The national Senior and Special Needs guide covers Medicare Parts A to D, the standardized Medigap plans, Medicaid and how long-term care insurance works. This guide covers the Vermont rules. Vermont community-rates Medicare supplement policies and requires insurers to sell them to people on Medicare because of disability. It also sets a 30-day free look, limits on Medigap commissions, sales-conduct rules for Medicare marketing, and minimum standards and producer training for long-term care.

Marketing Medicare products (8 V.S.A. § 4804(a)(8))

Two practices are grounds for license action:

• using a Medicare appointment to sell other products, unless the consumer asks for it and the products are identified in writing at least 48 hours in advance
• door-to-door solicitation of Medicare products before the consumer has invited the producer

Medicare supplement (8 V.S.A. § 4051; Reg. H-2009-04)

Rating and eligibility:

• Medigap premiums must be community rated. Medical underwriting and screening aren't allowed. Insurers may keep separate community rates for people eligible by age and by disability (§ 4051(a)).
• An insurer selling Medigap to people 65 and older must offer the same policies to people eligible for Medicare because of disability, with at least a six-month initial enrollment period (§ 4051(c)).
• If disabled policyholders are rated separately, DFR Bulletin 208 (revised January 2026) says they move to the over-65 pool automatically on the first day of the month they turn 65.

Open enrollment: for the six months starting with the first month a person is both 65 or older and enrolled in Part B, an insurer can't deny, condition or price a policy based on health (Reg. H-2009-04 § 11(A)).

Policy standards (Reg. H-2009-04):

• Preexisting conditions: a policy can't exclude a loss incurred more than six months after the effective date. A preexisting condition is one treated or advised in the six months before coverage began (§ 8(A)(1)).
• Free look: the first page must state that the policy can be returned within 30 days of delivery for a full premium refund (§ 17(A)(5)).
• Outline of coverage: it is given when the application is presented, with a signed acknowledgment except for direct-response sales (§ 17(D)).
• Part C enrollees: a Medigap policy can't be issued to someone in Medicare Advantage unless it takes effect after the Part C coverage ends. Selling a person a second Medigap policy is also prohibited (§ 21(C)).
• Commissions: first-year compensation can't exceed 200% of second-year compensation. Renewal compensation must equal the second year's for at least five renewal years (§ 16(A)).

Long-term care insurance (8 V.S.A. ch. 154)

Required benefits and limits:

• An LTC policy can't cover only skilled nursing care or favor skilled care over lower levels. It must include home health care and offer inflation protection (§ 8085(b)).
• An elimination period or deductible can't exceed 100 days (§ 8085(b)(8)).
• Benefits can't be denied because the need comes from a mental condition or Alzheimer's disease (§ 8085(b)(4)).
• Benefits can't be conditioned on a prior hospital stay or facility admission (§ 8087).
• A preexisting-condition exclusion can apply only to losses beginning within six months of the effective date (§ 8086(b)).

Sales and delivery:

• The outline of coverage is given at the first solicitation. An agent gives it before presenting the application (§ 8090).
• The applicant completes a personal worksheet, which goes back to the insurer before it considers the application. Employer group coverage sold to employees and spouses is excepted (§ 8084b(c)(3)).
• Individual LTC policyholders get a 30-day free look with a full refund (§ 8089(a)).

After issue:

• Contestability (§ 8094(b)):
  • From six months to two years, the insurer may contest only for a misrepresentation that was material to acceptance and relates to the condition claimed.
  • After two years, it may contest only for a knowing and intentional misrepresentation.
• An insured may appeal a benefit trigger decision to an independent review organization for a filing fee of no more than $15. The insurer pays the other costs (§ 8093(b)).
• The insurer must offer a nonforfeiture benefit. If declined, a contingent benefit upon lapse applies after a substantial rate increase (§ 8095(a)).

Producer training (Reg. H-2009-01). A producer selling LTC completes one 8-hour course with at least 2 hours of Vermont-specific material, then 4 hours every 24 months.

Guaranty protection: LTC is covered up to $300,000 (8 V.S.A. § 4173(c)).

Common exam traps

• Vermont Medigap is community rated with no medical underwriting.
• Disabled people under 65 must be offered the same Medigap policies.
• The Medigap and LTC free look is 30 days.
• A Medicare appointment can't be used to sell other products unless they are listed in writing 48 hours ahead.
• An LTC elimination period can't exceed 100 days. Alzheimer's can't be excluded, and benefits can't require a prior hospital stay.
• The LTC benefit-trigger appeal fee is capped at $15.
• LTC producer training is 8 hours once, then 4 hours every 24 months.