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 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 stay with your current carrier
When Exactly Is Your Birthday Rule Window?
Your Birthday Rule window starts on your birthday and lasts for 60 days. For example, if your birthday is March 15th:
- Begins: March 15th
- Ends: May 13th (60 days later)
Your new coverage usually begins on the first of the month after your application is approved.
Pro tip: Start shopping early—don’t wait until the last few days.
Who Can Use the Birthday Rule?
The Birthday Rule is available to California residents who:
- Already have a Medigap plan
- Have had their current Medigap plan for at least 12 months
- Want to switch to equal or lesser benefits
You cannot use the Birthday Rule to upgrade to a higher-benefit plan.
Equal or Lesser Benefits: What Does That Mean?
California ranks Medigap plans from most comprehensive to least:
Most Comprehensive:
- Plan A
- Plan F (if eligible before 2020)
- Plan C (if eligible before 2020)
- Plan G
- Plan G High Deductible
- Plan N
Less Comprehensive:
- Plan K
- Plan L
- Plan M
Examples:
- ✅ Plan G → Plan N (allowed)
- ✅ Plan G → High Deductible G (allowed)
- ❌ Plan N → Plan G (not allowed)
Why Would You Want to Switch Plans?
1. Lower Your Premiums
Premiums rise with age. Switching can save you $50–$200+ monthly.
2. Switch to a High Deductible Plan
High Deductible G has low premiums and full coverage after the deductible.
3. Change Carriers Due to Poor Service
4. Find Better Rate Stability
Some carriers raise premiums less aggressively than others.
How to Use Your Birthday Rule: Step-by-Step
Step 1: Mark Your Calendar
Set a reminder 30–45 days before your birthday.
Step 2: Review Your Current Coverage
- Your monthly premiums
- Your current Medigap plan
- Your satisfaction with your carrier
- Your expected healthcare needs
Step 3: Shop and Compare Plans
- Get quotes
- Compare identical plans
- Consider moving to a lower-benefit plan
Step 4: Apply During Your 60-Day Window
- Apply before your window ends
- Do not cancel your old plan first
Step 5: Verify Everything
- Confirm your new coverage
- Cancel your old plan in writing
- Keep documentation
Common Birthday Rule Mistakes to Avoid
- Canceling your old plan first — always wait for approval.
- Missing the 60-day window — set reminders.
- Trying to upgrade coverage — not allowed.
- Not shopping around — many save $1,200–$2,400 per year.
- Thinking you’re too old to switch — your rights never expire.
Real-World Example
Margaret, age 72
- Plan G premium: $247/month
- Found Plan G: $185/month
- High Deductible G option: $75/month
Final decision: Switched to High Deductible G → saves $2,064/year.
Birthday Rule vs. Other California Rights
Birthday Rule: switch annually to equal/lower coverage.
Guarantee Issue Rights: 63-day window if you lose other coverage.
What If You’re New to Medicare?
You cannot use the Birthday Rule until you’ve had a Medigap plan for 12 months.
During your Medigap Open Enrollment (first 6 months after enrolling in Part B), you can choose any plan with no health questions.
Frequently Asked Questions
Can I use the Birthday Rule with Medicare Advantage?
No. It applies only to Medigap.
Do I have to switch every year?
No. It’s optional.
What if approval is delayed?
You’re protected as long as you applied during the 60-day window.
Can I switch multiple times?
Yes, once per year after 12 months on your plan.
Will my rates go up if I switch carriers?
Possibly — compare prices carefully.
Why This Matters in 2026
Premiums rising 8–15% makes the Birthday Rule more valuable than ever.
How an Independent Agent Can Help
- Compare plans from 40+ carriers
- Check your savings potential
- Recommend the right plan
- Help with timing and applications
My services are completely free—carriers pay me, not you.
Take Action During Your Birthday Window
Your birthday month is your chance to save. Even if you’re happy with your plan, it’s smart to compare options.
Ready to explore your Birthday Rule options? Contact me for a free, no-pressure review.
This guide is for educational purposes. Always verify current Medicare rules.
