The national guide covers Medicare Parts A through D, Medigap plan letters and long-term care concepts. Florida sets its own Medicare supplement rules in Fla. Stat. 627.674 to 627.6745 and long-term care rules in 627.9407 to 627.94075. The LTC Partnership is in 409.9102.

Medicare supplement in Florida

• Standardized plans: policies follow the standardized benefit plan designs adopted under state and federal law (627.674).
• Free look: a prominently displayed 30-day no-loss cancellation clause with a full premium refund (627.674(4)(d)).
• Open enrollment (627.6741(1)(a)):
  • six months beginning when the person is 65 or older and enrolled in Part B, with guaranteed issue
  • also available to Florida residents under 65 who are on Medicare because of disability or end-stage renal disease and enrolled in Part B
• Losing group coverage: guaranteed issue during the two months after group health coverage ends (627.6741(1)(a)2.).
• Preexisting conditions: the look-back and the exclusion period are each limited to six months (627.6741(2)(b)).
• Replacement: the new policy must credit time already served under the old one's preexisting, waiting, elimination and probationary periods (627.6741(2)(c)).
• Renewability: coverage can be canceled or nonrenewed only for nonpayment or material misrepresentation (627.6741(2)(a)).
• Loss ratios: at least 65% for individual policies and 75% for group (627.6745).

Long-term care in Florida

• Benefit triggers: can't be stricter than three ADLs or cognitive impairment (627.94074).
• Free look: 30 days (627.9407(8)).
• First page: a notice that the policy is approved as LTC and may not cover all long-term care costs (627.9407(9)).
• Sales documents:
  • The agent gives the shopper's guide before presenting an application (Rule 69O-157.121).
  • The outline of coverage is delivered at application (627.9407(10)).
• Prohibited provisions:
  • premiums designed to rise solely because of age (627.9407(7))
  • requiring a prior institutional stay of more than 30 days before noninstitutional benefits (627.9407(5))
  • home health care conditioned on needing a nursing home, or limited to RN and LPN services (627.94071)
• Required offers:
  • inflation protection at least as good as 5% compounded annually
  • a nonforfeiture option (627.94072)
• Lapse protection (627.94073):
  • a 30-day grace period
  • a lapse notice mailed at least 30 days before cancellation to the policyholder and any secondary addressee
  • an annual reminder of the right to name a secondary addressee
• Group LTC associations must have at least 100 members at the outset (627.9405).
• LTC Partnership: assets equal to the benefits paid by a qualified Partnership policy are disregarded for Medicaid eligibility (409.9102).

Senior protections elsewhere in Florida law

• Annuities:
  • Surrender charges for buyers 65 or older are capped at 10% and must end after the 10th year (627.4554(9)).
  • Every annuity has a 21-day free look (626.99(4)(b)).
• Life policy lapse notice: for an insured 64 or older whose policy has been in force a year, the insurer must send notice at least 21 days before lapse to the owner and a secondary addressee (627.4555).
• Using titles that falsely suggest special training to advise seniors is an unfair practice (626.9541(1)(ff)).

Exam traps

• 30-day free look for Medigap and LTC. Annuities get 21 days.
• Medigap open enrollment also covers disabled and ESRD beneficiaries under 65.
• Medigap loss ratios: 65% individual, 75% group.
• LTC lapse notice: 30 days ahead, with a secondary addressee.