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 Wisconsin specifics, including the state's biggest quirk: Wisconsin is one of only three states that uses its own standardized Medicare supplement format rather than the federal lettered plans.

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.
• Part D — prescription drug coverage sold by private insurers.

Eligibility is generally at age 65, or earlier with sustained Social Security disability (or for ESRD/ALS). Medicare's skilled nursing facility coverage is limited and tied to a qualifying inpatient hospital stay—it does not pay for open-ended custodial care.

Wisconsin's distinctive Medicare supplement format

Here is the single most important Wisconsin senior fact: Wisconsin is one of only three states—along with Minnesota and Massachusetts—that did not adopt the federal standardized Medigap plans (Plans A through N). Instead, Wisconsin regulates Medicare supplement insurance using its own state-standardized format, typically a base policy to which buyers add optional riders to fill specific gaps. So a "Plan G" comparison you would make in Illinois does not translate directly to Wisconsin.

• The protections are similar in spirit—Medigap fills Original Medicare's gaps (deductibles, coinsurance, copays)—but the plan structure is Wisconsin-specific.
• Verify the current rider and benefit details, because the state format and its riders are set by Wisconsin rule and can change.

Medigap open enrollment and guaranteed issue

• 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).
• A guaranteed-issue right means the insurer cannot deny coverage or charge more because of health during that period.

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.

Wisconsin Medigap sales rules: free look, replacement, suitability

Wisconsin regulates Medigap sales closely through the Office of the Commissioner of Insurance:

• 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 around 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 required buyer's guide and an Outline of Coverage, and avoid twisting (misrepresentation to induce a switch).

Medicaid and long-term care in Wisconsin

Medicaid in Wisconsin (administered by the Department of Health Services, DHS) is the income- and asset-based program that, unlike Medicare, does pay for extended custodial long-term care for those who qualify financially. A person eligible for both Medicare and Medicaid is a dual eligible.

• 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 Wisconsin Partnership

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

• Inflation protection and nonforfeiture benefits must generally be offered.
• LTC policies generally cannot require prior hospitalization as a condition for benefits.
• Producer LTC training and suitability review are required before selling LTC.
• The Wisconsin Long-Term Care Insurance Partnership links qualified private LTC policies to Medicaid asset protection: dollars paid by a qualifying Partnership policy let the insured shield an equal amount of assets if they later need Medicaid—verify current program rules.

Wisconsin senior counseling and prescription help

Wisconsin offers free, unbiased Medicare counseling for seniors choosing among Medicare, Medigap, Advantage, and Part D (often through the state's benefit-counseling network and a dedicated Medigap helpline). Wisconsin also runs SeniorCare, a state prescription-drug assistance program for eligible older residents. Agents should know these exist as non-sales resources—verify current program details.

Key Wisconsin numbers to memorize

Common exam traps

• Applying the federal A–N Medigap plans to Wisconsin. Wisconsin uses its own standardized format (with Minnesota and Massachusetts as the other two states).
• 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 (DHS) is income/asset-based and central to Partnership asset protection.
• 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, and long-term care. The headline Wisconsin fact is that the state uses its own standardized Medicare supplement format instead of the federal A–N plans—one of only three states (with Minnesota and Massachusetts) to do so. The 6-month Medigap open enrollment beginning at age 65 with Part B grants guaranteed issue. Wisconsin adds a senior free look (commonly ~30 days), strict replacement and anti-duplication rules, and a suitability/twisting prohibition. Medicaid through DHS covers custodial long-term care after a spend-down and look-back, while stand-alone LTC insurance must offer inflation protection and nonforfeiture and connects to the Wisconsin Long-Term Care Insurance Partnership. Remember "Medigap supplements, Advantage replaces," the Wisconsin-specific Medigap format, and verify any specific figure.