Short answer: If you already have a Medicare supplement (Medigap) policy in California, you get a 60-day open enrollment period each year starting on your birthday. During it, you can buy another Medigap policy with the same or lesser benefits, including from a different insurer, without medical screening or a new waiting period (Insurance Code §10192.11).
How the rule works
| Item | Rule | Source |
|---|---|---|
| Who it's for | People who already have a Medigap policy | Insurance Code §10192.11 |
| When | A 60-day window each year beginning on your birthday | California Department of Insurance senior advisory |
| What you can buy | A Medigap policy with the same or lesser benefits | CDI |
| Underwriting | No medical screening and no new waiting period | CDI |
"Lesser benefits" means you can move to a plan that covers the same or less than your current plan. The California Department of Insurance notes the law specifies which current plans are treated as equal to older plans.
Why it matters
Medigap premiums vary by insurer for the same standardized plan. The birthday rule lets you shop each year without being turned down for health reasons, as long as you don't add benefits.
Checklist
- Mark your birthday window and compare premiums for your current plan letter a few weeks ahead.
- Apply within the 60 days. Outside the window, the birthday-rule protection doesn't apply.
- Don't cancel your current policy until the new one is approved and in force.
- Get free counseling from HICAP at 1-800-434-0222, as the Department of Insurance recommends.
Related: long-term care insurance and the retirement insurance checklist.
Frequently asked questions
What is the California birthday rule for Medigap?
If you already have a Medigap policy, you get 60 days each year starting on your birthday to buy a Medigap policy with the same or lesser benefits without medical screening or a new waiting period (Insurance Code §10192.11).
Can I switch to a different insurance company under the birthday rule?
Yes. The new policy can be from a different insurer as long as its benefits are the same as or less than your current policy's.
Can I upgrade to a plan with more benefits?
Not under the birthday rule. It applies only to equal or lesser benefits.
Who can help me compare Medigap plans for free?
HICAP, California's Health Insurance Counseling and Advocacy Program, at 1-800-434-0222.
Alishahi Insurance · 439 N Canon Dr, Penthouse, Beverly Hills, CA 90210 · (877) 711-4545 · CA License #4348151. General information only. Not legal, tax or financial advice, and not a coverage determination. Coverage depends on policy language and underwriting, and rules vary by state.