Medicare Supplement and Long Term Care on the Texas Life and Health Exam

Senior market products are a big chunk of the health side of the Texas Life and Health exam, and they are full of numbers that look alike. Six months here, 30 days there, 63 days somewhere else.

This page puts Medicare, Medicare supplement, and long term care in one place, the way the exam tests them. You will also find 8 practice questions I wrote, with answers.

The Texas rules come from the Texas Administrative Code and TDI's own consumer guides. Links are at the bottom. I checked them in October 2026. Medicare dollar amounts change every year, so I left them out. The exam tests the rules, not this year's deductible.

Where this shows up on the exam

In the Pearson VUE outline, Medicare supplement and long term care are part of Accident and Health Types of Policies, which is 16 questions. Medicare Parts A, B, C, and D sit in Social Insurance, which is 6 questions.

Then the Texas accident and health section, 7 questions, lists Medicare supplement minimum standards, Medicare supplement cancellation, and long term care rules by name. So this topic can reach you from three different directions.

Medicare in two minutes

Medicare is the federal health insurance program for people 65 and older, and for some younger people with disabilities, end stage renal disease, or ALS.

Part A is hospital coverage: inpatient hospital care, skilled nursing facility care after a hospital stay, home health, and hospice. Most people do not pay a Part A premium.

Part B is medical coverage: doctor visits, outpatient care, lab work, durable medical equipment, and preventive care. Everyone pays a Part B premium.

Part C is Medicare Advantage. Private plans, often HMOs or PPOs, provide Part A and B benefits in place of Original Medicare.

Part D is prescription drug coverage, sold by private insurers approved by Medicare.

Two limits the exam loves. Medicare covers up to 100 days of skilled nursing care in a benefit period after a hospital stay, and it does not cover custodial care when that is the only care you need. That gap is exactly what long term care insurance is for.

Medicare supplement basics

Medicare supplement, also called Medigap, is private insurance that pays some of the costs Original Medicare leaves behind: deductibles, coinsurance, and copayments. It only works with Original Medicare, not with Medicare Advantage.

There are 10 standardized plans, each named with a letter: A, B, C, D, F, G, K, L, M, and N. The benefits for each letter are set by law, so Plan G from one company covers the same things as Plan G from another. Only the price and service differ.

Every company that sells Medicare supplement must offer Plan A, the basic or core plan. The core benefits include Part A hospital coinsurance from day 61 through day 90, the lifetime reserve days, an extra 365 days of hospital coverage after Medicare runs out, the Part B coinsurance, the first three pints of blood, and hospice cost sharing.

A few plan details that get tested. Plan N has copays of up to $20 for most office visits and up to $50 for emergency room visits. Plans C, D, F, G, M, and N cover emergency care outside the U.S. at 80 percent, after a $250 calendar year deductible, up to a $50,000 lifetime maximum, for care that starts in the first 60 days of a trip.

Plans C and F cover the Part B deductible. They cannot be sold to people who first became eligible for Medicare on or after January 1, 2020. Those people can buy Plan G instead, which covers everything F does except the Part B deductible.

Medicare supplement rules Texas tests

Open enrollment: 6 months. It starts on the first day of the first month a person is enrolled in Medicare Part B. If the person is 65 or older, the company cannot refuse to sell them a policy, cannot attach conditions, and cannot charge more because of their health during this window. It happens once.

Preexisting conditions: 6 and 6. A Medicare supplement policy cannot exclude a preexisting condition for more than 6 months after coverage starts, and it can only look back 6 months before coverage to define one. If an applicant in open enrollment already has at least 6 months of continuous creditable coverage, the company cannot apply a preexisting exclusion at all.

Guaranteed renewable. Every Medicare supplement policy must be guaranteed renewable. The company cannot cancel or refuse to renew it because of the insured's health, and only for nonpayment of premium or material misrepresentation.

Free look: 30 days. The buyer can return the policy within 30 days and get a full refund.

Medicaid suspension. If the insured becomes entitled to Medicaid, they can have benefits and premiums suspended for up to 24 months, if they notify the insurer within 90 days.

Guaranteed issue: 63 days. People who lose certain other coverage have a guaranteed issue right to buy specific Medicare supplement plans, good for 63 days from when the coverage ends or from the notice that it will end, whichever is later.

Selling practices. TDI lists twisting, high pressure tactics, cold lead advertising, ads designed to look like government mail, and selling a Medicare supplement that duplicates coverage the person already has as unfair practices. And any ad for a Medicare related product must say it is not connected with or endorsed by the U.S. government or the federal Medicare program.

A training detail that confuses people. Texas requires 8 hours of training before selling Medicare related products and 4 hours of related CE each license period after that. The statute defines Medicare related products as Medicare Advantage, Medicare prescription drug plans, and similar plans, and it specifically leaves out Medicare supplement. So if a question asks about Medicare Advantage training, 8 and 4 are your numbers.

Long term care basics

Long term care insurance pays for care when someone cannot take care of themselves because of an illness, a disability, or a cognitive problem like Alzheimer's disease. It covers nursing homes, assisted living, home care, and adult day care, and it must cover all levels of care from custodial to intermediate to skilled.

Benefit triggers. Policies pay when the insured cannot perform activities of daily living or has a cognitive impairment. The six ADLs are bathing, eating, dressing, toileting, continence, and transferring. TDI describes that last one as moving from place to place.

