Key Takeaways
- Ohio requires a 6-month open enrollment period for Medicare Supplement starting at age 65
- Guaranteed issue rights apply when losing other coverage or during open enrollment
- Ohio prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
- Ohio allows attained age, issue age, and community rating for premiums
Ohio Medicare Supplement (Medigap) Regulations
Ohio has adopted regulations to protect Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance.
Open Enrollment Period
Ohio 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
- 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 period is critical. After it ends, insurers can use medical underwriting.
Guaranteed Issue Rights
Beyond open enrollment, Ohio provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer 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 |
| Losing Medicaid | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
Standardized Plans
Ohio requires Medigap plans to be standardized per federal requirements:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 enrollees only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 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, copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Pre-Existing Conditions
Ohio follows federal Medigap pre-existing condition rules:
During Open Enrollment
- No pre-existing condition exclusions allowed
- Must accept regardless of health status
- Cannot charge more for health conditions
Outside Open Enrollment
- Maximum 6-month look-back period
- Maximum 6-month exclusion period
- Credit for prior continuous coverage
Rating Methods
Ohio permits three premium rating methods:
| Method | Description |
|---|---|
| Attained Age | Premium increases with age |
| Issue Age | Premium based on age at purchase |
| Community Rating | Same premium regardless of age |
Comparison
- Attained age is most common, starts lower but increases
- Issue age locks in rate based on purchase age
- Community rating same for all, may start higher
Producer Requirements
To sell Medicare Supplement in Ohio:
- Must hold valid Ohio life and health license
- Complete Medicare-specific training
- Understand standardized plan benefits
- Follow suitability requirements
How long is the open enrollment period for Medicare Supplement in Ohio?
Which Medicare Supplement plans are only available to those eligible for Medicare before January 1, 2020?