The national guide explains Medicare Parts A through D, Medigap plan letters and long-term care basics. Connecticut has its own Medicare supplement law, in Conn. Gen. Stat. 38a-495 to 38a-495c and Regs. 38a-495a. That law is unusual because it requires community rating. Connecticut also has detailed LTC standards (Regs. 38a-528) and the Connecticut Partnership for Long-Term Care (38a-475).

Medicare supplement in Connecticut

• Community rating: Medigap rates are community rated and not based on age. An insurer can't deny an applicant because of age, gender, previous claims or medical condition. A six-month preexisting-condition exclusion is still allowed (38a-495c(a)).
• Disabled beneficiaries: the same plans must be offered to people on Medicare because of disability. Plan C is not required for newly eligible beneficiaries (38a-495c(d)).
• Preexisting conditions: the look-back is at most six months. Losses more than six months after the effective date can't be excluded (38a-495a(f)).
• Open enrollment: no denial or discrimination during the six months that begin once the person is both 65+ and enrolled in Part B (Reg. 38a-495a-8).
• Replacing a Medigap policy: if the old coverage was in force at least six months, the new policy can't impose new preexisting, waiting, elimination or probationary periods for similar benefits (Reg. 38a-495a-19).
• Delivery documents:
  • the outline of coverage at the time of application (38a-495a(l))
  • the NAIC/CMS Guide to Health Insurance for People with Medicare, with a signed receipt (Reg. 38a-495a-13)
  • the notice "This policy may not cover all of your medical expenses" (Reg. 38a-495a-16)
• Free look: 30 days after delivery (38a-495a(m)).
• Benefits and pricing:
  • Home health aide coverage is required, though not more than $500 a year, with no deductible or coinsurance (38a-495(c)).
  • Individual policies need an anticipated loss ratio of at least 65% (38a-495(b)).
• Medicaid: a policyholder who becomes eligible for Medicaid may suspend the policy for up to 24 months, if the request is made within 90 days of eligibility (Reg. 38a-495a-14).
• Sales conduct:
  • No sale that would leave a person with more than one Medicare supplement (Reg. 38a-495a-17).
  • Twisting, high-pressure tactics and cold-lead advertising are prohibited (Reg. 38a-495a-16).
  • First-year commission may be no more than 200% of the second year's, with level renewals for at least five years (Reg. 38a-495a-12).

Long-term care insurance (Regs. 38a-528)

• Activities of daily living include bathing, dressing, eating, toileting and transferring (Reg. 38a-528-3).
• Preexisting conditions: the look-back is at most six months, and no denial after six months (Reg. 38a-528-4(b)).
• No prior hospitalization or institutionalization requirement (Reg. 38a-528-4(h)).
• Elimination period: no more than 100 days of confinement (Reg. 38a-528-4(j)).
• Waiver of premium: a waiver after 90 consecutive days of benefits satisfies the rule (Reg. 38a-528-4(f)).
• Premiums may not rise solely because of aging past 65 or length of coverage (Reg. 38a-528-4(m)).
• Shopper's guide: delivered before an application is presented (Reg. 38a-528-11).
• Group LTC: members leaving the group may continue or convert coverage without evidence of insurability (Reg. 38a-528-4(a)(1)).

Connecticut Partnership for Long-Term Care

• Precertified Partnership policies must offer home and community-based care, provide inflation protection, and may not require prior hospitalization (38a-475).
• Free look: 30 days with a full refund (Reg. 38a-475-4(7)).
• Producer training: insurers must make sure their agents completed seven hours of LTC and Connecticut Partnership training (Reg. 38a-475-4(10)).

HUSKY (Medicaid)

• HUSKY C is Connecticut's Medicaid coverage for people 65 or older, or blind or disabled. HUSKY D covers low-income adults aged 18 to 64 (17b-290).

Exam traps

• Connecticut Medigap is community rated: no age rating, and no denial based on age, gender, claims or health.
• 30-day free look for Medigap and Partnership LTC. Life and individual health policies get 10 days.
• LTC elimination period: no more than 100 days. Waiver of premium after 90 days of benefits.
• Partnership training is seven hours.