Medicare's parts, Medicaid and the basics of long-term care are covered in the national Senior and Special Needs guide. This guide covers Texas's rules for Medicare supplement (28 TAC 3.3301 to 3.3326) and long-term care (28 TAC 3.3804 to 3.3844), plus the training agents need to sell them.

Agent training

• Medicare-related products (TIC 4004.252, 4004.253):
  • 8 hours of training before selling them
  • then 4 hours of Medicare-related CE every 2-year period, which counts toward the 24 hours
• LTC Partnership policies: an 8-hour certification course, then 4 hours of partnership CE each later period (28 TAC 19.1022, 19.1023).

Medicare supplement

Open enrollment (3.3324)

• The 6 months beginning with the first month of Part B enrollment. During it, the issuer can't deny or rate up for health.
• An applicant with at least 6 months of creditable coverage can't face a preexisting-condition exclusion. Shorter coverage reduces the exclusion.

Policy terms

• Preexisting conditions: benefits can't be excluded for losses more than 6 months after the effective date (3.3306).
• Guaranteed renewable. The only grounds to cancel are nonpayment or material misrepresentation (3.3306).
• Free look: 30 days from delivery (3.3308).
• MACRA: plans covering the Part B deductible (C, F and high-deductible F) can't be sold to people newly eligible from 2020 on (3.3306).

Selling rules

• Replacement requires a replacement notice before the policy is issued or delivered. Agents must not sell excessive coverage (3.3309, 3.3319).
• Prohibited marketing (3.3319):
  • twisting
  • high-pressure tactics
  • cold lead advertising
• Issuers report residents with more than one Medigap policy by March 1 each year (3.3321).

Long-term care

Policy protections

• At minimum guaranteed renewable, or noncancellable (3.3822).
• Free look: 30 days from delivery (3.3832).
• Preexisting conditions: limits can't extend beyond 6 months from the effective date (3.3824).
• No prior hospitalization may be required. Home health can't require prior institutionalization.
  • If noninstitutional benefits require prior institutional care, the required stay can't exceed 30 days (3.3825).
• Alzheimer's disease and serious biologically based mental illness can't be excluded (3.3826).

Benefit triggers

• The six ADLs are bathing, continence, dressing, eating, toileting and transferring (3.3804).

Inflation and nonforfeiture

• Insurers must offer inflation protection, such as 5% compound annual increases. It's included unless the applicant signs a rejection (3.3820).
• If the nonforfeiture offer is declined, the contingent benefit upon lapse still applies (3.3844).

Lapse protection (3.3841)

• The applicant names at least one other person to receive lapse notices, or signs a waiver.

Selling rules

• The outline of coverage and an NAIC-format shopper's guide are delivered before an application is presented (3.3832, 3.3840).

Free-look summary

Common exam traps

• Medicare products need 8 hours of training, then 4 hours each period.
• Medigap open enrollment: 6 months from Part B. The preexisting limit is 6 months.
• Plans C and F can't be sold to people newly eligible in 2020 or later.
• LTC: the outline and shopper's guide come before the application. Inflation protection is included unless rejected in writing.
• Alzheimer's can't be excluded.