The national guide explains Medicare Parts A through D, Medigap plan letters, Medicaid and long-term care basics. Colorado adds its own rules for Medicare supplement policies (C.R.S. Title 10, Article 18 and Regulation 4-3-1) and long-term care (Article 19 and Regulation 4-4-1). Expect questions on free-look lengths, preexisting-condition limits, producer training and commission limits.

Medicare supplement (Medigap) in Colorado

• No duplication: a Medigap policy may not pay benefits that duplicate what Medicare pays (C.R.S. 10-18-103(1)).
• Renewability: a Medigap policy can't be canceled or nonrenewed solely because of the insured's health or age (10-18-103(2)(a)).
• Preexisting conditions: the look-back is at most six months before the effective date. Claims for losses more than six months after the effective date can't be denied as preexisting (10-18-103(4)).
• Guaranteed issue after involuntary loss: at least six months after a prior policy is involuntarily terminated (10-18-103(5)).
• Open enrollment for under-65 beneficiaries: an applicant under 65 who applies within six months of first enrolling in Part B can't be denied, conditioned or priced on health status (Reg. 4-3-1, Sec. 10.B). The usual six-month open enrollment at 65 also applies.
• Outline of coverage: delivered when the application is made. It describes principal benefits and states exceptions, reductions and limitations (10-18-106).
• Free look: 30 days after delivery for a full premium refund (10-18-107).
• Cancellation refunds: if the insured cancels, prepaid premium is refunded pro rata for the full months remaining (10-18-107).
• Replacement: the issuer or producer gives a notice regarding replacement before issue or delivery. The applicant and producer both sign it, and the applicant keeps a copy (Reg. 4-3-1, Sec. 17).
• Commissions: first-year pay may be no more than 200% of second-year pay. Renewal pay must stay level for at least five renewal years (Reg. 4-3-1, Sec. 15).

Long-term care insurance in Colorado

• Free look: 30 days after delivery. The same right applies when an application is denied, and refunds are due within 30 days (10-19-111).
• Preexisting conditions: a preexisting-condition loss can be excluded only if it begins within six months of the effective date (10-19-108(2)).
• No prior-hospitalization requirement for any benefit (10-19-109(1)(a)).
• Dementia: policies may not exclude dementia diseases and related disabilities, and may not cover skilled care only (10-19-107(1)(d)).
• Lapse protection: the applicant must be offered the chance to name a third person to be notified before lapse. A declination must be signed (10-19-107(2)(a)). After a lapse, there is a 90-day reinstatement window with the same benefits and premium (10-19-107(2)(b)).
• Inflation protection must be offered, at least as good as 5% compounded annually or one of the listed alternatives (10-19-113(1)(a)).
• Point-of-sale documents (Reg. 4-4-1): the shopper's guide goes out before the application is presented. The Personal Worksheet and the "Things You Should Know Before You Buy" disclosure are given at or before application.
• Producer training: before selling LTC, a producer completes 16 credit hours, 8 of them on the LTC Partnership in a classroom setting. After that, 5 classroom hours every two years, beginning with the second two-year period after becoming eligible to sell.
• Partnership policies let the insured protect assets equal to the benefits paid when later applying for Medicaid (national concept).

Senior-specific sales conduct

• Senior designations: Regulation 1-2-18 bars misleading use of senior-specific certifications, including designations that don't exist or that the producer gave himself.
• Annuity sales to seniors fall under Colorado's best-interest rule, which covers all ages (Reg. 4-1-11). See the annuities guide.

Exam traps

• 30-day free look for both Medigap and LTC. The life free look is 15 days, and replacement life or annuity policies get 30 days.
• Six months appears everywhere: the Medigap preexisting look-back and exclusion, Medigap guaranteed issue, under-65 open enrollment, and the LTC preexisting window.
• 90 days is the LTC reinstatement window after a lapse.
• LTC training is 16 hours before selling (8 on the Partnership), then 5 hours every two years.