Medicare (Parts A through D and the 2026 figures), the standardized lettered Medigap plans and federal enrollment rights, Medicaid, and long-term care basics are covered in the national Senior and Special Needs guide. Maryland adds its own Medicare supplement rules (Ins. §§ 15-909, 15-910; COMAR 31.10.06), including a birthday rule and coverage for disabled beneficiaries under 65. Its long-term care rules are in Ins. Title 18 and COMAR 31.14.01.

Medicare supplement

Enrollment rights (§ 15-909(b)):

• Open enrollment. For six months, starting with the first month a person 65 or older first enrolls in Part B, a carrier can't deny, condition or price coverage on health.
• Under 65. Carriers must make Plans A and D available to disabled Medicare beneficiaries under 65 who apply within six months of Part B enrollment.
• Birthday rule (§ 15-909(b)(6)). Since July 1, 2023, in the 30 days after an enrollee's birthday, a carrier must offer Medigap policies with equal or lesser benefits without medical underwriting. It notifies the insured 30 to 60 days before the birthday.

Underwriting limits:

• Preexisting conditions may not be excluded for losses more than six months after the effective date. The look-back is limited to six months (§ 15-909(d)).
• Replacements. The new carrier credits time served under the old policy toward preexisting, waiting and probationary periods (§ 15-909(e)).
• Renewal. A carrier may cancel or nonrenew only for nonpayment or material misrepresentation, never because of declining health (§ 15-909(f)).

Sales rules:

• Free look. The buyer has 30 days after delivery to return the policy for a refund (§ 15-910).
• At application, the buyer gets the outline of coverage and the Guide to Health Insurance for People with Medicare (COMAR 31.10.06.13).
• First page. The policy must state "This policy may not cover all of your medical expenses."
• Replacements. The producer gives a replacement notice before the policy is issued.
• Duplicate coverage. Selling someone a second Medigap policy is prohibited. A Medigap policy may start for a Medicare Advantage enrollee only after Part C coverage ends.
• Advertising. Cold lead advertising is prohibited. That means mailers that don't disclose an agent will make contact.
• Commissions. First-year commission may not exceed 200% of the second-year commission, and renewals must be level for at least 5 years.
• Senior designations (COMAR 31.03.15). Producers may not use self-conferred designations, or designations from sales-training organizations.

Long-term care

Issue and renewal:

• Individual LTC must be guaranteed renewable or noncancellable (COMAR 31.14.01.04).
• It may be cancelled or nonrenewed only for nonpayment or material misrepresentation (Ins. § 18-118).
• For applicants 80 or older, the carrier gets an exam, a functional assessment or medical records before issuing a non-guaranteed-issue policy (§ 18-105).

Benefits:

• Benefit trigger. A policy may not require deficiency in more than 3 activities of daily living, or cognitive impairment (COMAR 31.14.01.26).
• Alzheimer's must be covered on the same terms as other illnesses (§ 18-111).
• Preexisting conditions may be excluded only for losses beginning within six months after coverage starts.
• Permitted exclusions (§ 18-109):
  • mental or nervous disorders other than Alzheimer's
  • alcohol or drug addiction
  • war
  • felonies
  • self-inflicted injury
  • benefits available under Medicare or workers' comp

Inflation protection (§ 18-114). Insurers must offer protection at least as favorable as 5% compounded annually.

Premium increases (§ 18-116). Increases may not be based on the insured's attained age.

Sales and lapse:

• Outline of coverage and buyer's guide. Delivered before the application is presented (§ 18-106).
• Free look. 30 days after receipt (COMAR 31.14.01.04).
• Lapse protection. The insured may designate another person to receive lapse notices (§ 18-118(b)). A policy can't lapse without 30 days' notice.
• Reinstatement. If a policy lapsed because of cognitive impairment or loss of functional capacity, it can be reinstated if requested within 5 months.

Contestability. After 2 years, a policy may be contested only for knowing and intentional misrepresentation (COMAR 31.14.01.33).

Training and CE. Producers complete 8 hours of LTC training before selling, then 4 hours every 24 months. Health producers who sell LTC also take at least 2 hours of LTC CE each renewal period.

State tax credits:

• Individuals. A one-time credit of up to $500 per insured for LTC premiums (Tax-Gen. § 10-718).
• Employers. 5% of costs, up to the lesser of $5,000 or $100 per employee (§ 10-710).

Common exam traps

• Medigap open enrollment lasts six months from age 65 plus Part B enrollment.
• The birthday rule gives 30 days for equal or lesser benefits.
• Disabled beneficiaries under 65 can buy Plans A and D.
• The free look is 30 days for both Medigap and LTC.
• Medigap and LTC can be cancelled only for nonpayment or material misrepresentation.
• An LTC benefit trigger may require no more than 3 ADLs. Inflation protection is 5% compound.
• LTC training is 8 hours, then 4 hours every 24 months.