicare Supplement will pick up ALL Medicare-approved costs over and above the $226 Part B deductible!

10 Standardized Medicare Supplement Plans to Choose From

Nationwide, there are 10 “standardized” Medicare Supplement plans to choose from, Plan A through Plan N. These plans are standardized meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits are exactly the same with every Plan G, Plan N, etc. making it easier to compare “apples with apples,” etc.

Although these plans are standardized, the rates are not standardized, so it is important to shop around and compare because the rates vary significantly between insurance carriers for the same identical plan and coverage.

Since there are co-payments, coinsurance, and deductibles and no out-of-pocket maximum with Original Medicare (Part A and Part B), most people get a Medicare Supplement plan in addition to Original Medicare to pay for most of these costs.

The Plan G Medicare Supplement is the Most Popular and Cost-Effective Plan

Of the 10 standardized Medicare Supplement plans, the three most popular plans are Plan F, Plan G, and Plan N. Of the three plans, Plan G is the best plan and most cost-effective because your only OOP cost for the entire year is the Medicare Part B deductible, which is $226 for all of 2023.

NOTE: The Part B deductible can change from year to year, but historically, it has never increased significantly. Once you meet this small annual deductible, you normally won’t have any other costs for the remainder of the year.

How Much Do Medicare Supplement Plans Cost?

In California, rates are based primarily on age and zip code, so Plan G will cost less for someone who is age 65 rather than age 85. For example, in the San Diego area (zip code 92024), the rates for age 65 range from $100 per month to $203 per month! For age 85 in the same zip code, the rates range from $221 per month to $395 per month!

The California Birthday Rule

In California, you can change your Medicare Supplement plan any time of the year, but you would normally have to be in relatively good health to do so because you will have to answer health questions and be medically underwritten. However, California is one of only a few states with a birthday rule called the California Birthday Rule.

Under this law, if you currently have a Medicare Supplement, you can apply for a new Medicare Supplement with “equal or fewer” benefits during the 60 days following your birthday each year, and you cannot be turned down for coverage. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, REGARDLESS OF YOUR HEALTH and without answering any health questions on the application.

NOTE: Only six states currently have a Medicare Supplement birthday rule including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states had a birthday rule.

It’s Important to Shop Around and Compare Medicare Supplement Rates Every Year!

Since there is such a large discrepancy in pricing and because Medicare Supplement rates are constantly changing as we get older, it’s important to take advantage of the California Birthday Rule and compare prices and shop around every year or two.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to contact me! Also, please feel free to forward this blog on to anyone you know who may be interested.

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

Upcoming Medicare Supplement Changes Beginning on July 1st, 2020

As of July 1st, 2020, under Senate Bill No. 407, the California Birthday Rule will be changing. Under the current law, for those individuals that have a Medicare Supplement, also known as Medigap, you can change your current plan to any Medigap plan that offers benefits “equal to or lesser than” your current plan during the 30 days following your birthday each year.

Under the new law, you will have the same opportunity to change plans, but the 30 day period has been extended to 60 days.

July-1st Use

Nationwide, there are 10 standardized Medigap plans to choose from, Plan A through Plan N. The term “standardized” means that every Plan F, every Plan G, every Plan N, etc. has the same exact coverage and benefits no matter what insurance carrier you have your coverage with. In other words, Plan F is Plan F, Plan G is Plan G, Plan N is Plan N, etc. Because Medigap plans are standardized, it is much easier to compare “apples with apples.”

Medigap Plans Are Standardized but Rates Aren’t

Although Medigap plans are standardized, Medigap rates are not standardized, and they vary widely between insurance carriers. For example, in the 92009 zip code in San Diego, for a 72 year old male, Plan G rates range from $165.78 per month to $223.47 per month. That’s a difference of $57.69 per month or $692.28 per year for the same identical plan and coverage!

