The national guide covers Medicare Parts A through D, Medigap plan letters and long-term care concepts. Georgia regulates Medicare supplement insurance in O.C.G.A. Chapter 33-43 and Rule 120-2-8, and long-term care in Chapter 33-42 and Rule 120-2-16.

Medicare in brief

• Part A is hospital insurance: inpatient care, skilled nursing, hospice and some home health.
• Part B covers doctors, outpatient care and preventive services.
• Part C (Medicare Advantage) provides Part A and B benefits through Medicare-approved private plans.
• Part D covers prescription drugs through private plans.
• Medigap policies are sold by private insurers as standardized lettered plans. Plan A contains only the basic (core) benefits.

Medicare supplement in Georgia

• No duplication of Medicare benefits (33-43-3(a)).
• Free look: a first-page notice gives 30 days from delivery to return the policy, with the refund paid directly to the applicant (33-43-6).
• Open enrollment: the six months starting on the first day of the month the person is both 65 or older and enrolled in Part B (Rule 120-2-8-.11).
• Under 65: insurers that sell Medigap to people 65 and over must also offer it to people on Medicare because of disability or end-stage renal disease (33-43-3(g)).
• Preexisting conditions: the look-back is six months, and losses more than six months after the effective date can't be excluded (33-43-3(b)).
• Replacement: the new issuer waives preexisting and waiting periods already satisfied under the old policy (Rule 120-2-8-.23).
• Renewability: every Medigap policy is guaranteed renewable.
• Medicaid: a policyholder may suspend benefits and premiums for up to 24 months by asking within 90 days of becoming eligible for Medicaid (Rule 120-2-8-.08).
• Delivery: applicants receive the Guide to Health Insurance for People with Medicare and an outline of coverage (Rule 120-2-8-.17).
• Loss ratios: at least 65% for individual policies and 75% for group (Rule 120-2-8-.14).
• Commissions: first-year pay may be no more than 200% of second-year pay, with renewal commissions for at least five years (Rule 120-2-8-.16).

Long-term care in Georgia

• Definition: LTC provides benefits for at least 12 consecutive months in a setting other than an acute-care hospital unit (33-42-4).
• Free look: 30 days after delivery (33-42-6(f)).
• Outline of coverage: delivered at the time of application, or by policy delivery for direct-response sales (33-42-6(g)).
• Shopper's guide: an agent delivers it before presenting an application (Rule 120-2-16-.32).
• Preexisting conditions: look-back of six months. An exclusion applies only to a loss beginning within six months of the effective date (33-42-6(c)).
• Prior hospitalization: a policy may require it only if the insurer also offers an LTC policy without that condition (33-42-6(d)).
• No termination because of age or declining health (33-42-6(b)).
• Lapse protection (Rule 120-2-16-.07):
  • The applicant may name another person to receive lapse notices.
  • Notice can't go out until premium has been unpaid 30 days, and the lapse can't take effect until 30 days after the notice.
  • Reinstatement is allowed within five months if the insured was cognitively impaired.
• Required offers:
  • inflation protection, such as 5% compounded annually (Rule 120-2-16-.13)
  • nonforfeiture. If it is declined, the contingent benefit upon lapse applies.
• Suitability: insurers set suitability standards and train their agents to use them (Rule 120-2-16-.24).
• Partnership policies (Rule 120-2-16-.34) must include inflation protection by age:

• Producer training: an initial 8-hour LTC course, then 4 hours every 24 months.

Exam traps

• Georgia free looks: 30 days for Medigap and LTC, and 10 days for individual life, annuities and A&S.
• Medigap open enrollment also covers disabled and ESRD beneficiaries under 65.
• A Medigap policy can be suspended for 24 months if the request comes within 90 days of Medicaid eligibility.
• LTC training: 8 hours first, then 4 hours every 24 months.