Health Insurance Matters: Birthday Month

May is the birthday month in the Thal household. I am on the 29th and my wife on the 31st. Therefore, we celebrate “ours” on the 30th.

As with every year, the mailman delivers into the P.O. box a letter from my Medicare Supplement company – a letter letting me know that I have an opportunity to make one change to my Medicare Supplement plan if I want, to a policy of “equal or lesser” coverage. The letter doesn’t do a very good job of informing me that I also can switch companies to a plan of “equal or lesser” coverage as well. This is the time for changing the supplement, and very frequently with identical coverage (the benefits are federally regulated to be the same).

Depending on your new age, that is significant, as some plans have had smaller price increases over the years than others, and as changing to a plan of “equal” might save monthly premium, it is a good idea to check. Some insurance companies also provide a “household discount” or 5 percent to 7 percent when both spouses are on the same plan. This alone can save hundreds of dollars a year. Known as the ‘Birthday Rule,’ this law is unique to California and a few other states, so not widely publicized in the Medicare Handbooks. I have the rates for all the plans and can generally quote these over the phone.

In the last few years, a new version of the Medicare Supplement Plan F has emerged. These plans have the same medical benefits with choice of any hospital and any doctor participating in Medicare, but with additional benefits and lower prices. These plans do ask medical questions, and for those who are successful in being accepted by the plan, save about $20 or more a month with additional benefits such as vision, hearing and an Emergency Response System. “Help I’ve Fallen, and I Can’t Get Up.” That includes the installation, instructions, monthly maintenance fees and monitoring.

One source of confusion is the Medicare Advantage plans. These plans are the Medicare HMO plans, and they are not covered by the Birthday Rule. However, there are several options that allow people in the HMO plans to change outside the Annual Enrollment Period (October 15 to December 7). Did you know that people on Medi-Cal can change plans three times a year? Often getting lower co-pays and lower costing prescriptions even at their same pharmacy! There are some plans that offer unlimited free transportation to doctor appointments, even if it is in Bakersfield or Los Angeles.

People with special needs, such as diabetes, pre-diabetics and many types of heart disease, even those with high blood pressure, may qualify for special needs plans with greater benefits than the standard HMO plans with lower or no co-pays. These plans are available for switching to year-round and have the same doctors as the standard Medicare Supplement F Plans plans.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 27 other states. His offices are in Kernville. He is a member of the Society of Certified Senior Advisors and Past-President of the Kern Association of Health Underwriters. He may be reached at 760-376-2100, e-mail or visit him on the web at