Medigap’s “Birthday Rule” is Extended to 60 Days

Medigap’s “Birthday Rule” is Extended to 60 Days

Want to change to a different Medigap plan? If you live in California and have a Medigap plan, you can. Our state law allows you an opportunity to buy certain plans without a health screening each year starting on your birthday for at least 60 days. This window used to be 30 days, but, thanks to the passage of SB 407 (Monning) in 2019, this Medigap “Birthday Rule” has been extended to 60 days as of January 1, 2020.

How does it work?

If you already have a Medigap plan, you can choose a plan from any company, but are limited to one that has the same or fewer benefits than your current plan. For example, if you already have Plan C, you may switch to another Plan C, but not to a Plan G. Note that companies can offer you a plan with more benefits if they choose, but they are not required to do so.

Also, additional or “innovative benefits” that some companies add to one or more of the standardized Medigap plans may not be consider greater benefits than the same lettered plan without those “innovative benefits”. This means that, for example, if you have Medigap Plan F with company X and want to switch to Medigap Plan F with company Y that has also added some innovative benefits to their Plan F, you by law must be allowed to make that switch. (Note that if you buy one of those plans with extra benefits, you should see a separate line item for the cost of those extra benefits on your Medigap premium bill.)

We have already heard some cases of beneficiaries being denied this right. If that happens, please contact your local Health Insurance Counseling and Advocacy Program (HICAP) for assistance at 1-800-434-0222.

For more information, view our Medigap section online.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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