Oregon's senior-market rules come from the Medicare supplement statutes (ORS 743.680-743.687) and their rules (OAR 836-052-0100 to 0180), and from the long term care statute (ORS 743.650-743.656) and its rules (OAR 836-052-0500 and following). Two Oregon features show up often:

• An annual birthday rule for switching Medicare supplement policies.
• Guaranteed Medigap access for people under 65 who are on Medicare because of disability.

How Medicare works (Parts A-D, enrollment periods, standardized plan letters, Medicaid, LTC benefit triggers) is in the national Senior and Special Needs guide.

Medicare supplement

Outline of coverage (ORS 743.685)

• It must be delivered at the time the application is made, with an acknowledgment of receipt.
• It must also be used to explain the coverage during the sales presentation.

Free look (743.686)

• 30 days from delivery, for a full premium refund.

Preexisting conditions (743.683)

• No denial for a preexisting condition for losses incurred more than 6 months after coverage begins.

Open enrollment (OAR 836-052-0138)

• A 6-month period beginning on the first day of the first month the person is enrolled in Part B. During it, issuers can't deny coverage or price it based on health.
• A person under 65 who has Medicare because of disability and enrolls in Part B gets the same 6-month open enrollment.
• Movers under 65: a disabled Medicare beneficiary who moves to Oregon from a state that didn't require issuing Medigap to people under 65 has a guaranteed issue period lasting 63 days from establishing Oregon residency.

Birthday rule (OAR 836-052-0143)

• Each year, from 30 days before through 30 days after the policyholder's birthday, the policyholder may switch to another Medicare supplement policy with the same or lesser benefits.
• The issuer can't deny, condition or price the new policy based on health or claims.

Sales rules (OAR 836-052-0156 to 0180; ORS 743.687, 743B.300)

• No duplicate coverage: a sale that would give someone more than one Medicare supplement policy is prohibited.
• Medicare Advantage enrollees: a supplement may be issued only if it takes effect after the Part C coverage ends.
• Commission: first-year commission can't exceed 200% of the second-year commission.
• Cold lead advertising is prohibited. This is marketing that doesn't disclose conspicuously that its purpose is to solicit insurance and that a producer or insurer will make contact.
• Notice to Buyer: the first page of the policy must state, "Notice to Buyer: This policy may not cover all of your medical expenses."
• Advertisements intended for use in Oregon must be provided to the Director.
• Replacing or adding coverage at 65 or older: the producer must offer to compare the existing coverage with the new coverage.

Long term care insurance

Definition and policy standards (ORS 743.652-743.655)

• Minimum coverage: LTC must be designed to cover each person for at least 24 consecutive months.
• Alzheimer's: a policy can't exclude Alzheimer's disease and related dementias.
• Preexisting conditions: a loss may be excluded only if it begins within 6 months after coverage takes effect.
• Prior institutional stay: if noninstitutional benefits depend on one, the required stay can't exceed 30 days.
• Lapse: a policy can't lapse for nonpayment until premium is 31 days overdue, and only after notice.

Free look, delivery and claims (ORS 743.655)

• Free look: 30 days from delivery.
• Outline of coverage: in a producer solicitation, delivered before an application or enrollment form is presented.
• Delivery: within 30 days after the application is approved.
• Denied claims: a written explanation within 60 days of a written request.

Benefit triggers (OAR 836-052-0516)

• The activities of daily living must include at least bathing, continence, dressing, eating, toileting and transferring.
• A tax-qualified policy conditions benefits on inability to perform a stated number of ADLs or on severe cognitive impairment (ORS 743.652(2)).

Inflation protection (OAR 836-052-0616)

• Insurers must offer an option at least as favorable as annual increases compounded at 3% or more.
• An applicant who declines must sign a rejection.

Shopper's Guide (OAR 836-052-0786)

• In a producer solicitation, the LTC Shopper's Guide is delivered before an application is presented.

Producer training (OAR 836-052-0639)

• Producers selling LTC complete the required training.
• They send the notice of completion to each insurer they will sell LTC for.

Partnership policies (OAR 836-052-0531)

Guaranty association

• The Oregon Life and Health Insurance Guaranty Association covers LTC benefits up to $300,000 per life (ORS 734.810).

Common exam traps

• Medigap birthday rule: 30 days before to 30 days after the birthday. The new policy must have the same or lesser benefits.
• Disabled under 65: the same 6-month open enrollment when they enroll in Part B. Movers get 63 days.
• Free looks: Medigap 30 days, LTC 30 days. The individual health right to return is 10 days.
• LTC minimum: 24 consecutive months. No Alzheimer's exclusion. Prior stay no more than 30 days.
• Outline timing: Medigap at application and in the presentation. LTC before the application in a producer sale.