The national guide covers Medicare (Parts A, B, C and D), Medigap plan letters, Medicaid and the basics of long-term care. Idaho's state rules for these products are in three places:

• Medicare supplement: Idaho Code chapter 41-44 and IDAPA 18.04.10.
• Long-term care: Idaho Code chapter 41-46 and IDAPA 18.04.11.
• Life settlements: Idaho Code chapter 41-19, which often affect seniors.

These notes cover the Idaho rules.

National concepts in brief

• Medicare Part A is hospital insurance. Part B is medical insurance. Part C is Medicare Advantage. Part D covers drugs.
• Medigap fills gaps in Original Medicare.
• Long-term care pays for custodial care when a person can't perform activities of daily living or is cognitively impaired.

Medicare supplement in Idaho

• Outline of coverage: delivered at the time of application (Idaho Code 41-4406).
• Free look: 30 days for a premium refund (Idaho Code 41-4407).
• Open enrollment: during the six months starting when a person is 65 and enrolled in Part B, the insurer may not deny coverage, set conditions or charge more (IDAPA 18.04.10.036).
• Under-65 enrollees: Idaho extends the six-month open enrollment to people under 65 who have Part B because of disability or ESRD. Their premium may not exceed 150% of the standard premium (IDAPA 18.04.10.061).
• Birthday rule: each year, an eligible policyholder gets a guaranteed-issue period that starts on their birthday and lasts 63 days (IDAPA 18.04.10.041).
• Community rating: for policies issued after February 28, 2022, pricing by attained age or issue age is an unfair practice. These policies are community-rated (IDAPA 18.04.10.061).
• Replacement:
  • The replacement notice is signed by the applicant and the agent (IDAPA 18.04.10.071).
  • A replacing policy may not apply new preexisting-condition, waiting or probationary periods to benefits similar to those under a policy in force for at least six months (IDAPA 18.04.10.081).
• Commissions: first-year compensation may not exceed 200% of second-year compensation, and renewal compensation stays level for at least five years (IDAPA 18.04.10.066).

Long-term care in Idaho

Definition: LTC insurance provides coverage for at least 12 consecutive months for each covered person (Idaho Code 41-4603).

Benefit triggers:

• Activities of daily living include at least bathing, continence, dressing, eating, toileting and transferring (IDAPA 18.04.11.010).
• Eligibility may not be stricter than a loss of three ADLs or the presence of cognitive impairment (IDAPA 18.04.11.033).

Policy standards:

• No termination for age or declining health (Idaho Code 41-4605).
• No skilled-care-only coverage: a policy may not cover only skilled nursing care, or favor skilled care heavily over lower levels of care.
• Preexisting conditions: an individual policy may look back only six months, and may exclude a condition only for losses beginning within six months of coverage.
• Incontestability: after two years, the insurer can contest the policy only for knowing and intentional misrepresentation of health facts (Idaho Code 41-4606).
• No field issue: policies may not be field-issued based on health status.
• Nonforfeiture: a nonforfeiture benefit must be offered. If it is declined, a contingent benefit on lapse applies (Idaho Code 41-4607).

Protection against lapse (IDAPA 18.04.11.013):

• The applicant designates another person to receive lapse notices, or signs a waiver.
• Lapse notice comes at least 30 days before lapse, and no sooner than 30 days after the premium was due.

Sales:

• The shopper's guide is delivered before an application is presented (IDAPA 18.04.11.036).
• A personal worksheet must be completed and returned before the insurer considers the application (IDAPA 18.04.11.028).
• Licensing and training: sellers need life and disability licenses, plus a one-time 8-hour LTC course and 4 hours every 24 months after that (IDAPA 18.04.11.027).

Life settlements (Idaho Code 41-1951 ff.)

• License: a life settlement provider or broker needs a life producer license and must notify the director within 10 days of starting that business (Idaho Code 41-1952).
• Two-year rule: a settlement within two years of policy issue is prohibited unless an exception applies, such as terminal or chronic illness, death of a spouse, divorce, retirement or disability (Idaho Code 41-1961).
• Definitions:
  • Terminally ill means death is expected within 24 months.
  • Chronically ill means unable to perform two ADLs, or severely cognitively impaired (Idaho Code 41-1951).
• Rescission: the owner may rescind within 20 days of signing by repaying the proceeds (Idaho Code 41-1956).
• STOLI is prohibited: a policy initiated for a third-party investor with no insurable interest (Idaho Code 41-1962).

Common exam traps

• The Medigap free look is 30 days, and the Idaho birthday rule window is 63 days.
• Medigap open enrollment in Idaho also covers under-65 Part B enrollees, at a premium of no more than 150%.
• LTC benefits can't require the loss of more than three ADLs.
• LTC training is 8 hours up front, then 4 hours every 24 months.
• The life settlement rescission period is 20 days. The general ban runs two years from issue.