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California Medicare Plans, Enrollment Period & More

Not surprisingly, California is the most populous state in the United States! Between the large well-known areas of Los Angeles, San Francisco, San Diego, and more, the amount of people who move to and live in California seems to be continuously growing. Therefore, it comes as no surprise that there are also a lot of Medicare-age residents in California trying to navigate the complex world of retirement! If you live in California and plan to enroll in Medicare, or if you are already enrolled, it is important to understand the timelines, rules, and options available to you!

What is the California Medicare Birthday Rule?

If you have a Medicare supplement plan in California, you can change plans once a year without medical underwriting.

When Does the Birthday Rule Apply?

The California birthday rule starts 30 days before your birthday and ends 30 days after your birthday. All changes must occur within this time period.

Who Can Use the Birthday Rule?

Anyone currently enrolled in a Medicare supplement plan can use the birthday rule. The birthday rule does not apply for those enrolled in a Medicare Advantage plan.

What are Medicare Options in California?

California, like most other states, offers the standard Medicare Supplement plans, also known as Medigap plans. If you are a resident, you can choose from the following plans: A, B, C, D, F, G, H, K, L, M, N, high-deductible Plan F, and high-deductible Plan G. You’re able to enroll during the year, but if you want your coverage to be guaranteed, you want to enroll during your open enrollment period in California. Luckily, unlike many other states, every year California residents are given the option to change their Medicare Supplement plan with no medical underwriting.

What are the Most Popular Medicare Supplement Plans in California?

  1. Medicare Supplement Plan F
  2. Medicare Supplement Plan G
  3. Medicare Supplement Plan N

When is the Open Enrollment Period in California?

Like all the other states, at age 65, you become eligible to enroll into Medicare. Beginning three months before your birthday, including your birth month, and ending three months after your birthday is a period known as your Initial Enrollment Period (IEP). This is the period that you can first enroll into Medicare Parts A and B. If you continue to work past age 65 and delay your Medicare enrollment, you may also qualify for what is known as a Special Enrollment Period (SEP) when you retire and leave your employer’s insurance.

Whether you enroll in Medicare at age 65, or after retirement, this is also the prime time to enroll in a MediGap plan. You have 6-months from your Medicare Part B effective date to enroll into a Medicare Supplement plan with no medical underwriting. This means that insurance companies are required to accept you into their plans and cannot deny you based on your medical history or pre-existing conditions. 

Can I Change Medicare Supplement Plans in California?

California Birthday Rule 

California is one of few states that gives Medicare Supplement plan enrollees the ability to change their MediGap plans once per year with no medical underwriting. This is known as the California Birthday Rule.california-birthday-rule

The California Birthday Rule begins 30 days before your birthday and ends 30 days after your birthday. This gives you a total of sixty days around your birthday to change your MediGap plan. Like all good things, however, there are a few rules to remember. The first rule is that you must already be enrolled in a Medicare Supplement plan to take advantage of the Birthday Rule. This means that people with no additional coverage or Medicare Advantage plans do not qualify. The second rule is that you must change your plan to one of equal or lesser coverage. Essentially you can change from one Plan G to another Plan G, or down to a Plan N, but you cannot use this rule to change from a Plan N to a Plan G.

Changing MediGap Plans without California Birthday Rule

Outside of using the California Birthday Rule, changing Medicare Supplement plans in California follows the same guidelines as most other states. Once you are more than 6 months past your Medicare Part B effective date, you must go through medical underwriting in order to be approved to enroll into or change your Medicare Supplement plan. This means that insurance carriers are given the ability to assess your health history, prescriptions, height and weight, as well as other health-related factors to determine if you will be approved or denied coverage. During medical underwriting, insurance carriers have the ability to deny a Medicare Supplement plan application based on pre-existing conditions, so it is important to enroll in a MediGap plan during your open-enrollment period to guarantee your acceptance.

Medigap Plan F in California

Medicare Supplement Plan F has been a very popular plan with Medicare beneficiaries over time. The reason for the popularity of Plan F, is that it covers the gaps left by Medicare Part A and B with no out-of-pocket. However, if you became Medicare eligible after January 1st 2020, you are not eligible to enroll in MediGap Plan F. Luckily, there are other great Medicare Supplement plan options available.

Medigap Plan G in California

Medicare Supplement Plan G is a very comprehensive Medicare Supplement plan with very little out-of-pocket expense. Once you have met your Part B annual deductible, MediGap Plan G becomes a full coverage plan, covering all of the gaps left by Original Medicare, with no additional out-of-pocket expenses. Plan G is typically a very cost-efficient plan with an affordable monthly premium to ensure gold-standard coverage.

Plan G can be a very good choice in California. It's a great plan but we may also be able to find better value. Give us a call and we will look through all options.
Keith Armbrecht
Medicare on Video

Medigap Plan N in California

Medicare Supplement Plan N is also a great, comprehensive MediGap plan available in California. This plan has slightly more out-of-pocket cost than MediGap Plan G, but also comes with a lower monthly premium. As with Plan G, you are still responsible for the Medicare part B annual deductible. Once you have met this deductible, your Original Medicare coverage kicks in, but you still have some cost-share. With MediGap Plan N, you will pay copayments up to $20 for office visits, and up to $50 for ER visits that do not result in an inpatient admission. Plan N also has the possibility of an excess charges if you use a doctor or healthcare provider that does not accept Medicare Assignment. Excess charges can be up to 15% of the Medicare-approved payment. If the monthly premium difference between Plan G and Plan N is large enough, Plan N is often times a very attractive option for your Medicare Supplement plan.

What is the Cost of a Medicare Supplement Plan in California?

Monthly premiums for Medicare Supplement plans are based on three main factors- age, gender, and location. There are other things that may impact your premium such as tobacco use. The premium amounts will vary based on these factors, so it is important to receive a quote based on your specific demographic information.

Medicare Plans in California for Those Under 65

If you have a disability before reaching 65, you have the right to buy a supplement plan within the first six months of being covered by Part B. The only exception is if you’ve been diagnosed with ESRD or kidney failure. Even though you can buy a plan, carriers can charge a higher premium, so these rates may often be higher. If they’re too expensive, consider a Medicare Advantage Plan.

Once you reach 65, more Medicare supplement plans will open up for enrollment in California without any health questions. This period guarantees acceptance.

Medicare Advantage in California

California also offers options for Medicare Advantage plans. In these plans you must live in your plan’s service area and enroll during an appropriate election period.  Medicare Advantage plans do not required medical underwriting if enrolling during an election period, but are also significantly different plans than Medicare Supplement plans.

Medicare and Medicaid in California

It is possible to qualify for both Medicare and Medicaid in the state of California. These two programs, however, are separate and have different qualifications you must meet in order to receive benefits. To qualify for Medicaid, you must meet California state income requirements. To qualify for Medicare, you must be either over the age of 65, or under 65 but receiving Social Security Disability Insurance for a minimum of 24 months before applying for Medicare. 

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