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 New York rules: community-rated, year-round Medicare supplement coverage (Regulation 193), the long-term care standards in Regulation 62 (11 NYCRR 52), the New York State Partnership for Long-Term Care (Regulation 144) and the state's long-term care tax credit.

Medicare supplement (Regulation 193, 11 NYCRR 58)

• Community rated: premiums don't vary by age, sex or health status. They do vary by plan and region (Ins. Law 3231(a)).
• Year-round guaranteed issue: applications must be accepted at all times during the year, not only during a six-month open enrollment window (Ins. Law 3231(a); 11 NYCRR 58).
• 30-day free look: the policy must state that it can be returned within 30 days of delivery for a full premium refund (11 NYCRR 58.1).

Because of community rating and continuous open enrollment, New York candidates shouldn't apply the federal "six-month open enrollment, then medical underwriting" model to New York Medigap sales.

Long-term care insurance (Regulation 62, 11 NYCRR 52.25)

• Guaranteed renewable: individual policies must be guaranteed renewable, with premium changes only by class.
• Minimum coverage: at least 24 consecutive months per covered person, including all levels of nursing home care and home care (11 NYCRR 52.65).
• Pre-existing conditions: the only allowed limitation excludes coverage for up to six months after the effective date for conditions treated or advised within six months before it.
• Alzheimer's: mental and nervous disorders may be excluded, but not Alzheimer's disease or demonstrable organic brain disease.
• No prior hospitalization or prior level of care may be required.
• Inflation protection must be offered at purchase, for example 5% a year compounded.
• Nonforfeiture: a policy may be offered only if the insured has the option of a nonforfeiture value, such as reduced paid-up coverage.
• Separate periods of care: two stays count as separate periods of care only if they're separated by at least 30 days without benefits.

Replacement of A&H and long-term care coverage. When a sale adds to or replaces accident and health coverage, the producer signs a statement that they reviewed the applicant's current coverage and the new coverage is appropriate, and a replacement notice is given (11 NYCRR 52.29).

New York State Partnership for Long-Term Care (Regulation 144, 11 NYCRR 39)

• Partnership policies let owners qualify for Medicaid while protecting assets (Social Services Law 367-f).
• Total Asset plans protect all assets once the policy's benefits are used. Dollar-for-Dollar plans protect assets equal to the benefits paid.
• The 4/4/100 design requires at least a 48-month lifetime maximum for each covered person (11 NYCRR 39.5).

New York long-term care tax credit

New York allows a state income tax credit of 20% of qualifying long-term care premiums paid during the year (Tax Law 606(aa)).

Common exam traps

• New York Medigap is community rated and sold year-round. There's no medical underwriting.
• 30-day free look on Medicare supplement policies.
• LTC minimum benefit: 24 consecutive months.
• Alzheimer's can't be excluded.
• Partnership: Total Asset protects everything; Dollar-for-Dollar protects what was paid.
• Tax credit: 20% of qualifying LTC premiums.