Medicare (Parts A, B, C and D), the standardized Medigap plans, Medicaid and the basics of long-term care insurance are covered in the national Senior and Special Needs guide. This guide covers the Nevada rules on top: Medicare supplement sales and enrollment rights (NRS 687B.351 to .352 and NAC 687B.200 to .290), including Nevada's birthday rule and coverage for people under 65, and the long-term care rules (NAC 687B.030 to .130).

Medicare supplement (Medigap)

Enrollment rights

• Under 65: a person under 65 who is on Medicare because of disability or end-stage renal disease may buy any Medicare supplement policy the insurer offers to new insureds 65 or older, with premium limits. Their open enrollment starts the first day of the first month of Part B enrollment and lasts at least 6 months (NRS 687B.351).
• Birthday rule: every year, an insured may switch to a Medicare supplement policy with the same or lesser benefits during an open enrollment that starts on the first day of the birthday month and lasts at least 60 days. Health status can't be used to deny or price the coverage (NRS 687B.352). The new policy is treated like a renewal for commission purposes.

Sales rules

• Outline of coverage: given when the application is presented, with a signed acknowledgment of receipt (except for direct response sales) (NAC 687B.250(1)).
• 30-day free look: the first page must say the policy can be returned within 30 days after delivery for a premium refund (NAC 687B.240(5)).
• No duplicate policies: a sale may not leave a person with more than one Medicare supplement policy (NAC 687B.282(2)).
• Medicare Advantage enrollees: a Medigap policy can't be issued to a Part C enrollee unless it takes effect after the Part C coverage ends (NAC 687B.282(3)).
• Replacement: if the replaced policy was in force at least 6 months, the new one can't impose new pre-existing condition, waiting, elimination or probationary periods for similar benefits (NAC 687B.258(2)).
• No drug coverage: Medigap policies with outpatient prescription drug benefits haven't been issued since December 31, 2005, when Medicare Part D began (NAC 687B.220(5)).
• Commissions: first-year compensation can't be more than 200% of second-year compensation, and renewal compensation must be level for at least 5 years (NAC 687B.275).
• Cold lead advertising (failing to disclose that the purpose is solicitation and that an agent will contact the person) is prohibited (NAC 687B.273).
• Insureds can be referred to the Commissioner or Nevada's State Health Insurance Assistance Program (SHIP) (NAC 687B.250(6)).

Long-term care insurance

• Definition: coverage for at least 12 consecutive months in a setting other than an acute care hospital unit (NAC 687B.030).
• Shopper's guide: the agent gives it before presenting an application (NAC 687B.113(2)). The outline of coverage is delivered at the time of initial solicitation (NAC 687B.075).
• 30-day free look: the applicant may return the policy within 30 days after delivery for a refund for any reason (NAC 687B.060).
• Pre-existing conditions: a look-back of no more than 6 months, and an exclusion only for losses beginning within 6 months after the effective date (NAC 687B.111).
• Alzheimer's disease: a mental or nervous disorder exclusion is allowed, but it can't exclude or limit benefits for Alzheimer's (NAC 687B.090).
• No prior hospitalization: benefits can't be conditioned on a prior hospital stay or a higher level of institutional care. Any prior institutional care required for noninstitutional benefits is capped at 30 days (NAC 687B.116).
• Producer training: an initial 8-hour course, then 4 hours in each 24-month period after the first (NAC 687B.051).

Common exam traps

• Nevada's birthday rule is already in effect: 60 days starting on the first day of the birthday month, same or lesser benefits.
• Under 65 on Medicare because of disability or ESRD: any plan offered to people 65 and older, with a 6-month open enrollment.
• 30-day free look for both Medigap and long-term care.
• Alzheimer's can't be excluded from long-term care coverage.
• Medigap commissions: first year no more than 200% of the second year.
• LTC shopper's guide comes before the application.