If you’re just turning 65 or newly eligible for Medicare, the Birthday Rule doesn’t apply yet—you need to be in a Medigap plan for at least 12 months first.
But here’s what you should know:
During your Medigap Open Enrollment Period (the 6 months starting when you’re 65 and enrolled in Part B), you can choose any Medigap plan with no health questions. This is your chance to pick the right plan from the start.
Then, after your first birthday on a Medigap plan, you’ll have Birthday Rule rights every year going forward.
If you’re a California Medicare beneficiary with a Medigap plan, you have a powerful right that most Americans don’t: the Birthday Rule. This little-known provision gives you a special 60-day window each year to switch your Medigap coverage without medical underwriting—and it could save you thousands of dollars or get you better coverage.
Let me explain how this works, why it matters, and how you can use it to your advantage.
What Is the California Medicare Birthday Rule?
The California Birthday Rule is a state law that allows you to switch your Medigap (Medicare Supplement) plan once a year during a 60-day window that begins on your birthday. During this period, you can move to any Medigap plan with equal or lesser benefits without answering health questions or going through medical underwriting.
This is huge. In most states, if you want to switch Medigap plans after your initial enrollment period, insurance companies can—and often do—deny you based on your health conditions. But California protects you with this annual opportunity.
Here’s What Makes It Special:
- No health questions asked during your Birthday Rule period
- You cannot be denied coverage based on pre-existing conditions
- Available every single year on your birthday
- Applies to all Medigap plans offered in California
- You can switch carriers or just change plans with your current carrier
In addition, Medicare covers end-stage renal disease (ESRD) and provides comprehensive care for patients who have suffered a stroke.
When Exactly Is Your Birthday Rule Window?
Your Birthday Rule window starts on your birthday and lasts for 60 days. Let’s say your birthday is March 15th:
- Your window begins: March 15th
- Your window ends: May 13th (60 days later)
You’ll want to apply during this timeframe, with your new coverage typically starting the first of the month after your application is approved.
Pro tip: Don’t wait until day 59 to start shopping. Give yourself time to compare options, gather quotes, and complete the application process comfortably.
Who Can Use the Birthday Rule?
The Birthday Rule is available to California residents who:
- Already have a Medigap plan (you can’t use it to get your first Medigap policy)
- Have been covered for at least 12 months by their current Medigap plan
- Want to switch to equal or lesser benefits
That last point is important. You can move “down” in coverage (like from Plan G to Plan N) or switch to a similar plan with another carrier, but you cannot use the Birthday Rule to upgrade to a plan with more comprehensive benefits.
Equal or Lesser Benefits: What Does That Mean?
California law defines a hierarchy of Medigap plans based on their benefit levels. Here’s how they generally rank from most comprehensive to least:
Most Comprehensive:
- Plan A (basic coverage)
- Plan F (if eligible—only for those who qualified before 2020)
- Plan C (if eligible—only for those who qualified before 2020)
- Plan G
- Plan G with High Deductible
- Plan N
Most Comprehensive:
- Plan K
- Plan L
- Plan M
You can move down this list or sideways to a similar plan, but not up. For example:
- ✅ Plan G → Plan N (allowed)
- ✅ Plan G → High Deductible Plan G (allowed)
- ✅ Plan F → Plan G (allowed)
- ❌ Plan N → Plan G (not allowed under Birthday Rule)
Why Would You Want to Switch Plans?
Great question. Here are the most common reasons California beneficiaries use their Birthday Rule:
1. Lower Your Premiums
Medigap premiums increase as you age, and some carriers raise rates more aggressively than others. If you’ve been with the same carrier for years, you might be paying significantly more than new customers pay elsewhere.
During your Birthday Rule period, you can shop around and potentially save $50, $100, even $200+ per month by switching to a more competitively priced carrier—without losing coverage.
2 Switch to a High Deductible Plan
High Deductible Plan G has become incredibly popular because of its low monthly premiums. For 2026, you’ll pay the first $2,870 of your Medicare-covered costs out of pocket, but after that, the plan covers everything at 100%.
If you’re healthy and don’t use medical services frequently, this can save you thousands annually compared to standard Plan G.
3 Change Carriers Due to Poor Service
Sometimes you’re just not happy with your insurance company’s customer service, claims processing, or other aspects of their operation. The Birthday Rule lets you take your business elsewhere without penalty.
4 Find Better Rate Stability
Some carriers are known for smaller, more predictable rate increases over time. If your current carrier has hit you with several large increases, switching to a company with better rate stability can provide peace of mind and long-term savings.
How to Use Your Birthday Rule: Step-by-Step
Here’s how to make the most of this opportunity:
Step 1: Mark Your Calendar
Set a reminder 30-45 days before your birthday. This gives you time to shop before your window opens.
Step 2: Review Your Current Coverage
Take a look at:
- What you’re currently paying in monthly premiums
- Which Medigap plan you have
- How satisfied you are with your current carrier
- Your expected healthcare needs for the coming year
Step 3: Shop and Compare Plans
During your Birthday Rule window, you can:
- Get quotes from multiple carriers
- Compare identical plans (like Plan N from different companies)
- Consider moving to a different plan level (like switching from Plan G to High Deductible Plan G)
Important: Make sure you’re comparing apples to apples. A Plan G from one carrier covers the exact same things as Plan G from another—the only differences are price and customer service.