Medicare-Supplement-Plan-Chart

Medigap rates are based primarily on your age and zip code, and whether you use tobacco or not. In California, rates usually increase every year as we get older. An insurance carrier that has competitive rates this year may increase rates and not be as competitive next year. For this reason, it is very important to take advantage of the California Birthday Rule and shop around every year to make sure that you aren’t paying too much money for your Medigap insurance premiums.

This is a free service that I provide to all of my California clients every year around their birthday.

NOTE: You can change your Medigap plan or insurance carrier any time of the year, but if you do so other than around your birthday, you will have to answer health questions on the application, and your application will be medically underwritten, and you could be turned down for coverage. If you have a serious health condition, you should definitely take advantage of the California Birthday Rule and apply around your birthday. That way, you cannot be turned down for coverage, REGARDLESS OF YOUR HEALTH.

Innovative Medigap Plans Are Also Changing On July 1st

There is another significant change that will be occurring beginning on July 1st under Senate Bill No. 407. Several insurance carriers have recently introduced new “Innovative” Medigap plans that are the same as the standardized plans, but they also include some additional non-medical coverage for such things as hearing and vision.

For example, Blue Shield of California replaced their “standardized” Plan F with a different plan called “Plan F Extra.” Anthem Blue Cross offers two different Plan F Medigap plans, Plan F and “Plan F Innovative,” which also includes some additional coverage for vision and hearing. And Health Net now offers two different Plan F supplements as well, Plan F and “Plan F Innovative.” Blue Shield currently offers two Plan G Medigap plan, Plan G and “Plan G Extra,” and Health Net offers Plan G and and a “Plan G Innovative” plan as well.

As you can see, the recent introduction to these newer innovative plans has made the Medigap marketplace confusing and defeated the purpose of having standardized Medigap plans. It is no longer so easy to compare Medigap plans and benefits because the “extra” and “innovative” benefits are all similar yet slightly different from each other.

The real problem however, is that when someone wants to take advantage of their open enrollment period under the California Birthday Rule, Blue Shield and Anthem Blue Cross do not allow someone with a “regular” Plan F or Plan G to switch to one of their “Extra” or “Innovative” plans. Both of these companies claim that their innovative plans have “richer” benefits, and they do not qualify under the California Birthday Rule.

birthday-rule candles

Furthermore, Blue Shield no longer offers their “regular” Plan F, only their Plan F Extra, so this has prevented anyone with Plan F with a different insurance carrier to switch to Blue Shield’s Plan F during their annual open enrollment period under the birthday rule. And you would think that someone with Blue Shield’s Plan F Extra could switch to Anthem’s Plan F Innovative plan under the California Rule or vice versa around their birthday, but no. Neither carrier will accept these plans during someone’s 30 day open enrollment period because they consider their plans superior to the other carrier’s plan.

NOTE: Health Net has always allowed someone with the “regular” Plan F or Plan G to switch to their Plan F Innovative or Plan G Innovative plans.

As of July 1st, 2020, Blue Shield of California, Anthem Blue Cross, and all insurance carriers are now required to accept any Plan F or Plan G Medigap plans for any of their innovative Medigap plans under the California Birthday Rule! For example, if you have Plan F with Mutual of Omaha, you can now switch to Blue Shield’s Plan F Extra or Anthem’s Plan F Innovative plan under the birthday rule.

Which is Better, Plan F or Plan G?

Many people with Plan F have switched to Plan G because both plans are identical except Plan F covers the Medicare Part B deductible, which is currently $198 per calendar year, and Plan G does not cover the Part B deductible. Other than that, both plans are identical in coverage.

NOTE: The Medicare Part B deductible can change from year to year, but historically, it has never increased significantly.

plan-f-and-plan-g

Since the only difference between Plan F and Plan G is the $198 Medicare Part B deductible, if you can save more than $198 per year on your premiums by switching from Plan F to Plan G, then Plan G ends up being more cost effective.

If you are saving exactly $198 per year, you are breaking even, and you’re better off staying with Plan F. If you are saving $300 or more per year by switching, it will definitely cost you less money by switching from Plan F to Plan G.

