Medicare, the standardized Medigap plans, Medicaid and the basic design of long-term care insurance are covered in the national Senior and Special Needs guide. This guide covers Montana's own Medicare supplement law and rules (Mont. Code Ann. 33-22-901 and following; ARM 6.6.501 and following) and its long-term care law and rules (33-22-1101 and following; ARM 6.6.3101 and following). These come up on Montana's Disability exam.

Medicare supplement (Medigap) in Montana

• Open enrollment lasts six months. It starts on the first day of the first month in which the person is both 65 or older and enrolled in Part B (ARM 6.6.507B).
• Outline of coverage. It must be delivered when the application is made (33-22-907).
• Notice on the first page. The policy must carry a buyer's notice that it may not cover all medical expenses (ARM 6.6.519).
• Free look. The buyer may return the policy within 30 days of delivery for a premium refund (33-22-908).
• Preexisting conditions. A policy may not exclude losses incurred more than 6 months after the effective date because of a preexisting condition. It may not duplicate benefits Medicare provides (33-22-904).
• No second Medigap policy. Any sale that would leave a person with more than one Medicare supplement policy is prohibited (ARM 6.6.520).
• Application duties. The producer lists other health policies sold to the applicant that are still in force, plus those sold in the past 5 years that are no longer in force (ARM 6.6.510).
• Replacement (ARM 6.6.510, 6.6.522):
  • The applicant and producer both sign a replacement notice. One copy goes to the applicant, and the issuer keeps one for 3 years.
  • If the replaced policy was in force at least six months, the new policy may impose no new preexisting condition or waiting period.
• Medicaid suspension. An insured who becomes eligible for Medicaid can have Medigap benefits and premiums suspended for up to 24 months. The request must be made within 90 days of becoming eligible (ARM 6.6.510).
• High-pressure tactics. Marketing through force, fright, threat or undue pressure is prohibited (ARM 6.6.519).

Long-term care insurance in Montana

What qualifies

• An LTC policy must be designed to provide coverage for at least 12 consecutive months (33-22-1107).
• Montana lists six activities of daily living (ADLs): eating, toileting, transferring, bathing, dressing and continence. Managing medications isn't one.
• A benefit trigger may require a deficiency in no more than three ADLs, or the presence of cognitive impairment (33-22-1125).

Policy rules

• Renewability. An individual LTC policy must be at least guaranteed renewable. The premium can't rise because the insured ages past 65 or because of how long coverage has been in force (ARM 6.6.3104).
• Exclusions (ARM 6.6.3104):
  • May exclude alcoholism and drug addiction and intentionally self-inflicted injury.
  • May exclude mental or nervous disorders, but never Alzheimer's disease or irreversible dementia.
• Preexisting conditions. An exclusion may apply only to losses that begin within 6 months after coverage starts (33-22-1108).
• No prior hospitalization. Benefits can't be conditioned on a prior hospital stay. Noninstitutional benefits conditioned on prior institutional care can't require a stay of more than 30 days. Home health benefits can't require a prior stay at all (33-22-1115).
• Inflation protection. The insurer must offer benefit increases compounded annually at 5% or an equivalent permitted form (ARM 6.6.3108).
• Nonforfeiture. If the buyer declines the nonforfeiture offer, the policy must still include a contingent benefit upon lapse, available after a substantial premium increase (33-22-1116).
• No field issue. No LTC policy may be field-issued based on health status (ARM 6.6.3104).

Contestability (33-22-1127)

Selling LTC

• Free look. The buyer may return the policy within 30 days of delivery for a refund (33-22-1119).
• Shopper's guide. The producer delivers the LTC shopper's guide before presenting an application (ARM 6.6.3115).
• Training. A producer needs a life or disability license, a one-time 8-hour LTC course, and 4 hours of LTC training every 24 months (33-22-1128).

Other senior protections

• A producer who owns, manages or works in a long-term care facility may not sell life or disability insurance to its residents (33-18-502).
• Funeral insurance must allow return within 30 days of delivery for a full refund (ARM 6.6.1014).
• Montana's elder abuse law treats anyone 60 or older as a vulnerable adult. Exploitation includes taking control of an adult's money by deception, undue influence or intimidation (52-3-803).

Common exam traps

• The Medigap and LTC free look in Montana is 30 days. Montana has no general free-look statute for other individual health policies. HMO contracts have their own 10-day return right under ARM 6.6.2506.
• Medigap open enrollment begins when the person is both 65 and in Part B, and it lasts six months.
• Medigap preexisting exclusions are limited to 6 months, and there's no new waiting period when replacing a policy held 6 months.
• An LTC policy can't exclude Alzheimer's, can't require a prior hospital stay, and can't use a trigger of more than three ADLs.
• LTC training: 8 hours once, then 4 hours every 24 months.