Key Takeaways
- Florida provides a 6-month open enrollment period for Medicare Supplement starting at age 65
- Florida allows continuous open enrollment for those under 65 on Medicare due to disability
- Guaranteed issue rights apply when losing other coverage or during specific situations
- Florida prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
Florida Medicare Supplement (Medigap) Regulations
Florida has adopted consumer protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance, including special protections for disabled beneficiaries.
Open Enrollment Period
Florida provides a 6-month open enrollment period for Medicare Supplement:
When It Begins
The 6-month period starts:
- First day of the month you are 65 or older AND
- Enrolled in Medicare Part B
Protections During Open Enrollment
- Guaranteed issue - Must be accepted regardless of health
- No pre-existing condition exclusions during this period
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan A through N
Exam Tip: The 6-month open enrollment begins when you are 65 AND enrolled in Part B. Both conditions must be met.
Disabled Beneficiaries Under 65
Florida provides special protections for Medicare beneficiaries under age 65:
Continuous Open Enrollment
For those on Medicare due to disability (under 65):
- 6-month open enrollment upon first enrolling in Part B
- Another 6-month period when they turn 65
- Some plans may use medical underwriting after initial periods
Limited Plan Options
Not all insurers are required to offer plans to under-65 beneficiaries:
- Check which insurers serve this population
- Plans may be limited to Plans A, B, C, F, K, or L
- Premiums may be higher than for 65+ population
Guaranteed Issue Rights
Beyond open enrollment, Florida provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer/union coverage | Can purchase Medigap within 63 days |
| Leaving Medicare Advantage | Can return to Medigap within 63 days |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Medicare SELECT moves out of service area | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan (if within first year of MA)
- Guaranteed issue, no health questions
- Applies if first time trying Medicare Advantage
Standardized Plans
Florida requires Medigap plans to be standardized:
Available Plans
| Plan | Key Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 Medicare eligible only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 eligible only) |
| Plan G | Like F without Part B deductible |
| Plan K | 50% cost sharing, out-of-pocket max |
| Plan L | 75% cost sharing, out-of-pocket max |
| Plan M | 50% Part A deductible |
| Plan N | Cost sharing with copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Pre-Existing Condition Rules
During Open Enrollment
- No waiting period for pre-existing conditions
- Must cover all conditions from day one
- Cannot charge higher premiums for health conditions
Outside Open Enrollment
If purchasing outside guaranteed issue periods:
- Up to 6-month waiting period for pre-existing conditions
- Conditions treated or advised in prior 6 months
- Credit for prior creditable coverage
Rate Regulation
Florida allows different rating methods for Medigap:
Rating Methods
| Method | Description |
|---|---|
| Attained Age | Premium increases with age |
| Issue Age | Premium based on age at purchase |
| Community Rated | Same premium regardless of age |
Rate Filing Requirements
- All rates must be filed with OIR
- Rate increases must be justified
- Insurers must provide loss ratio data
- Minimum loss ratio requirements apply
Marketing Requirements
Prohibited Practices
Producers cannot:
- Use high-pressure tactics
- Claim policy is part of Medicare or government program
- Make false statements about coverage
- Sell duplicate Medicare Supplement coverage
Required Disclosures
Must provide:
- Outline of Coverage before sale
- Buyers Guide
- Written comparison of all plans available
- Clear explanation of what is and is not covered
How long is the open enrollment period for Medicare Supplement in Florida?
What special protection does Florida provide for Medicare beneficiaries under 65?
Which Medicare Supplement plans are only available to those eligible for Medicare before January 1, 2020?