Life and Health Insurance · Texas statutes and rules pertinent to accident and health insurance only · 8 min read
Medicare supplement and long-term care insurance rules in Texas
- Identify Texas rules governing Medicare supplement policy standards, definitions, and plan eligibility restrictions.
- Explain Texas requirements for long-term care policy benefits, definitions of activities of daily living, and renewal provisions.
- Determine Texas disclosure and delivery requirements for long-term care outlines of coverage and premium refunds.
Purpose and Scope of Texas Medicare Supplement Rules
The purpose of Texas Medicare supplement rules is to provide reasonable standardization of coverage and simplify terms and benefits (28 TAC §3.3301). These rules aim to eliminate provisions that may be misleading or confusing in the purchase of coverage or claim settlements (28 TAC §3.3301). In addition, Texas regulations provide for full disclosures in the sale of accident and sickness insurance coverages to persons eligible for Medicare (28 TAC §3.3301).
Except as otherwise specifically provided, the Texas Medicare supplement subchapter applies to all Medicare supplement policies delivered or issued for delivery in Texas on or after its effective date (28 TAC §3.3302(a)(1)). Texas minimum standards also apply to all certificates delivered or issued for delivery in Texas under group policies, regardless of where the master policy was delivered or issued (28 TAC §3.3302(a)(2)). In the case of a group Medicare supplement policy, the applicant is the proposed certificate holder (28 TAC §3.3303(4)(B)).
Under Texas regulations, an issuer includes an insurance company, fraternal benefit society, health care service plan, or health maintenance organization delivering policies or certificates in Texas (28 TAC §3.3303(12)). However, the definition of a Medicare supplement policy explicitly excludes a policy or contract of an employer or labor organization, or trustees of its fund, for its employees, former employees, members, or former members (28 TAC §3.3303(20)(A)). Furthermore, Medicare supplement policies and certificates delivered or issued for delivery before June 1, 2010, remain governed by the laws and rules in effect at their delivery or issuance (28 TAC §3.3302(b)).
Common mistakes
- Believing an agent can hand over the long-term care outline of coverage when delivering the policy. Under Texas law, for agent solicitations, you must deliver the outline of coverage prior to presenting an application or enrollment form (28 TAC §3.3832(a)).
- Assuming Texas Medicare supplement policies can include named-condition exclusion waivers for difficult health histories. Specific waivers that exclude or reduce coverage for named preexisting conditions are strictly prohibited (28 TAC §3.3305(b)).
- Confusing guaranteed renewable and noncancellable long-term care policies. A guaranteed renewable policy permits the insurer to increase the premium in the future, while a noncancellable policy generally prevents the insurer from changing its terms or the current premium, subject to the stated exception for additional inflation-protection benefits (28 TAC §3.3832(b)(9)(A)).
Key points
- Texas Medicare supplement rules standardize benefits, prevent misleading terms, and mandate full disclosure to Medicare-eligible consumers (28 TAC §3.3301).
- Individuals newly eligible for Medicare on or after January 1, 2020, cannot purchase plans covering the Part B deductible, eliminating Plans C, F, and High Deductible F for this group (28 TAC §3.3306(a)).
- Medicare supplement policies cannot exclude preexisting conditions beyond six months, cannot use accidental means tests, and cannot attach specific preexisting condition exclusionary waivers (28 TAC §3.3304(1), §3.3305(b), §3.3306(b)(1)(A)).
- Texas defines a long-term care benefit plan as providing coverage for not less than 12 consecutive months for each covered individual; a long-term care insurance policy or certificate issued in Texas must have renewal provisions no less favorable than guaranteed renewability or noncancellability (28 TAC §§3.3804(b)(19), 3.3822).
- Texas defines activities of daily living as bathing, continence, dressing, eating, toileting, and transferring (28 TAC §3.3804(b)(1)).
- Long-term care outlines of coverage must be freestanding in at least 12-point type, delivered before an application is presented in agent solicitations, and describe the policyholder's right to return the policy within 30 days of delivery, or longer if the policy provides, for a full premium refund (28 TAC §3.3832(a), (b)(3)(A)).
- If an insurer denies a long-term care application, it must refund any collected premiums within 30 days (28 TAC §3.3832(b)(13)).
The full lesson continues with 4 more sections with exam tips, audio in English and Spanish and 5 Check yourself questions.
- 1 month
$53.99$26.99 - 3 months
$158.99$79.49 - Lifetime
$323.99$161.99
One payment, no subscription.
See Life and Health plansAlready a member? Log in
25 practice questions on this exam
Each Life and Health practice test has 25 original questions with the answers explained. No account needed.
Open the Life and Health practice testsOriginal lesson written for Life and Health Insurance practice · updated October 30, 2026. Exam names are trademarks of their owners; tests.global is not affiliated with them.