Seniors rely on a mix of federal programs and private products—Medicare, Medicare Supplement (Medigap), Medicaid, and long-term care insurance—and the Texas exam tests both the national framework and the Texas consumer-protection rules layered on top. This standalone guide covers the four parts of Medicare and enrollment timing, then drills into Texas-specific Medigap rules (open enrollment, under-65 access, replacement) and long-term care specifics. Because Medicare itself is federal, the Texas points center on how policies are sold, replaced, and protected.

Medicare: the federal foundation (quick version)

Medicare is the federal health program for people 65 and older and certain younger people with disabilities or end-stage renal disease. Its four parts:

• Part A — Hospital Insurance: inpatient hospital, short-term skilled nursing, hospice, some home health; usually no premium; uses benefit periods.
• Part B — Medical Insurance: doctor visits, outpatient care, preventive services; monthly premium, deductible, and ~20% coinsurance.
• Part C — Medicare Advantage: private plans bundling A and B (often with D).
• Part D — Prescription Drug Coverage: private, optional drug plans, each with a formulary.

Memory aid: A = hospital, B = medical (doctor), C = combo, D = drugs. Enrollment timing matters: the Initial Enrollment Period (IEP) is a 7-month window around the 65th birthday, and late enrollment can trigger lasting Part B and Part D penalties. This federal structure is identical in Texas; the Texas exam focuses on the supplement and LTC sales rules below.

Medicare Supplement (Medigap) in Texas

Medigap policies are sold by private insurers to fill the gaps—deductibles, coinsurance, copays—left by Original Medicare (Parts A and B). Plans are standardized and labeled by letter (e.g., Plan A, G, N), so every insurer's "Plan G" has the same core benefits and consumers compare on price and service. Medigap works only with Original Medicare, never with Medicare Advantage, and it does not include drug coverage.

Open enrollment and guaranteed issue

• The federal Medigap Open Enrollment Period is a 6-month window that begins when the person is age 65 and enrolled in Part B. During it, coverage is guaranteed issue with no medical underwriting, and the insurer cannot deny or surcharge based on health.
• Texas access for those under 65: Texas requires Medigap availability to Medicare beneficiaries under 65 who qualify due to disability, giving them an open-enrollment opportunity (typically a similar 6-month window when they enroll in Part B). This consumer protection is broader than what many states provide—worth remembering as a Texas distinctive.

Free look and outline of coverage

• Texas follows the standard rule that a Medicare Supplement policy carries a free-look (right to return) period of about 30 days, during which the buyer can cancel for a full refund.
• An Outline of Coverage must be delivered to the applicant (generally at the time of application) so the buyer can compare plans.

Replacement rules

Replacing one Medigap policy with another is tightly regulated to protect seniors:

• The agent must provide a replacement notice ("Notice to Applicant Regarding Replacement of Medicare Supplement Coverage") and have the applicant acknowledge it.
• The replacing insurer generally must waive any time periods (such as pre-existing condition or probationary periods) already satisfied under the policy being replaced, so the client is not penalized twice.
• Agents should never replace coverage that leaves the client worse off; needless replacement to generate commission can be an unfair trade practice.

Pre-existing conditions

A Medigap policy may impose a limited pre-existing condition waiting period (federal law caps the look-back at up to 6 months), but that period shrinks or disappears when the applicant has prior creditable coverage or buys during guaranteed-issue open enrollment.

Medicaid and dual eligibility

Medicaid is a joint federal-state, needs-based program (in Texas, administered through state health agencies) covering people with limited income and assets. Unlike age-based Medicare, eligibility turns on financial need. Medicaid is the largest payer of long-term nursing home care, so many seniors "spend down" assets to qualify. Someone eligible for both Medicare and Medicaid is a dual eligible.

Long-term care (LTC) insurance in Texas

Long-term care insurance pays for extended custodial and personal care—help with everyday living—that Medicare largely does not cover, whether at home, in assisted living, or in a nursing facility.

• Benefit triggers: benefits begin when the insured cannot perform a stated number (usually 2 of 6) of Activities of Daily Living (ADLs)—eating, bathing, dressing, toileting, transferring, continence—or has a cognitive impairment such as dementia.
• Elimination period: a waiting period (in days) before benefits start.
• Inflation protection: Texas, following the NAIC model, requires insurers to offer an inflation-protection option so the daily benefit keeps pace with rising care costs.
• Free look: LTC policies carry a free-look period of about 30 days.
• Suitability and disclosure: agents must assess whether LTC coverage is suitable for the applicant's finances and deliver an Outline of Coverage; policies are typically guaranteed renewable.

Texas Long-Term Care Partnership

Texas participates in the Long-Term Care Partnership Program, linking a qualifying LTC policy to Medicaid asset protection. For every dollar the policy pays in benefits, the insured may protect an equal dollar of assets and still qualify for Medicaid if benefits run out—encouraging private LTC purchase rather than sole reliance on Medicaid.

Key Texas numbers to memorize

Common exam traps

• Medicare vs. Medicaid: Medicare is age/disability-based; Medicaid is needs-based (income/assets).
• Medigap pairs with Original Medicare only—never Medicare Advantage—and contains no drug coverage.
• Medigap is standardized by letter; identical core benefits across insurers, so compare on price.
• Texas requires Medigap access for under-65 disabled Medicare beneficiaries—a state-specific protection.
• On replacement, satisfied waiting/pre-existing periods carry over; the buyer should not restart them.
• Don't forget the ~30-day free look on both Medigap and LTC policies.
• Medicare does not cover most long-term custodial care—that's what LTC insurance is for.
• Inflation protection must be offered on LTC, and the Partnership program ties LTC benefits to Medicaid asset protection.

Quick recap

• Medicare (federal) has four parts—A hospital, B medical, C Advantage, D drugs—with a 7-month IEP and penalties for late enrollment.
• Medigap is standardized and pairs only with Original Medicare; the 6-month open enrollment at 65 + Part B is guaranteed issue, and Texas extends Medigap access to under-65 disabled beneficiaries.
• Watch the Texas sales protections: ~30-day free look, mandatory Outline of Coverage, and strict replacement rules that carry over satisfied waiting periods.
• Medicaid is the needs-based program and the main payer of long-term nursing care; dual eligibles qualify for both.
• LTC insurance covers custodial care, triggered by 2 of 6 ADLs or cognitive impairment, with required inflation-protection offers and the Texas Partnership program for Medicaid asset protection.