Medicare (Parts A, B, C and D), the standardized Medigap plans, Medicaid and the basics of long-term care insurance are covered in the national Senior and Special Needs guide. This guide covers the Ohio rules on top: Medicare supplement requirements (R.C. 3923.33 to 3923.336; O.A.C. 3901-8) and the long-term care law and rule (R.C. 3923.44; O.A.C. 3901-4-01).

Medicare supplement (Medigap)

• Open enrollment: the six months starting with the first month a person is both 65 or older and enrolled in Part B. During it, an insurer can't deny, condition or price coverage based on health status, including tobacco or nicotine use (O.A.C. 3901-8-08(N)).
• Outline of coverage: a policy can't be delivered unless the outline was given when the application was made (R.C. 3923.334).
• Pre-existing conditions: a look-back of no more than six months, and no exclusion of losses incurred more than six months after the effective date (R.C. 3923.332(B)).
• 30-day free look: a prominent notice of the right to return the policy within 30 days of delivery for a refund (R.C. 3923.335).
• Advertising: every Medicare supplement ad intended for Ohio goes to the Superintendent for review (R.C. 3923.336).

Long-term care insurance

Required protections (R.C. 3923.44):

• 30-day free look from delivery, with the premium refunded.
• The agent gives the outline of coverage and a consumer information notice before presenting an application. A shopper's guide goes to all prospective applicants (O.A.C. 3901-4-01).
• No termination because of age or declining health.
• Pre-existing conditions: a six-month look-back, excluded only for losses beginning within six months after coverage starts.
• No skilled-nursing-only policies, and no policies with much more coverage for skilled care than for lower levels.
• A required prior institutional stay can't exceed 30 days, with a hospital stay of no more than three days as an alternative.

Rules on lapse and inflation (O.A.C. 3901-4-01):

• Lapse protection: the applicant names at least one other person to receive lapse notices, or signs a waiver. Notice comes at least 30 days before lapse and can't be sent until the premium is 30 days overdue.
• Reinstatement: if requested within five months after termination, with proof of cognitive impairment or loss of functional capacity.
• Inflation protection must be included unless the policyholder signs a rejection.
• Suitability: insurers develop and use suitability standards and train agents on them.

Common exam traps

• Medigap open enrollment ignores tobacco use in Ohio.
• 30-day free look for both Medigap and long-term care.
• LTC outline of coverage before the application.
• Prior stays: at most 30 days institutional or 3 days hospital.
• LTC lapse: third-party notice or waiver; reinstatement within five months for cognitive or functional impairment.
• Inflation protection is included unless rejected in writing.