Tax qualified policies. To be tax qualified, a policy pays when the insured has a cognitive impairment or cannot perform 2 of the 6 ADLs for at least 90 days, and there must be a plan of care from a doctor or licensed health care practitioner. Benefits from a tax qualified policy are generally not taxable income.

Elimination period. This is the waiting period between when care starts and when the policy starts paying. TDI says most policies use 30 to 180 days. A longer elimination period means a lower premium.

Benefit period. How long benefits last, from one year to a lifetime. Some policies use a total benefit amount instead, such as a daily benefit times a number of days.

Long term care rules Texas tests

Outline of coverage. When an agent solicits a long term care policy, the outline of coverage must be delivered before the application is presented.

Renewability. A Texas long term care policy must be at least guaranteed renewable. Noncancellable is also allowed. Nothing weaker is.

Free look: 30 days. The buyer gets at least 30 days to review the policy and return it for a refund.

Inflation protection and nonforfeiture. The company must offer both. If the buyer does not want them, the buyer must reject them in writing.

Alzheimer's and mental illness. Policies must cover Alzheimer's disease and related dementias, and certain serious mental illnesses, when the insured meets the benefit triggers.

Preexisting conditions. A policy can delay coverage of a preexisting condition for up to 6 months after the effective date. The look back is also 6 months.

Denied applications. If the company denies the application, it must refund any premium within 30 days of the denial.

Lapse protections. The company cannot cancel for nonpayment unless the premium is at least 65 days past due, and once it is 30 days past due, the company must notify the insured and a person the insured designated.

Rate increases. Companies can raise rates only for everyone with the same policy, not because one person's health got worse, and they must give at least 45 days' notice.

Texas Long Term Care Partnership. Partnership policies give dollar for dollar asset protection: for every dollar the policy pays in benefits, Medicaid disregards a dollar of the person's assets.

Practice questions

These are my own practice questions, not real exam items.

1. Which part of Medicare covers prescription drugs? A) Part A. B) Part B. C) Part C. D) Part D.

Answer: D. Part C is Medicare Advantage, which may include drug coverage, but Part D is the drug program.

2. Helen enrolled in Medicare Part B on March 1. When does her Medicare supplement open enrollment end? A) June 30. B) August 31. C) December 31. D) It never ends.

Answer: B. Six months starting with the first month of Part B enrollment: March through August.

3. Every company that sells Medicare supplement insurance must offer which plan? A) Plan A. B) Plan F. C) Plan G. D) Plan N.

Answer: A. Plan A is the core plan and must be offered. Plan F cannot even be sold to people newly eligible on or after January 1, 2020.

4. For what reason can an insurer refuse to renew a Medicare supplement policy? A) The insured's health got worse. B) The insured filed several large claims. C) The insured stopped paying premiums. D) The insured turned 80.

Answer: C. Medicare supplement is guaranteed renewable. Only nonpayment or material misrepresentation ends it.

5. How long is the free look period on a Medicare supplement policy? A) 10 days. B) 20 days. C) 30 days. D) 60 days.

Answer: C. 30 days, the same as long term care.

6. To qualify for benefits under a tax qualified long term care policy, the insured must be unable to perform how many ADLs, for how long? A) 1 ADL for 30 days. B) 2 ADLs for 90 days. C) 3 ADLs for 60 days. D) 2 ADLs for 180 days.

Answer: B. Two of six for at least 90 days, or a cognitive impairment, plus a plan of care.

7. An agent is selling a long term care policy face to face. When must the outline of coverage be delivered? A) With the policy. B) Within 10 days after the application. C) Before the application is presented. D) Only if the applicant asks.

Answer: C. For agent solicitations, the outline of coverage comes before the application.

8. A buyer does not want inflation protection on a long term care policy. What has to happen? A) Nothing, it is optional. B) The agent notes it on the application. C) The buyer must reject it in writing. D) The insurer must add it anyway.

Answer: C. The company must offer inflation protection, and the buyer has to decline it in writing.

Numbers to keep straight

Medicare supplement: 6 month open enrollment from Part B, 6 month preexisting limit and 6 month look back, 30 day free look, 24 month Medicaid suspension with 90 day notice, 63 day guaranteed issue window.

Long term care: 2 of 6 ADLs for 90 days for tax qualified, 30 day free look, 6 month preexisting limit, 30 day refund on denial, 65 days past due before cancellation, 30 day past due notice, 45 day notice of rate increases.

Training: 8 hours before selling Medicare Advantage or Part D plans, then 4 hours each license period. That rule does not cover Medicare supplement.

Practice senior market questions under time

Take the free timed practice test at getlicensedtx.com/diagnostic. It is free, needs no card, and breaks out your health insurance and Texas law results so you know where to focus.

GetLicensedTX has 1,000+ Pearson VUE style practice questions, weak area drills, flashcards, the Full Exam Simulator (145 questions, timed), and the AI Study Tutor, which can explain why Plan G and Plan N differ or why a policy is guaranteed renewable. Start 3 days free, then $12.99 a month. See getlicensedtx.com/pricing.

For every Texas health deadline in one place, including claim timelines and newborn coverage, use getlicensedtx.com/articles/texas-life-health-exam-cheat-sheet.