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 Washington rules. Washington community-rates Medicare supplement policies with no attained-age rating and requires level commissions. It sets a 30-day free look for Medigap and LTC, guaranteed-issue rights for people replacing coverage, and Washington's LTC standards and producer training. Medigap law is in chapter 48.66 RCW and chapter 284-66 WAC. LTC law is in chapter 48.83 RCW.

Medicare supplement: issue rights

• Open enrollment (RCW 48.66.025): the protection lasts six months starting the first month a person is both 65 or older and enrolled in Part B. For applications submitted before or during that period, an insurer can't deny coverage or price it based on health.
• Preexisting conditions: an open-enrollment applicant with at least three months of continuous creditable coverage can't be subject to a preexisting-condition exclusion.
• Guaranteed issue (RCW 48.66.055): people losing certain coverage are protected if they apply within 63 days after it ends.
• Replacement (RCW 48.66.045(2)(b)): an issuer must offer its listed standardized plans, including Plan N, without evidence of insurability to someone replacing another Medigap policy or more comprehensive coverage.
• When a Medigap policy replaces one that was in force at least three months, the new policy can't impose new preexisting, waiting, elimination or probationary periods (WAC 284-66-170).

Medicare supplement: rating and commissions

• Premiums are community rated with only limited variations (RCW 48.66.045(3)). Allowed variations include spousal discounts, payment frequency and method, and separate pools for people eligible by age and by disability or ESRD.
• Attained-age rating is prohibited (WAC 284-66-310).
• Policies are guaranteed renewable. The issuer may cancel or nonrenew only for nonpayment or material misrepresentation (WAC 284-66-064).
• Commissions must be the same percentage of premium every policy year while coverage stays in force (WAC 284-66-350). Washington doesn't allow front-loaded first-year commissions.

Medicare supplement: sales rules

• Free look: the first page says the policy may be returned within 30 days of delivery for a refund (RCW 48.66.120).
• The outline of coverage and the Guide to Health Insurance for People with Medicare are given at application, with a signed receipt except for direct-response sales (WAC 284-66-080, -110).
• No sale may leave a person with more than one Medigap policy. A Medigap policy can't be issued to a Medicare Advantage enrollee unless it takes effect after the Part C coverage ends (WAC 284-66-340).
• Only the applicant, a relative, a legal guardian or a physician may fill in the medical history (RCW 48.66.140).
• High-pressure tactics, such as force, fright or threat, are prohibited (WAC 284-66-330).
• Policies say they "may not cover all of your medical expenses."
• Health policies sold to Medicare beneficiaries that aren't Medigap carry a notice of at least 12-point type saying so (WAC 284-66-120).
• A policyholder who becomes eligible for Medicaid may suspend benefits and premiums for up to 24 months by asking within 90 days of becoming eligible (WAC 284-66-130).

Long-term care (chapter 48.83 RCW)

• Definition: LTC insurance covers at least 12 consecutive months of care in a setting other than an acute care hospital unit (RCW 48.83.020(5)).
• Renewability: the first page has a captioned provision stating whether coverage is guaranteed renewable or noncancellable (WAC 284-83-030).
• Outline of coverage: in a face-to-face sale, the outline is given before the application is presented (RCW 48.83.070(1)(b)).
• Delivery: the policy is delivered within 30 days after approval (RCW 48.83.070(2)).
• Free look: 30 days after delivery, with a premium refund (RCW 48.83.060).
• Producer training (RCW 48.83.130):
  • a one-time 8-hour course before selling LTC
  • 4 hours of LTC education every 24 months
  • Insurers certify their producers' training each year by March 31 (WAC 284-17-262).
  • LTC hours count toward the 24-hour CE requirement.
  • Washington doesn't require a separate Partnership course.
  • Selling a Washington supplemental LTC policy also requires a one-time, one-credit course.

Counseling

The OIC runs SHIBA, the Statewide Health Insurance Benefits Advisors program. Its OIC-trained volunteers help people with Medicare choices (WAC 284-02-010).

Guaranty protection

The Washington Life and Disability Insurance Guaranty Association covers LTC up to $500,000 (RCW 48.32A.025).

Common exam traps

• Washington Medigap is community rated, and attained-age rating is banned.
• Medigap commissions are level every year.
• The Medigap and LTC free look is 30 days.
• Guaranteed issue after losing coverage requires applying within 63 days.
• Three months of creditable coverage removes preexisting-condition exclusions.
• LTC must cover at least 12 months. Producer training is 8 hours, then 4 hours every 24 months.
• A Medigap suspension on Medicaid can last up to 24 months and must be requested within 90 days of becoming eligible.