3.2 Ohio Medicare Supplement (Medigap) Regulations
Key Takeaways
- Ohio follows the federal 6-month Medigap open enrollment that begins the first month the person is both age 65+ and enrolled in Medicare Part B.
- Every new Medigap policy carries a 30-day free look during which the buyer can return it for a full refund.
- Guaranteed issue rights also arise from triggering events (loss of group coverage, MA plan leaving the area, insolvency, Medicaid disenrollment) and last 63 days.
- Medigap plans are federally standardized A through N; Plans C and F are closed to anyone first eligible for Medicare on or after January 1, 2020.
- Outside open enrollment, carriers may apply a 6-month pre-existing condition look-back, reduced by prior creditable coverage.
Open Enrollment Period
The single most-tested Medigap fact is the 6-month Medigap open enrollment period. It begins automatically on the first day of the month in which the person is both age 65 or older AND enrolled in Medicare Part B, and it runs for six months. During this window the applicant has the strongest rights available:
- Guaranteed issue – the carrier must accept the applicant regardless of health.
- No pre-existing condition exclusions may be applied.
- No medical underwriting – the applicant cannot be charged a higher rate for health history.
- Any standardized plan the carrier offers (A through N) is available.
Critical trap: this window is one time only and is tied to Part B enrollment, not to age alone. A 67-year-old who delayed Part B because of active employer coverage gets a fresh 6-month window when they finally enroll in Part B. Once the six months lapse, carriers may use medical underwriting and may decline or surcharge applicants.
The 30-Day Free Look
A new Medigap policy carries a 30-day free look. The buyer may return the policy within 30 days for a full refund of premium. This is longer than the 10-day free look on standard individual health coverage and matches the long-term care free look. If a beneficiary buys a second Medigap policy intending to replace the first, they should keep the old policy in force until the new one passes its free look.
Guaranteed Issue Outside Open Enrollment
Beyond open enrollment, federal and Ohio rules grant guaranteed issue rights after specific triggering events. The general window to act is 63 days from the loss of prior coverage.
| Triggering event | Guaranteed issue right |
|---|---|
| Group/employer retiree health plan ends | Buy Medigap within 63 days |
| Medicare Advantage plan leaves the service area or stops Medicare | Buy Medigap within 63 days |
| The Medigap insurer becomes insolvent or ends the plan through no fault of the insured | Switch to a comparable plan |
| Beneficiary is disenrolled from Medicaid | Guaranteed-issue Medigap (Ohio-specific protection) |
| Trial right: first joined a Medicare Advantage plan at 65, or dropped a Medigap plan to try MA | Within the first 12 months of MA, return to a Medigap plan guaranteed issue |
The trial right is heavily tested: a beneficiary who tries Medicare Advantage for the first time has 12 months to return to a Medigap plan with no health questions.
Standardized Plans A through N
Medigap is federally standardized, so a Plan G from one Ohio carrier covers exactly what a Plan G from another covers; only price and service differ. The exam expects you to recognize the chart and the 2020 closure rule.
| Plan | Defining feature |
|---|---|
| A | Core benefits only (Part A coinsurance, Part B coinsurance, first 3 pints of blood) |
| B | Core + Part A deductible |
| C | Comprehensive incl. Part B deductible – closed to newly eligible on/after 1/1/2020 |
| D | Like C without Part B deductible coverage |
| F | Most comprehensive; covers Part B deductible and excess – closed to newly eligible on/after 1/1/2020 |
| G | Like F but does not cover the Part B deductible; most popular for new enrollees |
| K | 50% cost sharing with annual out-of-pocket maximum |
| L | 75% cost sharing with annual out-of-pocket maximum |
| M | Covers 50% of the Part A deductible |
| N | Lower premium; copays up to $20 office / $50 ER, no Part B excess coverage |
The MACRA law of 2015 barred any plan covering the Part B deductible for people first eligible on or after January 1, 2020. That is why Plans C and F are closed to newer beneficiaries while G remains open.
Pre-Existing Conditions and Look-Back
- During open enrollment: no pre-existing condition exclusion is permitted.
- Outside open enrollment / underwritten sale: the carrier may impose at most a 6-month look-back and exclude a pre-existing condition for at most six months, reduced by months of prior creditable coverage.
Rating Methods
Ohio allows three ways to set Medigap premiums. Recognizing how each behaves over time is a common question.
| Method | How the premium behaves |
|---|---|
| Attained age | Starts lowest, rises as the insured ages; most common in Ohio |
| Issue age | Locked to the age at purchase; does not rise simply because the insured ages |
| Community (no-age) rating | Same premium for everyone regardless of age; often starts highest |
Worked example: a healthy 65-year-old who plans to keep the plan for 20 years may pay more long-term on attained-age rating than on issue-age rating, even though the issue-age premium looks higher at purchase.
Producer Duties
To sell Medigap in Ohio a producer must hold an active Ohio life and health (accident and health) license, understand the standardized benefit chart, and apply suitability standards so the product fits the beneficiary's needs and budget. Replacing existing Medigap or Medicare Advantage coverage requires proper replacement disclosure.
A 65-year-old enrolled in Medicare Part B buys a Medigap policy, then changes her mind. How long is her free look period to return the policy for a full refund?
Why are Medigap Plans C and F unavailable to a person who first became eligible for Medicare in 2022?
When does the one-time 6-month Medigap open enrollment period begin in Ohio?