Step 4: Apply During Your 60-Day Window
Once you’ve found a better option:
- Complete your application during your Birthday Rule period
- You do not need to cancel your old plan first
- Your new coverage typically begins the first of the month after approval
- Once your new coverage starts, cancel your old plan
Step 5: Verify Everything
After your new plan is active:
- Confirm your new coverage started
- Cancel your old Medigap plan in writing
- Keep documentation of both the new enrollment and old cancellation
Common Birthday Rule Mistakes to Avoid
After helping hundreds of Californians navigate this process, I’ve seen these mistakes come up again and again:
Mistake #1: Canceling Your Old Plan First
Never cancel your existing coverage before your new plan is approved and active. You don’t want any gap in coverage.
Mistake #2: Missing the Window
Life gets busy, and 60 days goes by quickly. Set multiple reminders so you don’t miss your opportunity.
Mistake #3: Trying to Upgrade Coverage
Remember, you can only move to equal or lesser benefits. Trying to upgrade won’t work under the Birthday Rule.
Mistake #4: Not Shopping Around
Some people assume switching isn’t worth the hassle. But saving $1,200-$2,400 a year is worth a few hours of research and paperwork.Mistake #5: Believing You’re “Too Old” to Switch
Your Birthday Rule rights don’t expire. Whether you’re 65 or 95, you have this protection every single year.
Real-World Birthday Rule Example
Let me share a real scenario (with names changed for privacy):
Margaret’s situation:
- Age 72, living in San Diego
- Had Plan G with Carrier A for 8 years
- Paying $247/month ($2,964/year)
- Healthy, rarely meets her Part B deductible
Margaret’s situation:
- Compared Plan G rates from other carriers
- Found Plan G with Carrier B for $185/month
- Also explored High Deductible Plan G at $75/month
Margaret’s decision:
She switched to High Deductible Plan G at $75/month, saving $172/month ($2,064/year). Even with the $2,870 deductible, her worst-case scenario was still better than what she’d been paying, and in a typical year where she has minimal healthcare costs, she pockets most of those savings.
Birthday Rule vs. Other California Rights
California actually gives you several Medigap protections:
Birthday Rule: Switch to equal or lesser coverage annually, during 60 days starting on your birthday
California Guarantee Issue Rights: If you lose other coverage (like employer insurance or Medicare Advantage), you get 63 days to enroll in any Medigap plan without underwriting
These work together to give California beneficiaries more flexibility than anywhere else in the country.
What If You’re New to Medicare in California?
If you’re just turning 65 or newly eligible for Medicare, the Birthday Rule doesn’t apply yet—you need to be in a Medigap plan for at least 12 months first.
But here’s what you should know:
During your Medigap Open Enrollment Period (the 6 months starting when you’re 65 and enrolled in Part B), you can choose any Medigap plan with no health questions. This is your chance to pick the right plan from the start.
Then, after your first birthday on a Medigap plan, you’ll have Birthday Rule rights every year going forward.
Frequently Asked Questions
Q: Can I use the Birthday Rule if I have Medicare Advantage instead of Medigap?
No, the Birthday Rule only applies to Medigap plans. However, if you want to switch from Medicare Advantage to Medigap, California does offer some protections depending on your situation.
Q: Do I have to switch every year?
Not at all. The Birthday Rule is an option, not a requirement. If you’re happy with your current plan and rate, you can stay put.
Q: What if I apply during my Birthday Rule window but the insurance company delays the approval?
As long as you applied during your 60-day window, you’re protected. The carrier cannot deny you based on health, even if the approval process extends beyond your birthday window.
Q: Can I switch multiple times using the Birthday Rule?
Technically yes, but practically speaking, most people use it once per year if needed. You must be in your new plan for at least 12 months before using the Birthday Rule again.
Q: Will my rates go up if I switch carriers?
Your new carrier will price your plan based on their current rates for your age. Sometimes you’ll pay less, sometimes more—that’s why shopping around is so important.
Why This Matters More Than Ever in 2026
Medigap premiums have been rising steadily, and 2026 is no exception. Many carriers are implementing rate increases of 8-15% or more. At the same time, competition among carriers means there are often significantly better deals available if you’re willing to shop.
The Birthday Rule is your protection against being locked into expensive coverage. It ensures that California beneficiaries can always seek better value without being penalized for health conditions.
How an Independent Agent Can Help
Navigating the Birthday Rule doesn’t have to be complicated, but it does require:
- Understanding which plans you’re eligible to switch to
- Comparing rates from multiple carriers
- Timing your application correctly
- Ensuring you don’t have any gaps in coverage
As an independent Medicare broker, I work with 40+ carriers and can show you all your options side-by-side. I’ll help you understand:
- What you’re currently paying vs. what’s available
- Whether switching makes sense for your situation
- The pros and cons of different plan options
- How to complete the application process smoothly
My services are completely free carriers pay me the same commission regardless of which plan you choose, so my job is simply to help you find the best fit.
Take Action During Your Birthday Window
If your birthday is coming up in the next few months, now’s the time to start looking at your options. Even if you’re perfectly happy with your current plan, it’s worth 30 minutes to see what else is available.
The worst-case scenario? You discover you already have a great deal and stay put. The best-case scenario? You save thousands of dollars or get coverage that better fits your needs.
That’s the beauty of California’s Birthday Rule—it gives you the freedom to choose what works best for you, year after year.
Ready to explore your Birthday Rule options? Contact me for a free, no-pressure review of your current coverage and available alternatives. I’ll walk you through everything and help you make the most of your California rights.
This guide is for educational purposes. Medicare rules and plan availability can change. Always verify current information before making enrollment decisions.
