Medicare: Medicare Supplements (Medigap)

A contract designed primarily to augment reimbursement under Medicare for hospital, medical, or surgical expenses is:

A Medicare supplement plan

Which of the following will be covered by a Medicare supplement policy?

Hospice care

S wants to qualify for a Medicare supplement policy. All of the following statements about her qualification are correct EXCEPT:

If S is at least 65 years old and applies for a Medicare supplement policy within 6 months of enrolling in Part B, she qualifies for the policy of her choice in her state as long as she meets the program's health requirements.

Widowed M purchases a Medicare supplement policy. Three weeks later, when her son, R, learns of the purchase, he wants to cancel the policy because M has dementia and she forgot that she already had a supplement. Which of the following will be R's best course of action?

Cancel the policy because it is still in the free-look period

What is another name for Medicare supplement policies?

Medigap policies

The premium for A's Medicare supplement policy was based on her age on the date of policy issue. Ten years later, the insurer increased the premium because of inflation but could not increase it due to her age. On what basis was A's policy issued?

Issue Age

Which of the following fills in the gaps of Medicare?

Medicare supplement policies

As Medicare adjusts its deductibles and co-payments, what must Medicare supplement policies do, and what can they NOT do?

Medicare supplement policies must align their benefits to match the adjustments, and they cannot drop people for health reasons.

E wants to purchase a Medicare supplement policy that will provide the most basic coverage. What type of policy should E purchase?

Plan A

Which of the following is true about the range of Medicare supplement plans?

The coverages provided in each individual plan is the same across insurers.

L buys a Medicare supplement insurance policy on June 15 but decides not to keep it. Two weeks later, she mails the policy back to the insurer. What action must the insurer take?

The insurer must cancel the policy and refund her entire premium.

Which of the following is covered by all Medicare supplement policies?

first three pints of blood

Which of the following benefits is not provided under Medicare Supplement A?

prescription drug coverage

Which of the following statements is false regarding Medigap policies?

Sold by the government

According to the National Association of Insurance Commissioners' standardized model Medicare supplement policy, insurers must offer coverage for all of the following core benefits, EXCEPT:

The Medicare Part A deductible

Medicare Parts A and B have gaps in their coverage, where Medicare subscribers must pay the costs. What do these gaps include?

The Part A deductible and daily co-payments for hospitalization and nursing home care, and the Part B deductible and its required 20 percent coinsurance or co-payments

You have a Medicare SELECT client who wants to choose her own doctor. The doctor is not part of the provider network. What can you tell her to expect?

The plan will not cover the services.

Medicare supplement policies were designed mainly as supplements to reimbursements under Medicare. In practice, which of the following statements is true?

They help pay for the hospital, medical, or surgical costs of persons eligible for Medicare and provide funds to pay deductibles and coinsurance.

All of the following statements about the purpose of Medicare supplement policies are correct, EXCEPT:

They were designed to make funds available to pay medical services providers.

Parts A and B have gaps in their coverage, where Medicare subscribers must pay the costs. Which of the following was done to fill these gaps in standard Medicare coverage?

To fill the gaps in standard Medicare coverage, the insurance industry created Medicare supplement policies.

An agent's commission for the sale of a Medicare supplement policy in the first year following its effective date cannot exceed what percentage of the commission paid for servicing the policy in the second year?

200

J purchases a Medicare supplement insurance policy but decides not to keep it. How many days does she have to return it for the full refund of the premium she paid?

30

A Medicare supplement policy cannot define a pre-existing condition more restrictively than a condition for which medical advice was given or treatment recommended by or received from a medical doctor within how many months before the effective date of coverage?

6

A suffers from congestive heart failure and purchased a Medicare supplement policy on June 1. What is the maximum length of time that A's policy can exclude coverage for her pre-existing condition?

6 months

What is the maximum period for pre-existing limitations or exclusions under the Medicare supplement insurance policies?

6 months

The individual most likely to buy a Medicare Supplement policy would be a(n):

68-year old male covered by Medicare

Premiums for Medicare Part B and Medicare supplement insurance are tax deductible if, when added to other medical expenses, they exceed how much of a person's adjusted gross income?

7.5 percent

Which of the following is a Medicare supplement core benefit?

Blood deductible

Which of the following statements about the standard Medicare supplement plans is NOT correct?

Companies selling Medicare supplement policies do not have to sell Plan A, but they may sell any or all of the other plans.

The core supplementary policy (Plan A) developed by the NAIC as a standard Medicare supplement policy includes all of the following, EXCEPT:

Coverage for the Part A Medicare deductible

A Medicare supplement policy must provide coverage Medicare Part A-eligible expenses for hospitalization:

From days 61 through 90

G's Medicare SELECT plan offers the same benefits as the coverage provided under a standard plan. So why are G's Medicare SELECT plan premiums lower than those for a standard Medicare supplement policy?

G must obtain covered services through the plan's network. For this reason, his Medicare SELECT plan's premiums are lower than those for standard Medicare supplement policies.

J is almost 65 years old. What conditions must he meet to be eligible for Medicare?

He must be eligible for Social Security and apply for Medicare coverage.

Medigap policies are sold by:

Private insurers

Medicare Supplement policies are primarily designed to:

Provide additional benefits beyond those provided by Medicare

Which of the following best describes the main purpose of Medigap policies?

Provide extra coverage not offered in Medicare

Judith Jones discovers that the premium cost for her Medicare supplementary policy increased in the month of March. She does not recall receiving a notice of this increase. Which of the following courses should Ms. Jones take?

