Medicare (Parts A through D and the 2026 figures), the standardized Medigap plans and federal enrollment rights, Medicaid, and long-term care basics are covered in the national Senior and Special Needs guide. Kentucky adds its own Medicare supplement rules (KRS 304.14-520 to 304.14-550) and long-term care rules (KRS 304.14-615 and 304.14-644, and 806 KAR 17:081). Two of the Medigap rules are more generous than federal law: a birthday rule and coverage for disabled beneficiaries under 65.

Medicare supplement (Medigap)

Open enrollment (KRS 304.14-525(2)(a)). For six months, starting with the first month an applicant is both 65 or older and enrolled in Part B, an insurer can't deny a policy or charge more because of health.

Birthday rule (304.14-525(2)(c)):

• A person who already has a Medicare supplement policy may switch to the same plan with a different insurer.
• The application must be made within 60 days of the person's birthday.
• The new insurer can't deny the application or price it on health.

Disabled beneficiaries under 65 (304.14-525(3)):

• All Medicare supplement policies sold in Kentucky must be available to Medicare beneficiaries under 65 who enroll in Part B.
• During their open enrollment, the premium may be no more than the weighted average premium the insurer charges at ages 65 and over.
• There may be no waiting period or preexisting condition limitation.

Other Medigap rules:

• Preexisting conditions (304.14-520). A policy may not deny a claim for a preexisting condition for losses more than six months after the effective date. The look-back is limited to six months before coverage.
• Outline of coverage (304.14-540). It is delivered when the application is made.
• Free look (304.14-550). A Medicare supplement buyer may return the policy within 30 days of delivery for a full premium refund.
• Refunds on cancellation (304.14-545). The unearned premium paid beyond the month of cancellation is returned promptly.

Long-term care insurance

Renewability and termination:

• An individual LTC policy may be only guaranteed renewable or noncancellable (806 KAR 17:081 Sec. 3).
  • Under guaranteed renewable, the insurer can't change the provisions on its own or refuse to renew, but it may revise rates by class.
  • Noncancellable also locks the premium.
• Coverage can't be cancelled or nonrenewed because of the insured's age or deteriorating mental or physical health (KRS 304.14-615(2)).
• Protection against unintentional lapse (806 KAR 17:081 Sec. 4). Before issuing an individual policy, the insurer gets the applicant's designation of at least one other person to receive lapse notices, or a signed waiver. A policy can't lapse for nonpayment without at least 30 days' notice to the insured and any designee.

Benefit conditions (KRS 304.14-615(3), (4)):

• A preexisting condition may be defined only as one treated or recommended within six months before the effective date. It can't be excluded for losses beginning more than six months after that date.
• A policy may not require a prior hospitalization for any benefit.
• A rider that requires a prior institutional stay before paying noninstitutional benefits may require no more than 30 days.

Exclusions (806 KAR 17:081 Sec. 3):

• Mental and nervous disorders may be excluded, but Alzheimer's disease may not.
• Permitted exclusions also include:
  • alcoholism and drug addiction
  • war
  • felonies
  • care by immediate family members
  • services available under Medicare (other than Medicaid) or workers' comp

Inflation protection (806 KAR 17:081 Sec. 10):

• The insurer must offer protection at least as good as 5% compounded annually. It is included unless the policyholder signs a rejection.
• Increases continue regardless of the insured's age, claim status or claim history.
• The outline of coverage includes a 20-year graphic comparison of benefits with and without inflation protection.

Sales and delivery:

• Outline of coverage. In an agent sale, it is delivered before the application is presented (KRS 304.14-615(7)).
• Free look. The applicant may return the policy within 30 days of delivery for a refund (304.14-615(6)).
• Partnership policies. A policy intended to qualify for the Kentucky Long-Term Care Partnership comes with a Partnership Program Notice (304.14-644). Agents selling partnership policies complete 8 hours of initial LTC training, then 4 hours each CE biennium (806 KAR 9:025 Sec. 5).

Life insurance for older owners

When the insured is 60 or older, or terminally or chronically ill in specified situations, the insurer must notify the owner of alternatives to lapse or surrender, including life settlements (KRS 304.15-075). By regulation the notice applies to policies with a net death benefit of $100,000 or more (806 KAR 15:090).

Common exam traps

• Medigap open enrollment lasts six months from age 65 plus Part B enrollment.
• Kentucky's birthday rule gives 60 days to switch to the same plan with no health questions.
• Disabled beneficiaries under 65 may buy Medigap, with no waiting period and a premium capped at the age-65+ average.
• The free look is 30 days for both Medigap and LTC.
• LTC can't exclude Alzheimer's or require a prior hospital stay. The preexisting look-back is six months.
• Inflation protection is 5% compound unless rejected in signed form.
• Partnership training is 8 hours initially, then 4 hours per biennium.