NOTE: If you decide to switch from Plan F to Plan G, and you have already met the $198 Medicare Part B deductible for the current year, you would not have to pay that deductible again until the following year.

Conclusion

As of July 1st, 2020, your annual open enrollment period under the California Birthday Rule is increasing from 30 to 60 days after your birthday. Most carriers will let you apply for coverage during the 30 days prior to your birthday, but the effective date of your new policy would normally be the 1st of the month following your birthday. And if you have Plan F or Plan G with another insurance carrier and you want to switch to an “Innovative” plan under the birthday rule with Blue Shield of CA, Anthem Blue Cross,  Health Net, etc., you can now do so.

Since rates vary significantly between insurance carriers for the same identical plan and coverage, it is important to shop around, EVERY YEAR, to make sure that you aren’t paying too much.

As an independent insurance agent specializing in Medicare Supplement (Medigap) insurance, I work with all the major insurance carriers in California and several other states. If you have any questions or if you would like for me to shop around for you to save you money on your Medicare Supplement insurance, please don’t hesitate to let me know.

Ron Lewis
CA Lic# 0B33674
760.525.5769 (Cell)
760.718.1600 (Toll-free)
Ron@RonLewisInsurance.com
www.MedigapExpress.com

Major Medicare Supplement Rate Discrepancies Between Insurance Carriers!

Do you know that Medicare Supplement (MediGap) rates vary significantly between insurance carriers for the same identical plan and coverage? In the US, there are 10 “standardized” Medicare Supplement plans to choose from, plans A through N.

medigap

NOTE: The plans are labeled A, B, C, D, F, G, K, L, M and N to signify the plan differences. (Plans E, H, I and J are no longer available.)

The word “standardized” means that the coverage for Plan F, Plan G, etc. is exactly the same no matter what insurance carrier you have. For example, the coverage for Plan F is exactly the same with Mutual of Omaha, UnitedHealthcare, Blue Shield of CA, Aetna, Cigna, Anthem Blue Cross,  etc.

Although the coverage is exactly the same between insurance carriers for the standardized plans, the PREMIUMS ARE NOT THE SAME! In fact, most people are paying hundreds of dollars per year more for their insurance premiums than they should be!

For example, the Plan F premiums for a 70 year old living in the 92056 zip code in San Diego range in price from $153.98 per month to $264.19 per month. That’s a difference of $110.21 per month or $1,322.52 per year for the same identical plan and coverage! On the following rate sheet, you can see the different Plan F rates for 18 different insurance carriers in the 92056 zip code. Obviously, some carriers are more competitively priced than others!

Mary Jones Plan F Rates_Page_1

Mary Jones Plan F Rates_Page_2

As you can see, in the 92056 zip code, the Plan F rates for a 70 year old range in price from $153.98 per month to $264.19 per month! Again, that’s a difference of $110.21 per month or $1,322.52 per year for the same exact plan and coverage!

It’s Important to Shop Around Every Year!

The Medicare Supplement market is constantly changing, and so are the premiums. If you have a Medicare Supplement and you haven’t shopped around during the last year, there’s a good chance that you’re paying hundreds of dollars a year more for your insurance than you should be! Many people that I meet haven’t shopped around at all since they first signed up for Medicare! Many of these individuals haven’t heard from their insurance agent since then as well!

This past year, two of my clients (a husband and wife) had Plan G, and they were paying $809 per month for both of them, approximately $404.50 each! I shopped around for them and found them Plan G with a different carrier, Mutual of Omaha, and their total monthly premium is now $367.01 per month! That’s a savings of $441.99 per month or $5,303.88 per year! While this is not the norm, I can usually save most of my clients from $300 to $600 per year each on their Medicare Supplement insurance premiums and often more.

What is the Price Range for Plan F Medicare Supplement Rates?

In the following chart, I have taken the lowest and highest Plan F premiums for ages 65 through 90 in the 92056 zip code. As you can see, the monthly and annual differences are significant for every age group.

2 Lowest Plan F vs Highest Plan F

Is There An Open Enrollment Period for Medicare Supplement Plans?

