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How the California and Oregon “Birthday Rule” Can Save You Money

Insurance premiums are spiraling out of control, but that doesn’t mean you have to pay high prices — it just means you need to shop around. We shop around to buy a house. We shop around to buy a car. We even shop around when it comes to groceries, so why not shop around for health insurance?

It is uncommon to have a guarantee-issue enrollment period for Medicare supplement plans unless you are in your initial enrollment period when you turn 65. Oregon and California, however, offer a guarantee-issue enrollment period every year that falls under the “birthday rule.”

Lower Premiums = More Money in Your Pocket

Under the birthday rule, current policy holders can shop around for another Medicare supplement plan in an effort to lower their premiums. You can begin shopping 30 days before your birthday, and the deadline ends 30 days after your birthday. The significance of this enrollment period is that you can obtain a new policy guarantee-issue. You don’t have to undergo underwriting, and you don’t have to qualify for a plan. Pre-existing conditions or age can’t be held against you. This ultimately results in lower premiums.

Save Money Without Sacrificing Benefits

To be eligible for the birthday rule, you must already have a Medicare supplement plan in force. When choosing your new plan, you must choose a plan that provides equal or lesser benefits than your current plan. For example, if you currently have Plan F, the highest Medigap coverage available, you can switch to any plan. However, if you currently have Plan B, you can only switch to either Plan A or another company’s Plan B.

Below is a chart example that further explains your options when switching from one plan to another of equal or lesser benefits:

If you have: You may replace it with:
Medicare Supplement Plan A Medicare Supplement Plan A
Medicare Supplement Plan B Medicare Supplement Plan A, B
Medicare Supplement Plan C Medicare Supplement Plan A, B, C, D, K, L, M or N
Medicare Supplement Plan D Medicare Supplement Plan A, B, D, K, L, M or N
Medicare Supplement Plan F (not high-deductible plan F) Any Medicare Supplement Plan (except for Innovative F plan)
Medicare Supplement Plan FHigh-Deductible Medicare Supplement Plan FHigh-Deductible
Medicare Supplement Plan K Medicare Supplement Plan K
Medicare Supplement Plan L Medicare Supplement Plan K or L
Medicare Supplement Plan M Medicare Supplement Plan M or N
Medicare Supplement Plan N Medicare Supplement Plan N

 

Frequently Asked Questions About the Birthday Rule Open Enrollment Period

Q: Why should I consider changing Medicare supplement plans?

A: To decrease your premiums and save money. We believe in saving you, the consumer, money and keeping as much money as possible in your pocket—where it belongs. The reality is, premiums go up. By taking advantage of a guarantee-issue enrollment period, you can get a new plan regardless of any pre-existing conditions and therefore reduce your premiums.

Q: How complicated is it to switch plans?

A: We believe in taking the complexity of insurance and making it easy to understand and hassle-free. Our Personal Advisors use the information you provide to gather plan information and help you compare plans that best fit your needs and save you the most money. They will help you with your application and keep you updated on its progress.

Q: When will my policy take effect?

A: Your policy takes effect no sooner than your actual birthday. In California, your policy must be effective within 30 days after your birthday. In Oregon, your policy becomes effective the first day of the month following the application date.

Q: When can I cancel my old policy?

A: To avoid a lapse in coverage, do not cancel your old policy until you know for sure your new policy is in effect. At MediGap Advisors, we will advise you when the appropriate time is to cancel your old policy.

Q: How do I know what plans I can change to?

A: You can choose a plan from any company; however, you must choose a plan that offers the same or equal benefits as your current plan. The above chart provides more extensive examples of what plans you can switch to in relation to your current plan. For example, if you currently have Plan B, you cannot switch to a Plan F as it offers more benefits than your Plan B. Your Personal Advisor can provide plans that satisfy these guidelines and save you money in the process.

Q: What if I have a lot of health problems? Can I be denied?

A: No, you can’t be denied. You definitely want to consider your options during this enrollment period. The birthday rule allows you to purchase a new policy guarantee-issue, regardless of any current or past health problems, and your premiums will not be affected.

Q:    Is there a waiting period?

A: No. Since pre-existing conditions are not considered, there is no waiting period.

Q: What if I don’t like my new plan—can I switch back to my old plan?  

A: You can switch Medicare supplement plans at any time during the year; however, if you are not within a guarantee-issue enrollment period, you could be subject to underwriting and therefore higher premiums.

Q: Is someone going to want to come to my house?

A: Absolutely not. Any information needed can be provided by phone. Once you have an appointment set up with your Personal Advisor, you will have plenty of time during your appointment to discuss the process, provide the information needed, and review plans and rates. Your Advisor will also help with your application.

Q: How much time is this going to take?

A: By scheduling using your Personal Advisor’s calendar, you can schedule a time that is convenient for you. Your Advisor will already have plans prepared for you to review and will just need to ask you a few questions. You will then complete your application, and your Advisor will send it on for processing and keep you informed of its status.

Q: Where do I start?

A: You have several options: You can start with a simple phone call to a Personal Advisor at MediGap Advisors, or call 1-866-323-1441. You can also run an instant quote or schedule an appointment on your Personal Advisor’s schedule. Our staff is kind and well-trained, and won’t throw you into the web of touchtone options. Our Personal Advisors have substantial experience and expertise in the field of Medicare supplement plans; they believe everyone should be provided the tools to make an informed decision about their health care.

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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