The federal programs (Medicare, standardized Medigap plans, Medicaid) are covered in the national Senior and Special Needs guide. Senior products are a large part of California's Accident & Health outline. The state adds rules for Medicare supplement policies (CIC 10192.1 and following), long-term care insurance (CIC 10231 and following), HICAP counseling, and broad protections for buyers 65 and older (CIC 785 to 789.10).

Resources and programs

• Medi-Cal is California's Medicaid program.
• HICAP (Health Insurance Counseling and Advocacy Program) gives Medicare beneficiaries free counseling and advocacy. It is run by the Department of Aging through local Area Agencies on Aging (Welf. & Inst. Code 9541).
• LTC agents must give applicants the local and statewide HICAP contact information.

Medicare supplement in California

Open enrollment. For six months starting the first month a person is 65 or older and enrolled in Part B, the issuer may not deny or rate up coverage (CIC 10192.11). An applicant with at least six months of prior creditable coverage gets no preexisting condition exclusion.

Extra California enrollment rights:

• Birthday rule: each year, starting on the birthday, an enrollee has at least 60 days to switch to a Medigap plan with equal or lesser benefits without health underwriting (CIC 10192.11(h)).
• A person whose Medicare Advantage plan ends their coverage gets an extra 60-day open enrollment after any federal period (CIC 10192.11(g)).
• Many guaranteed issue periods end 63 days after the prior coverage ends (CIC 10192.12).

Policy rules:

• A preexisting condition can be excluded for no more than six months (CIC 10192.8).
• Free look: 30 days, with the refund due within 30 days after the return (CIC 10192.17).
• A Medicare Select issuer must let applicants buy any other Medigap policy it sells.

Sales rules:

• The application asks about existing Medigap, Medicare Advantage, Medi-Cal, and other coverage. A replacement requires a replacement notice (CIC 10192.18).
• First-year commission can't exceed 200% of second-year commission (CIC 10192.16).
• Twisting is prohibited in Medigap sales. The Commissioner publishes an annual Medicare supplement rate guide (CIC 10192.20).

Long-term care insurance in California

Sales and suitability:

• The outline of coverage and the LTC shopper's guide are delivered before the application in an agent sale (CIC 10233.5).
• The applicant receives the LTC Personal Worksheet at or before application (CIC 10234.95).
• Insurers and agents owe honesty, good faith, and fair dealing (CIC 10234.8).

Advertising:

• LTC ads go to the Commissioner 30 days before use.
• Lead-generating ads must say "An insurance agent will contact you" (CIC 10234.9).

Policy features:

• Every LTC policy is guaranteed renewable or noncancelable (CIC 10236).
• It may not be ended for age or declining health (CIC 10233.2).
• Free look: 30 days (CIC 10232.7).
• Inflation protection must be offered, at least as favorable as 5% compounded (CIC 10237.1).
• Nonforfeiture: a shortened benefit period option must be offered, with eligibility no later than after 10 years of premiums (CIC 10235.30).
• A non-tax-qualified policy with home care must trigger benefits at no worse than 2 of 7 ADLs or cognitive impairment (CIC 10232.8).
• Home and community-based benefits must include home health, adult day, personal, homemaker, hospice, and respite care (CIC 10232.9).
• A tax-qualified policy must say so on page one (CIC 10232.1).

Replacement:

• A third or later LTC policy sold to the same person within 12 months is presumed an unnecessary replacement (CIC 10234.85).
• The replacing insurer credits satisfied waiting periods.
• First-year commission is based only on the premium difference (CIC 10234.97).

Training: 8 hours in each of the first four years, then 8 hours before each renewal. It counts toward CE (CIC 10234.93).

Protections for buyers 65 and older

• Insurers and agents owe a duty of honesty, good faith, and fair dealing (CIC 785).
• Disability policies and group life sold to people 65+ have a 30-day free look (CIC 786).
• Lead-generating ads aimed at seniors must disclose that an agent may call, and may not imply government endorsement (CIC 787).
• In-home meetings about life or annuities need written notice 24 hours to 14 days ahead, and the agent must leave when asked (CIC 789.10).
• Selling a life or annuity product to someone 65+ requires a written warning about taxes and penalties from liquidating assets. Selling based on Medi-Cal treatment requires a statutory disclosure (CIC 789.8).

Common exam traps

• California's birthday rule allows a switch to equal or lesser Medigap benefits within 60 days of the birthday.
• Medigap first-year commission is capped at 200% of second-year commission.
• LTC training is 8 hours a year for four years, then 8 per renewal.
• A third LTC policy within 12 months is presumed an unnecessary replacement.
• HICAP is free counseling run by the Department of Aging. It doesn't sell insurance.