No. Unlike Medicare Advantage (MA) plans, which have an annual open enrollment period from October 15th through December 7th every year, you can shop around and apply for Medicare Supplement plans all year long.

NOTE: There is a six month-open enrollment period for Medicare Supplements when you first sign up for Medicare Part B.

Do I Need to Be In Good Health to Get a New Medicare Supplement Plan?

Unless you are in a Special Enrollment Period (SEP), if you already have a Medicare Supplement, you need to be in relatively good health to apply for a new Medicare Supplement with a different carrier. However, if you have a Medicare Supplement and you apply during the 30 days before or after your birthday, you don’t have to answer any health questions on the application, and you cannot be turned down due to health reasons if you apply for the same plan or another plan with fewer benefits. For more details, please see the California Birthday Rule section below.

Heart

What Happens If I Am Not In Good Health? Can I Still Apply For a New Medicare Supplement Plan?

Yes, absolutely! Because of the California Birthday Rule, if you already have a Medicare Supplement and you have serious health issues, YOU CANNOT BE TURNED DOWN FOR COVERAGE if you apply during the 30 days before or after your birthday.

California Birthday Rule

In California, there is a law called the California Birthday Rule. This law guarantees you the right to apply for a new Medicare Supplement plan EVERY YEAR, as long as you apply during the 30 days following your birthday. This is also known as the annual 30-day open enrollment period.

NOTE: Although the California Birthday Rules specifies that you can apply, REGARDLESS OF YOUR HEALTH, during the 30 days following your birthday without being turned down for coverage, several insurance carriers will let you apply during the 30 days BEFORE or AFTER your birthday!

This is more advantageous for you because the premiums with these carriers are based on your current age when you apply, and your rates will be lower if you apply during the 30 days prior to your birthday. With these carriers, your new rates are also guaranteed and locked in for the first 12 months of your policy, so there won’t be any unexpected rate increases.

NOTE: Not all insurance carriers lock your rates for the first 12 months.

If you want to take advantage of the California Birthday Rule and apply during the 30 days before or after your birthday,  YOU CANNOT BE TURNED DOWN FOR COVERAGE as long as you apply for the same plan that you currently have OR if you apply for a different plan that has fewer benefits. For example, if you have Plan F (the most comprehensive plan) and you want to apply for Plan F with another carrier to save money on your premiums, or if you have Plan F and you want to apply with Plan G, etc.

NOTE: If you apply under the California Birthday Rule, there are no preexisting waiting periods for prior health conditions.

If you are in relatively good health, you can apply for a new Medicare Supplement plan any time of the year. If you have serious health issues, you should take advantage of the California Birthday Rule and apply for coverage during the 30 days before your birthday to save money on your premiums.

Consider Plan G to Save More Money On Your Premiums

Besides shopping around every year to make sure that you aren’t paying too much for your premiums, if you currently have Plan F, you should consider Plan G. Why? Because Plan G is identical to Plan F in EVERY way except you would pay a small $166 Part B (Medical) deductible one time per calendar year. That is the only difference between the two plans!

NOTE: I have an Obamacare Bronze plan, and my individual medical deductible is only $6,000 per year! I would gladly pay $166 per year for my medical deductible!

In other words, the most you would pay for any out-of-pocket expense with Plan G in any calendar year is $166. However, in most cases, you will save significantly more than $166 per year on your premiums, which usually makes Plan G a better value and more cost effective.

NOTE: The Part B (Medical) deductible is subject to change each year, but historically, it has remained stable.

To see the difference in coverage between Plan F and Plan G, please see the following chart:

Medigap Chart Plans F and G

As you can see, when you compare Plan F and Plan G, everything is exactly the same except for the $166 Part B deductible. Plan F has no deductible, and Plan G is basically Plan F with a small, $166 deductible.

Price Differences Between Plan F and Plan G

Although the two plans are almost identical in coverage, the rates for Plan G are usually significantly less than the Plan F rates. For a 70 year old in the 92056 zip code, the Plan F rates (above) range in price from $153.98 per month to $264.19 per month. The Plan G rates (below) range in price from $132.64 per month to $152.32 per month!

