Medicare Supplement Plans

Florida Health Insurance Main Page

Open enrollment:

Medicare supplements have open enrollment periods or conditions. If the conditions are met the person would be guaranteed a Medicare supplement regardless of current or past health history except for permanent kidney failure. If not during open enrollment then the person must meet medical underwriting standards to qualify. Premiums do not increase because of age as one gets older only due to a change in benefits or overall premium adjustments.

•  If you are enrolled in an Medicare HMO and you are involuntarily terminated by the HMO due to the HMO ceasing to offer the plan, your moving out of the HMO service area or insolvency of the HMO you are eligible for open enrollment.

•  If you are age 65 or older, for a period of six months from the date enrolled in Medicare Part B

•  If you were eligible for Part B benefits before age 65, you are eligible for a six month period when you attain age 65

•  Upon termination of group coverage, Florida residents are eligible for two months. This open enrollment period is for persons who enrolled in Medicare Part B at age 65 but remained covered under group insurance beyond the the six month open enrollment period

Frequently Asked Questions:

1. If I am changing my Medicare supplement, does the pre-existing condition of the new policy apply?

If you replace your Medicare supplement policy with another Medicare supplement policy and have met the six month's pre-existing condition provision under your old contract, you do not have to meet another pre-existing condition under the new contract.

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2. I purchased a Medicare supplement policy three months age, and now I want to change to another plan. I gave the agent a check for one year's premium. Is the company obligated to return my premiums?

For policies issued or renewed on or after October 1, 1991, an insurer must promptly return the unearned portion of any premium paid, in the event of cancellation. If the insured cancels, the earned premium will be calculated using the short rate table filed with the Department of Insurance. If the insurer cancels, the earned premium shall be computed pro rata. Prior to October 1, 1991, there were no statutory provisions requiring companies to refund premiums.

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3. How long do I have to decide whether or not I want to keep my Medicare supplement policy?

You have a 30-day "free-look" period from the date the policy is delivered to you. During this time, the company will fully refund all premiums paid, if cancellation is requested in writing by the insured.

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4. I am 65 years old and still working. I am covered under a group plan and do not need a medicare supplement policy at this time. Will I lose my right to a guaranteed issue medicare supplement policy if I do not purchase it now?

No, upon retirement you have a two month open enrollment period. However, you may want to elect medicare part B to avoid a premium penalty for deferring enrollment in part B.

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5. How many Medicare supplement policies should I buy?

Under Florida law, only one Medicare supplement policy is allowed to be sold by an agent. These policies are designed so that you generally do not need other similar coverage. Duplicate coverage can be expensive and is generally unnecessary. It is illegal for an insurance company to sell you a second policy unless you state in writing that you intend to cancel the first policy.

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6. An agent wants to sell me a nursing home policy. I was under the impression my Medicare supplement policy provided nursing home coverage.

A Medicare supplement policy provides very limited nursing home coverage. It supplements payments made by Medicare toward skilled nursing care only. The major percentage of patients in nursing homes receive either intermediate or custodial care, which is not covered under the Medicare supplement policy.

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7. I have a Medicare supplement policy that has always paid 100% of the charges Medicare did not pay. Now the company is only paying 100% of the charges approved by Medicare. Can they do this?

You need to read your contract very carefully to determine if benefits are paid on the basis of actual charges or the amount of charges approved by Medicare. If it pays based on the amount approved by Medicare, then Medicare would pay 80% of the amount approved, and your supplement policy would pay 20% of the amount approved. For example, if the doctor's bill is $1,000 and Medicare approves $800, Medicare will pay 80% of $800 ($640). Your policy will pay the remaining 20% of $800 ($160). Medicare supplement policies F, I & J will pay the excess amount. You should verify with your doctor that he/she accepts Medicare assignment.

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9. Why can't your Department help me resolve the many problems I am having with my Medicare claim?

Medicare is a Federal program which does not fall within the jurisdiction of this Department. Specific problems concerning this program should be referred to:

Department of Health and Human Services
Region IV
101 Marietta Tower
Atlanta, Georgia 30323

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10. I am considering switching to an HMO. If I decide I don’t like it, how long will it take to go back to Medicare and a supplement?

It normally takes 4-5 weeks to put you back on Medicare from an HMO. However, a medicare supplement company is not required to take you back. We would recommend you request a post dated policy and not cancel your HMO until you have been approved by the supplement company.

Peter C. Hegeman
Florida Health Insurance
Group, Employee Benefits & Individual Health Insurance Specialist
Website Address  www.florida-health-quotes.com 

Phone: 407-425-9347 (Best number to reach me)
Phone: 407-342-9945
Fax:     407-423-7483

If outside the US, it is best to e-mail as we can respond more quickly.  Thanks.

Let me know how I can help you.

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