3.2 Florida Medicare Supplement (Medigap) Regulations
Key Takeaways
- Medigap open enrollment is a 6-month window that starts the first month you are both age 65 and enrolled in Medicare Part B.
- Florida uniquely extends a 6-month Medigap open enrollment to under-65 disabled beneficiaries, plus a fresh window at age 65.
- Guaranteed-issue rights are triggered by specific events and generally must be exercised within 63 days.
- Medigap plans are federally standardized A through N; Plans C and F are closed to anyone newly Medicare-eligible on or after January 1, 2020.
- Medigap carries a 30-day free look, and producers must deliver an Outline of Coverage and the official Buyer's Guide.
Medigap Open Enrollment
A Medicare Supplement (Medigap) policy fills gaps in Original Medicare (Parts A and B) such as deductibles and coinsurance. The single most-tested fact is the 6-month open enrollment period (OEP).
When the 6 months starts
The OEP begins on the first day of the month in which the beneficiary is BOTH:
- age 65 or older, AND
- enrolled in Medicare Part B
Both conditions must be met. If someone turns 65 in March but delays Part B until July, the window opens in July. During the OEP the beneficiary has:
| Protection | Effect |
|---|---|
| Guaranteed issue | Any participating insurer must sell, regardless of health |
| No medical underwriting | No health questions used to decline |
| No pre-existing waiting period | Conditions covered from day one (subject to crowd-out by prior creditable coverage rules) |
| Standard rates | Cannot surcharge for health |
Exam trap: the window is tied to Part B, not Part A. Someone with Part A only has not started the clock.
Florida's Under-65 Disability Protection
Federal law does not require insurers to sell Medigap to people on Medicare due to disability who are under 65. Florida goes further and is a frequent exam distinction:
- A disabled beneficiary under 65 receives a 6-month open enrollment when first enrolled in Part B
- They receive a second 6-month window when they turn 65
- After those windows, medical underwriting may apply
- Plan choice may be limited (commonly Plans A, and sometimes B, D, G, K, L depending on the insurer's filings), and premiums for the under-65 block are typically higher
Scenario: a 47-year-old on Social Security Disability enrolls in Part B. Florida gives them a guaranteed-issue Medigap window now, and another at 65 — two bites at the apple, which a non-Florida question would not offer.
Guaranteed-Issue Rights Outside Open Enrollment
Even after the OEP closes, federal/Florida rules grant guaranteed-issue (GI) rights when certain events occur. The deadline to act is almost always 63 days from the qualifying event:
| Triggering event | Guaranteed-issue right |
|---|---|
| Employer or union retiree coverage ends | Buy Medigap within 63 days |
| Medicare Advantage (MA) plan leaves your area or you move out of its service area | Return to Medigap |
| Medigap insurer becomes insolvent or ends coverage through no fault of yours | Switch to a comparable plan |
| Medicare SELECT moves out of its service area | Buy a standard Medigap |
| You drop a Medigap plan to try MA for the first time and want out | Trial-right return (see below) |
The 12-Month Trial Right
If a beneficiary leaves a Medigap policy to try Medicare Advantage for the first time, they have 12 months to change their mind and return — guaranteed issue, no health questions — to their prior Medigap plan if still sold, or to specified plans otherwise. The trial right only applies the first time they enroll in MA.
Standardized Plans A through N
Medigap is federally standardized: a Plan G from any insurer covers exactly the same benefits as a Plan G from any other; insurers compete on price and service, not benefit design.
| Plan | Defining feature |
|---|---|
| A | Core benefits only (baseline every insurer offering Medigap must sell) |
| B | Core + Part A deductible |
| C | Comprehensive incl. Part B deductible (closed post-2020) |
| D | Comprehensive, no Part B excess charges |
| F | Most comprehensive incl. Part B deductible (closed post-2020); high-deductible F also closed |
| G | Like F but does not pay the Part B deductible — top seller for new enrollees |
| K | 50% cost-sharing with annual out-of-pocket maximum |
| L | 75% cost-sharing with annual out-of-pocket maximum |
| M | 50% of Part A deductible |
| N | Copays for some office and ER visits |
Closed-plan rule: anyone first eligible for Medicare on or after January 1, 2020 cannot buy a plan that pays the Part B deductible — that closes Plans C and F (and high-deductible F). Those already eligible before 2020 keep access. Plan G became the de facto replacement.
Pre-Existing Conditions and Rating
During open enrollment
No waiting period applies; the plan covers pre-existing conditions immediately and may not surcharge for health. Prior creditable coverage can reduce or eliminate any waiting period that would otherwise apply.
Outside guaranteed-issue periods
If the beneficiary buys outside a GI window, the insurer may impose up to a 6-month pre-existing condition waiting period for conditions treated or diagnosed in the 6 months before the policy's effective date — reduced by months of prior creditable coverage.
Three rating methods
| Method | How premium behaves | Buyer impact |
|---|---|---|
| Attained age | Rises as the insured grows older | Cheapest early, costliest later |
| Issue age | Fixed by age at purchase; rises only with general inflation | Locks in a younger-age basis |
| Community (no-age) rated | Same premium for everyone regardless of age | No age-based increases |
All Medigap rates and rate increases must be filed with the OIR, and insurers must meet a minimum loss ratio (the share of premium returned as benefits) — generally 65% individual / 75% group for Medicare Supplement.
Marketing Rules and Required Disclosures
Medigap sales are tightly policed. Producers are prohibited from:
- High-pressure tactics or cold-lead advertising disguised as government mail
- Stating or implying the policy is part of Medicare or a government program
- Twisting or misrepresenting coverage to induce a switch
- Selling a beneficiary a duplicate Medigap policy (an applicant must sign a statement that any existing Medigap will be replaced)
Before or at the time of application the producer must deliver:
- An Outline of Coverage summarizing benefits and limits
- The official Guide to Health Insurance for People with Medicare (Buyer's Guide)
- A plain comparison of the standardized plans offered
Medigap also carries a 30-day free look. Scenario: an agent persuades a beneficiary who already owns Plan G to also buy Plan N for "extra protection" — that is an illegal duplicate sale, regardless of the 30-day free look.
A man turns 65 in April but delays enrolling in Medicare Part B until August. When does his 6-month Medigap open enrollment period begin?
A beneficiary first became eligible for Medicare in 2023. Which Medigap plans are unavailable to her?
Which special Medigap protection does Florida provide that federal law does not require?
An agent sells a client a second Medicare Supplement policy while the client's existing Medigap remains in force. What rule has the agent most likely violated?