Plan F or Plan G

Plan G Rates Age 70

As you can see, the Plan G rates are significantly less than the Plan F rates for almost the same identical coverage.

Conclusion

The rates vary significantly from one insurance carrier to the next for the same identical plan and coverage. I recommend that you take advantage of the California Birthday Rule and shop around, every year, to make sure that you aren’t paying too much for your insurance. I would also suggest that you check out Plan G as another way to save a lot of money on your insurance premiums.

If you have any questions, or if you would like a free, no obligation quote, please don’t hesitate to let me know! I’m always happy to help!

Ron Lewis OHCC AD

Also, your feedback and comments are appreciated!

Thanks!

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

Save Money On Your Medicare Supplement by Comparing Rates Each Year

One of the most rewarding parts of my job is helping my clients save money on their Medicare Supplement (Medigap) insurance premiums. Most of the time, I can usually save individual clients at least $30 to $50 per month ($360 to $600 per year) on their premiums. Occasionally, I have saved them as much as $1,000 to $1,200 per year on their premiums!

medigap

I don’t mean to come across as bragging, because I’m not. However, I am very happy and excited because this past week I was able to save one of my clients (a husband and wife on a fixed income) over $5,300 per year on their Medicare Supplement premiums!  I was able to do this just by simply switching them to the same exact plan that they had, but with a different carrier!

They had Plan G with another company for quite a few years, and they were very happy with the company and their coverage. Their insurance rates were very low when they originally took out their plans, and the company always paid their claims promptly and without a problem, just as most Medicare Supplement insurance companies do. However, over time, their rates crept up, slowly but steadily. Until this past week when they called me, they didn’t realize that they were literally paying thousands of dollars more for their insurance than they should be!

Most people shop around every year or two and compare rates on their auto and homeowner’s insurance. Medicare Supplements are no different. If you have a Medicare Supplement plan, it is critically important that you shop around every year and compare rates between various companies because insurance rates vary significantly from one carrier to the next for the same identical plan and coverage. For example…

For a 72 year old female living in the 92056 zip code, the current Plan F rates range from $164.06 per month to $245.50 per month! That is a difference of $81.44 per month or $977.28 per year more for the same exact insurance coverage!

Attained Age

In California, Medicare Supplement insurance premiums are based on attained age. This means that as you get older, your rates usually continue to go up every year. Many companies start off at the “younger” ages (65 to 70) with very competitive rates, but over time, the rates continue to go up. Every company is different, and some companies raise their rates a lot more than others.

If you become complacent and don’t shop around every year to compare rates, you are probably paying hundreds or even thousands of dollars more per year on your insurance premiums than you should be!

California Birthday Rule

In California, there is a law called the California Birthday Rule. This law allows anyone with a Medicare Supplement to switch to another insurance carrier every year within 30 days of their birthday (before or after), REGARDLESS OF THEIR HEALTH and without medical underwriting, if another insurance carrier is offering the same plan, such as Plan F, at a lower rate. During the annual 30-day open enrollment period, you are also guaranteed the right to switch to a “lesser” plan, such as from Plan F to Plan G, etc.

CA Birthday Rule

If you have a Medicare Supplement plan, you are guaranteed the right to shop around every year within 30 days of your birthday to save money on your insurance premiums. During this period, you cannot be turned down for coverage, regardless of your health.

You Can Apply for Medicare Supplement Plans All Year Long

Unlike Medicare Advantage plans that have an Annual Enrollment Period (AEP) from October 15th to December 7th every year for a January 1st effective date, you can apply for Medicare Supplement plans all year long. The only difference is that if you apply using the California Birthday Rule within 30 days of your birthday, you do not have to answer any of the health questions on the application, and you cannot be turned down for coverage due to health conditions.

