The national Senior and Special Needs guide covers Medicare Parts A through D, the standardized Medicare supplement plans, Medicaid and long-term care concepts, including the 2026 Medicare figures. This guide covers Maine's own rules. Those are the Medicare supplement law (24-A M.R.S. 5002-B to 5013, and Bureau Rule 275), the long-term care law (24-A M.R.S. 5051 to 5082, and Rule 425), and Maine's limits on Medicare marketing.

Medicare supplement (Medigap)

• "Not a Medicare supplement": a health policy sold to a Medicare beneficiary that isn't a Medigap policy must say so. The notice reads "THIS POLICY IS NOT A MEDICARE SUPPLEMENT POLICY" in at least 12-point type, with a reference to the Buyer's Guide and the Bureau (5013).

Medicare marketing limits (24-A M.R.S. 2152-B)

• Cold lead advertising is marketing that doesn't clearly disclose that its purpose is insurance sales and that a producer or insurer will make contact. It's an unfair practice.
• No door-to-door Medicare solicitation without the consumer's invitation.
• Appointment scope: at a Medicare sales appointment, a producer may sell life, health or annuity products only if the consumer asks and the products are identified in writing at least 48 hours in advance.
• Marketing materials may not use "Medicare," "Medicaid" or "MaineCare" in a way that looks like an official government document.

Long-term care insurance

Definition and design (5051, 5051-A)

• An LTC policy is designed to cover at least 12 consecutive months.
• A policy may not require a prior hospital stay for any benefit. A prior institutional stay can't be required for home health benefits.
• Custodial care benefits must be at least 50% of skilled nursing benefits.
• Home health coverage must allow at least 90 visits in any 12-month period.
• Renewal must be guaranteed renewable or noncancelable. No other renewal provision is allowed (Rule 425).

Buyer protections

• Free look: a 30-day right to return for a refund (5052-A).
• Contestability (5076):
  • First 6 months: a policy can be rescinded for a material misrepresentation.
  • 6 months to 2 years: the misrepresentation must also relate to the condition claimed.
  • After 2 years: contestable only if the insured knowingly and intentionally misrepresented health facts.
• Field issue isn't allowed if the field issuer is paid by the number of policies issued.

Lapse protection (Rule 425)

• An individual policy can't be issued until the applicant designates at least one person to receive lapse notices, or signs a waiver.
• A lapse notice can't go out until the premium is 30 days overdue. Coverage can't lapse until at least 30 days after the notice.
• If lapse was caused by cognitive impairment, reinstatement is available on request within 5 months, with past-due premium paid.

Producer training (5081)

• Producers must hold a life or health license.
• They complete a one-time course of at least 8 hours before selling LTC, then at least 4 hours every 24 months.

Partnership

• A Long-Term Care Partnership policy is an LTC policy effective July 1, 2009 or later that is designed to meet the partnership program rules (5082).

Common exam traps

• Medigap free look: 30 days. LTC free look: 30 days. Ordinary individual health: 10 days.
• Maine requires a yearly Plan A guaranteed issue window and must sell to disabled Medicare beneficiaries under 65.
• The Medigap pre-existing limit is 6 months. Continuity holds if the gap is 90 days or less.
• LTC: no prior hospital stay, custodial care at least 50% of skilled, 90 home health visits.
• LTC training: 8 hours once, then 4 hours every 24 months.
• Door-to-door Medicare sales without an invitation are an unfair practice.