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 Missouri specifics: Medigap regulation and free-look rights, the Missouri Partnership for Long-Term Care, Missouri's CLAIM counseling program, and the replacement and suitability rules that protect older Missouri 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), administered by the Centers for Medicare & Medicaid Services (CMS):

• 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.
• 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 key gap: Original Medicare generally does not cover most long-term custodial care.

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. All standardized plans cover certain core benefits, such as Part A hospital coinsurance.

• 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.

Missouri Medigap regulation: free look, replacement, suitability

Missouri regulates Medigap sales closely through the Missouri Department of Commerce & Insurance (DCI):

• 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 Missouri is called MO HealthNet (administered by the Department of Social Services)—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.

Long-term care insurance and the Missouri Partnership

Stand-alone LTC insurance covers nursing-home, assisted-living, and home care, and pays when the insured cannot perform a set number of activities of daily living (ADLs) or has a cognitive impairment (the benefit triggers). Missouri follows the NAIC LTC model protections and adds a Partnership program:

• LTC policies use an elimination period (a waiting period in days before benefits begin) and a benefit period.
• Inflation protection and nonforfeiture benefits must generally be offered, because care costs tend to rise over time.
• LTC policies generally cannot require prior hospitalization as a condition for benefits.
• Producer LTC training and suitability review are required before selling LTC (Missouri commonly requires an initial 8-hour course plus ongoing 4-hour Partnership training—verify).
• The Missouri Partnership for Long-Term Care links qualified private LTC policies to MO HealthNet (Medicaid) asset protection: dollars paid by a qualifying Partnership policy let the insured shield an equal amount of assets if they later need Medicaid.

Missouri CLAIM and senior counseling

Missouri operates its State Health Insurance Assistance Program (SHIP) under the name CLAIM (Community Leaders Assisting the Insured of Missouri)—free, unbiased Medicare counseling for seniors choosing among Medicare, Medigap, Advantage, and Part D options. Agents should know CLAIM exists as a non-sales resource and may refer clients to it.

Key Missouri 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.
• Using a 10-day free look for seniors. Missouri 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—MO HealthNet (Medicaid) or LTC insurance fills that gap.
• Confusing Medicare with Medicaid. Medicare is federal, age-based; Medicaid (MO HealthNet) is income/asset-based and central to Partnership asset protection.
• Naming the wrong counseling program. Missouri's SHIP is CLAIM.
• 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. Missouri adds a senior free look (commonly 30 days), strict replacement and anti-duplication rules, and a suitability/twisting prohibition. Medicaid through MO HealthNet 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 connects to the Missouri Partnership for Long-Term Care for Medicaid asset protection. Missouri's CLAIM program offers free counseling. Remember "Medigap supplements, Advantage replaces," the 6-month window, and the 30-day senior free look—and verify any specific figure.