She should consult current Medicare regulations to determine if program coverages, including deductible and co-payment percentages, have increased. Such changes can increase costs of supplement policies.

A, age 66, is applying for an individual health insurance policy with ABC Insurers. What must ABC Insurers do since A is eligible for Medicare?

It must notify her that the policy is not a Medicare supplement policy.

What Medicare supplement plans provide for payments to limit a person's annual out-of-pocket medical costs related to coinsurance, copays, and deductibles?

K and L

C retires from her job when she turns 65. She wants comprehensive hospital and medical coverage under a single Medicare program. Which of the following would meet her need?

Medicare Advantage

S just turned 65 and is overwhelmed by the Medicare program. She knows that part of her coverage is provided at no charge and that she will pay for other parts. Which of the following coverages will she have to buy through a private insurer?

Medicare Advantage

All of the following are Medicare supplement policy core benefits, EXCEPT:

Medicare Part A deductible

All of the following are Medicare supplement additional benefits, EXCEPT:

Medicare Part B 20% coinsurance

All of the following are excluded from a Medigap policy, EXCEPT:

Medicare Part B coinsurance

Which of the following is a Medicare supplement additional benefit?

Medicare Part B deductible

JBO Insurers offers Medicare supplement policy benefits through a network of doctors, hospitals, and health-care service providers. Each insured must use the providers within its network to be eligible for full benefits. Which type of Medicare supplement plan has JBO created?

Medicare SELECT

What is a Medicare supplement plan of an insurance company that offers the policy's benefits through a network of doctors, hospitals, and health-care service providers called?

Medicare SELECT plan

If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses?

Medicare Supplement

M wants to purchase a Medicare supplement policy that includes prescription drug coverage. As his advisor, you inform him that:

Medicare supplement plans can no longer contain prescription drug coverage.

Which policy fills in the gaps of Medicare?

Medicare supplement policy

E purchased a Medicare supplement policy five years ago from ABC Insurers and now suffers from dementia. Which action can ABC Insurers take, given the decline in E's health?

Nothing, because the policy cannot be canceled

Open enrollment for Medigap policies spans a three-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare Part B.

Open enrollment for Medigap policies spans a six-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare Part B.

When is open enrollment for Medicare supplement policies?

Open enrollment for Medigap policies spans a six-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare Part B.

Medicare supplement plans are provided by private insurance companies, but federal law ensures that people who meet the minimum requirements can qualify for coverage. What are those requirements?

People must be at least 65 years old, regardless of their health condition, and must apply for a Medicare supplement policy within six months of enrolling in Medicare Part B.

Your client wants to purchase a Medicare supplement with a high deductible option and low premium payments. Which plan would you recommend among the following options?

Plan K or L

Medicare Supplement Plan A provides the co-payment for hospitalization from day 61 through day 90. Which of the other Medicare supplement plans also provide this coverage?

Plans A through N

Which of the following statements about Medicare supplement Plans K and L is correct?

Plans K and L can offer high-deductible options, which further decrease premium payments.

For Medicare Supplement plans K and L, which of the following statements is true?

Plans K and L pay 100 percent of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached.

Which of the following statements about the standard Medicare supplement plans is correct?

Plans contain the basic core benefits available under Plan A plus additional benefits.

Medicare supplement policies were originally designed to address what need?

assistance with co-payments and deductibles

G is applying for Medicare supplement Plan C. At what point must the insurer give her an outline of coverage?

at the time of application

When must a producer deliver an outline of coverage for Medicare supplement policies?

at the time of application

Under federal law, eligible persons who apply for a Medicare supplement policy

cannot be denied coverage based on health status

During Medicare's open enrollment period, an insurance company selling Medigap policies

must sell Medigap policies to individuals who are eligible to enroll in Medicare on a guaranteed issue basis.

Which type of Medicare supplement policy provides that as long as the insured pays the premiums, the insurer cannot modify the premium, coverage, or any provisions of the policy?

noncancelable

You are an agent in a state that allows the marketing of Medicare SELECT plans. This means that you, through your insurance company, can do which of the following?

offer the policy through a network of providers

Agent M discovered that a client was covered by Medicare Parts A and B and also owned Medicare supplement Plan A. Because the client wanted more health insurance protection, Agent M recommended that he purchase another Medicare supplement policy. Agent Mallory's actions are

prohibited

The sale of a Medicare supplement policy that results in the insured having coverage already provided under Medicare is

prohibited in all cases

G owns a Medicare Advantage policy and requires emergency care while visiting her daughter, but there are no network providers nearby. What should G do?

see a nonnetwork provider

F is comparing the Medicare supplement he offers with one that his customer, J, owns from a competitor. F leads J to believe that his current policy will not pay out as stated in the contract and suggests that J buy his (F's) supplement. Which of the following unfair practices is F engaging in?

twisting

Which statement about the Medicare supplement program is NOT correct?

As Medicare adjusts its deductibles and co-payments, Medicare supplement policies can align their benefits to match the adjustments, but that is not required.

Ingrid has a Medicare Part C policy. Which statement correctly identifies the agent's duties with respect to transacting Medicare supplement policies to Ingrid?

An agent may sell Ingrid a Medigap policy if she is switching to Original Medicare

All of the following statements about Medicare supplement policies are false, EXCEPT:

Each standardized Medicare supplement policy must cover the basic benefits.

Medicare supplement policies cover all of the following, EXCEPT:

Prescription drugs

Marcy has Medicare Part C. Which of the following is true?

An agent may sell her a Medigap policy if she is switching to Original Medicare

Mary has Medicare Part C. Which of the following is true?

An agent may sell her a Medigap policy if she is switching to Original Medicare