If you apply for a Medicare Supplement plan any time of the year other than during your annual 30-day open enrollment period, you will have to answer the health questions on the application, and if you have certain health conditions, you could be turned down for coverage. If you are in relatively good health, you should not have any problem qualifying for a Medicare Supplement plan.

Guaranteed Issue Situations In California

In California, there are certain circumstances when you would qualify for a Medicare Supplement due to a guaranteed issue situation.

CA Bear

If you can answer YES to any of the following questions, you may be eligible for guaranteed issue:

  1. Has your employer-sponsored retiree plan that is supplementing Medicare involuntarily terminated?
  2. Has your employer-sponsored retiree plan stopped providing Medicare supplement benefits or the Medicare Part B 20% coinsurance for services?
  3. Have you lost eligibility for an employer-sponsored retiree plan due to divorce or death of a spouse or family member?
  4. Has your Medicare Advantage plan increased your premium or co-payments by 15% or more, reduced your benefits, or terminated its relationship with your medical provider who was treating you?
  5. Have you moved out of the area of your MA plan or Program for All-Inclusive Care for the Elderly (PACE) organization?
  6. Has your MA plan, Medicare SELECT Plan, PACE provider or any other health plan under contract with Medicare: (a) committed fraud; (b) ended or lost its contract with Medicare; (c) misrepresented the plan you bought, or (d) failed to meet its contractual obligations to Medicare beneficiaries, as determined by the federal government?
  7. Did you join a MA plan or PACE organization when you first became eligible for Medicare at age 65, and you want to switch to a Medicare Supplement policy during your first 12 months in the MA plan or PACE organization?
  8. Have you switched from a Medicare Supplement policy to a MA plan, PACE organization, Medicare SELECT plan, or any other health care organization contracting with Medicare, for the first time since becoming eligible for Medicare within the past 12 months?
  9. Has your MA plan left your area, and if so, did your MA plan benefits end within the past 123 days?

NOTE: Many people with Medicare Advantage plans who have serious health issues can still qualify for a guaranteed issue Medicare Supplement plan. See item #4 above.

What Insurance Carriers Do I Work With?

As a licensed independent insurance agent, I work with ALL the major insurance carriers in California. Most importantly, I WORK FOR YOU, not a particular insurance company! I’m also licensed in Arizona, Colorado, Nevada, and Washington state. Here are some, but not all, of the Medicare Supplement insurance carriers that I work with:

  • Aetna
  • Anthem Blue Cross
  • Blue Shield of California
  • Cigna
  • Health Net
  • Humana
  • Individual Assurance Company (IAC)
  • Mutual of Omaha
  • Oxford
  • Stonebridge
  • Transamerica
  • UnitedHealthcare (AARP)
  • United of Omaha

Let Me Do the Shopping For You!

While it is unusual for me to be able to save most of my clients over $5,300 per year on their annual insurance premiums like I did this past week, it is not unusual for me to give someone a free, no obligation quote and save them anywhere from $300 to $500 per year on their Medicare Supplement premiums. That happens quite frequently.

As an independent insurance agent, I have access to insurance quote engines and other information that is not available to the public. You should take advantage of my knowledge and experience and let me do the shopping for you to save you money on your insurance premiums.

grocery-shopping-cartIf you have a Medicare Supplement plan, please contact me for a free, no obligation quote. More than likely, I will save you hundreds of dollars on your Medicare Supplement insurance premiums.

As one of my clients, I will contact you every year, about a month before your birthday, and I will let you know what the best rates are at that time. You always have the option to either keep your current plan, or you can take advantage of the California Birthday Rule and change carriers if another company is offering better rates.

Either way, I strive to build trust and relationships with my clients. I will not do a magic act and disappear after you have your new policy, 😉 and you will always have the peace of mind knowing that you are not paying hundreds or even thousands of dollars more than you should be for your Medicare Supplement insurance.

If you have any questions, or if you or anyone that you know would like a free Medicare Supplement quote, please contact me at (760) 652-6060 or toll-free at (866) 718-1600. You can also reach me by email at Ron@RonLewisInsurance.com. Your questions and feedback are always welcome!