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 Maryland specifics: Medigap regulation and replacement disclosures, LTC suitability and benefit triggers, the role of Medicaid in long-term care, and the protections the Maryland Insurance Administration (MIA) enforces for older 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, some home health; usually premium-free for those with enough Medicare-covered work history (payroll taxes).
• Part B — physician/outpatient services, preventive care, durable medical equipment; carries a monthly premium.
• Part C (Medicare Advantage) — private plans approved by Medicare that bundle Parts A and B (often with drug coverage) as an alternative to Original Medicare.
• 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).

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, 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.

Medicare Advantage and Part D

• Medicare Advantage (Part C) replaces how you receive A and B through a private HMO/PPO plan, 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.

Maryland Medigap regulation: replacement, suitability, disclosures

Maryland regulates Medigap sales closely through the Maryland Insurance Administration:

• Replacement — when a sale replaces an existing Medicare supplement (or LTC) policy, the producer must deliver the required replacement disclosures, compare benefits, and ensure the change genuinely benefits the client. Replacement of a Medicare supplement triggers specific senior-protection disclosure requirements.
• 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 generally deliver consumer guides and an Outline of Coverage, and must avoid twisting (misrepresentation to induce a switch).
• Free look — Medicare Supplement (and LTC) policies carry a free-look window during which the buyer may return the policy for a full refund; senior policies commonly use a longer window than ordinary policies—verify the current figure with the MIA.

Medicaid and long-term care

Medicaid is the needs-based, joint federal-state program that, unlike Medicare, does pay for extended custodial long-term care for those who qualify financially. In Maryland it is administered by the state's health/human-services agency, not the MIA:

• 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 generally 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. Remember the difference: Medicare is federal and age-based; Medicaid is needs-based and central to long-term-care financing.

Long-term care insurance

Stand-alone LTC insurance covers nursing-home, assisted-living, and home care—levels of care that range from skilled (physician-ordered, medical) down to custodial (help with everyday activities, non-medical). Maryland follows NAIC-style LTC protections:

• Benefit triggers — benefits commonly begin when the insured cannot perform a specified number of activities of daily living (ADLs) or has a cognitive impairment.
• Inflation protection and nonforfeiture benefits must generally be offered so coverage keeps pace with rising care costs.
• Producer LTC training and suitability review are generally required before selling LTC.
• Respite care (temporary relief for an unpaid family caregiver) is a common feature.
• Tax-qualified LTC policies that meet federal standards may offer favorable tax treatment.

Many states also operate an LTC Partnership program linking qualifying private policies to Medicaid asset protection; confirm Maryland's current Partnership details with the MIA if a question turns on it.

Special-needs and senior planning tools

On the life side, seniors and special-needs planning often use survivorship (second-to-die) policies for estate liquidity, accelerated death benefit riders for terminal illness, and annuities (immediate or deferred) to convert savings into lifetime income. These pair with the health products above when serving older clients.

Key Maryland numbers to memorize

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.
• Selling duplicate coverage. A second Medigap policy is a prohibited practice.
• Assuming Medicare pays for long-term custodial care. It largely does not—Medicaid or LTC insurance fills that gap.
• Confusing Medicare with Medicaid. Medicare is federal, age-based; Medicaid is needs-based and runs through the state's health/human-services agency, not the MIA.
• Forgetting LTC suitability/training and the inflation & nonforfeiture offer.
• 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 lettered plans), 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. Maryland, through the MIA, adds strict replacement and anti-duplication rules, suitability/twisting prohibitions, and a senior free look (commonly longer than ordinary—verify). Medicaid (needs-based, through the state health/human-services agency) 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, pays on ADL/cognitive triggers, and requires producer training and suitability. Remember "Medigap supplements, Advantage replaces," the 6-month window, and that Medicare ≠ Medicaid—and verify any specific figure.