Selling to seniors means working with Medicare, Medicare Supplement (Medigap) policies, Medicare Advantage and Part D, Medicaid / long-term care, and stand-alone long-term care (LTC) insurance—an area with strong consumer protections because buyers are often vulnerable. This guide reviews the national fundamentals and then focuses on Louisiana specifics: Medigap regulation and free-look rights, Medicaid through the Louisiana Department of Health, free Medicare counseling through Louisiana's SHIIP, and the replacement and suitability rules that protect older Louisiana consumers.
The federal base: Medicare Parts A/B/C/D
Medicare is the federal program for people 65+ (and certain younger people with disabilities or ESRD):
- Part A — hospital/inpatient, skilled nursing (limited), hospice; usually premium-free for those with enough work credits.
- Part B — physician/outpatient services, preventive care, durable medical equipment; carries a monthly premium.
- Part C (Medicare Advantage) — private plans that bundle Parts A and B (often with drug coverage) as an alternative to Original Medicare, frequently using provider networks and sometimes referrals.
- Part D — prescription drug coverage sold by private insurers.
Eligibility is generally at age 65, or earlier with 24 months of Social Security disability (or immediately for ESRD/ALS). A person eligible for both Medicare and Medicaid is dual eligible.
Medicare Supplement (Medigap)
Medigap policies are sold by private insurers to fill Original Medicare's gaps—deductibles, coinsurance, and copays. They are federally standardized into lettered plans (A through N), so a "Plan G" offers the same core benefits from any company; insurers compete on price and service.
- The Medigap Open Enrollment Period is a 6-month window that begins when the applicant is age 65 or older AND enrolled in Part B. During it, coverage is guaranteed issue—no health-based decline or surcharge.
- After that window, insurers may use medical underwriting unless a separate guaranteed-issue right applies (for example, when a Medicare Advantage plan exits the area).
Medicare Advantage and Part D
- Medicare Advantage (Part C) replaces how you receive A and B through a private HMO/PPO network, often adding extras (dental, vision, drug coverage). It is not a supplement—you cannot pair Medigap with an Advantage plan.
- Part D drug plans carry their own enrollment periods and a late-enrollment penalty for those who delay without other creditable coverage.
A core distinction: Medigap supplements Original Medicare; Medicare Advantage replaces how you get it.
Louisiana Medigap regulation: free look, replacement, suitability
Louisiana regulates Medigap and senior sales closely through the Louisiana Department of Insurance (LDI), whose elected Commissioner enforces the marketing rules under La. Rev. Stat. Title 22:
- Free look — Medicare Supplement (and LTC) policies carry a free-look window during which the buyer may return the policy for a full refund; for seniors this is commonly cited as 30 days—verify the current figure.
- Replacement — when a sale replaces an existing Medigap or LTC policy, the producer must deliver a replacement notice, compare benefits, and ensure the change genuinely benefits the client.
- Anti-duplication — selling a second Medigap policy to someone who already has one, or coverage that duplicates Medicare, is a prohibited unfair practice.
- Suitability and disclosures — producers must deliver the "Guide to Health Insurance for People with Medicare" and an Outline of Coverage, and avoid twisting (misrepresentation to induce a switch).
Medicaid and long-term care
Medicaid in Louisiana, administered by the Louisiana Department of Health (LDH), is the income- and asset-based program that, unlike Medicare, does pay for extended custodial long-term care for those who qualify financially:
- Applicants must meet income and asset limits; many seniors must spend down assets to become eligible.
- A look-back period (commonly cited as 5 years—verify) reviews asset transfers to discourage giving away assets to qualify.
- A community spouse is protected from full impoverishment through spousal asset/income allowances.
Medicare, by contrast, largely does not cover long-term custodial care—the gap the LTC insurance market exists to fill. Custodial care assists with activities of daily living (ADLs) such as bathing, dressing, and eating, and does not require skilled medical personnel.
Long-term care insurance
Stand-alone LTC insurance covers nursing-home, assisted-living, and home care. Louisiana follows the NAIC LTC model protections:
- Inflation protection and nonforfeiture benefits must generally be offered, so the benefit can keep pace with rising care costs.
- LTC policies generally cannot require prior hospitalization as a condition for benefits.
- Benefit triggers are commonly the inability to perform a set number of ADLs, or cognitive impairment (e.g., dementia).
- Producer LTC training and a suitability review are required before selling LTC.
Louisiana SHIIP and senior counseling
Louisiana operates the Senior Health Insurance Information Program (SHIIP) through the Department of Insurance—free, unbiased Medicare counseling for seniors choosing among Medicare, Medigap, Advantage, and Part D options. Agents should know SHIIP exists as a non-sales resource and may refer clients to it.
Key Louisiana numbers to memorize
| Topic |
Louisiana / standard rule |
| Medicare eligibility age |
65 (or disability/ESRD) |
| Medigap standardization |
Lettered plans A–N (federal) |
| Medigap open enrollment |
6 months, from age 65 + Part B |
| Open-enrollment protection |
Guaranteed issue, no health decline/surcharge |
| Senior free look (Medigap/LTC) |
Commonly 30 days (verify) |
| Replacement |
Required notice; no duplicate Medigap |
| Medicaid administrator |
Louisiana Department of Health (LDH) |
| Medicaid look-back |
Commonly 5 years (verify) |
| LTC inflation & nonforfeiture |
Must be offered |
| LTC benefit trigger |
Inability to perform ADLs or cognitive impairment |
| Senior counseling |
SHIIP (free Medicare counseling) |
Common exam traps
- Confusing Medigap with Medicare Advantage. Medigap supplements Original Medicare; Advantage (Part C) replaces how you get A/B—and you cannot hold both.
- Miscounting open enrollment. It is 6 months and requires both age 65 and Part B.
- Using a 10-day free look for seniors. Louisiana senior policies commonly use 30 days—verify.
- Selling duplicate coverage. A second Medigap policy is a prohibited practice.
- Assuming Medicare pays for long-term custodial care. It largely does not—Medicaid (LDH) or LTC insurance fills that gap.
- Confusing Medicare with Medicaid. Medicare is federal, age-based; Medicaid (LDH) is income/asset-based.
- Asserting exact look-back or free-look figures. Treat them as statutory and verify.
Quick recap
Senior sales center on Medicare (Parts A/B/C/D), Medigap (federally standardized A–N), and long-term care. The headline protection is the 6-month Medigap open enrollment beginning at age 65 with Part B, which grants guaranteed issue. Louisiana adds a senior free look (commonly 30 days), strict replacement and anti-duplication rules, and a suitability/twisting prohibition enforced by the LDI. Medicaid through the LDH covers custodial long-term care for those who qualify after a spend-down and look-back, while stand-alone LTC insurance must offer inflation protection and nonforfeiture and pays on ADL or cognitive triggers. Louisiana SHIIP offers free counseling. Remember "Medigap supplements, Advantage replaces," the 6-month window, and the 30-day senior free look—and verify any specific figure.
Practice questions are study aids generated for exam preparation and are not actual exam
questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules,
and exam specifications with the Pennsylvania Insurance Department and the exam administrator before relying on it.