Medigap Plans
Each carrier has specific payment rules, submission dates, application fees, and more. Where can this be found?
The Carrier Drive in Google Drive
What is an Excess Charge?
The amount that doctors are allowed to charge above the Medicare contracted allowable amount, up to 15%
What is GI?
The client has 60 days prior and 63 days after the client loses credible coverage (current plan is no longer available in your area, you move out of coverage area, or lose employer coverage) to enroll in select medigap plans without underwriting. Plan A, B, C, F, K, and L are available.
Medical Underwriting is what?
The process that an insurance company uses to decide, based on your medical history, whether or not to approve your application for insurance, whether or not to add a waiting period (if your state allows it), and how much to charge for the insurance plan
Medigaps are called "gap" because:
They fill the gaps found in Original Medicare
Medigap Plans work to fill in the gaps found in Original Medicare. Plan F is the most comprehensive Medigap Plan. Medigap Plans supplement Original Medicare. Medigap Plans are standardized and offered by the government. There are 10 different Medigap Plans.
True
Part C is a Medicare Advantage Plan Plan B is a Medigap Supplement Plan Plan C is a Medigap Supplement plan Part B covers ambulance services
True
Medigap Plans help pay for some or all of the services provided under Original Medicare
True, Medigap Plans help pay for some or all of the services provided under Original Medicare
Plan L and Plan K are the only two Medigap plans with out-of-pocket limits.
True, Plan L ($2,620) and Plan K ($5,240) are the only two Medigap plans with out-of-pocket limits.
The most common Medigap Plans that we sell are Part F, Part G, and Part N.
True, The most common Medigap Plans that we sell are Part F, Part G, and Part N.
What is the deductible for the HD Plan F?
$2,300, and has a significantly lower premium
What is the coinsurance for Plan N and what else does the client have to cover?
$20 or less for Doctor visits, $50 or less for ER, doesn't cover Excess Charges, Part B deductible of $183
There are how many Medigap plans?
10, A, B, C, D, F, G, K, L, M, and N and a HD Plan F
The monthly premiums of Medigap plans can depend on:
Age Tobacco Use Height and Weight Gender checkmark County
What States do not allow an Excess charge to be charged?
CT, MA, MN, NY, OH, PA, RI, VT, advise clients about Plans C, D, and N in these states
What States have birthday rules for GI?
California and Oregon, plan must be with similar or fewer benefits
Which of the resources can you find on the Carrier Information Drive and SelectQuote U?
Carrier Height and Weight Limitations Chart Carriers' Health Questions Declinable Drug Lists CA-OR-MO Rules
Which of the following resources can you find on the carrier info drive?
Carrier Height and Weight Limitations Chart Carriers' Health Questions CA-OR-MO Rules
An insurance company will set rates for a certain area and charge the same for everyone, regardless of age Which Medigap Rating Method does this describe?
Community-rated policy
A customer who finds a company with Issue-Age Medicare Supplement policies will have their price locked in forever... no increases whatsoever over time.
False
Everyone qualifies for Medigap Plans when they decide to get one, unless you have ESRD.
False
Medigap Plans cover routine dental services.
False
Medigap plans are a great way for beneficiaries to pay for the things Medicare does not cover, such as dental and vision.
False
Some Medigap plans (currently available for purchase) include prescription drug coverage.
False
There is a maximum out-of-pocket limit/cap for beneficiaries on Original Medicare.
False
In both Trial Right #1 and Trial Right #2 the client's time frame is: 60 calendar days before their prior coverage ends and no later than 60 calendar days after that.
False, 60 days before and 63 days after
Medigap Plans cover dental services.
False, Medigap Plans cover don't vision, dental, long term care, or drug.
Some Medigap plans include prescription drug coverage.
False, No Medigap plans include prescription drug coverage.
SelectQuote Senior agents typically advise clients to purchase Plans F, G, or L.
False, SelectQuote Senior agents typically advise clients to purchase Plans F, G, or N
There is a maximum out-of-pocket expense for the client on Original Medicare
False, There is no maximum out-of-pocket expense for the client on Original Medicare
Everyone qualifies for Medigap Plans.
False, there is underwriting, so unless you are in a qualifying enrollment period you will have to go through underwriting
Which Medigap carriers are underwritten by MOO?
Gerber Life GPM Life checkmark Assured Life Association
How do you know if your client may pass underwriting?
Go through the carriers specific health questions (this can be found in google drive in the Carrier Drive) Discuss their medications
Jan is 68 years old, lives in Texas, and has a Plan F. What can she do with the Plan F?
Go to any doctor that accepts Original Medicare Can see a specialist in New York that accepts Original Medicare
Kramer is turning 65 in 3 months and is concerned he will not quality for a Medigap Supplement plan due to his poor health. What can you advise as his agent?
He can get a Medigap plan with no health questions asked.
Medigap Plans are offered by:
Private insurance companies and regulated by the government. All plans are the same regardless of the carrier
What is Trial Right #2?
If your previously had a Medigap plan and switched to a Medicare Select or MA/MAPD plan you can switch back to your previous Plan without underwriting within one year of switching to an MA/MADP plan. Medigap plan must be the same as the previous plan with the same carrier. If the carriers plan is not available they can switch to Plans A, B, C, F, K, and L 60/63
Elaine has a Plan G. She has an outpatient shoulder surgery for a total cost of $10,185. It will be the first time she has used her plan this year. How much does Medicare Pay, how much does Plan G Pay, and what does Elaine pay for this service/procedure?
Medicare pays $8,000 Plan G pays $2,000 Elaine pays $185
The following statements are true:
Medigap Plans supplement Original Medicare Medigap Plans work to fill in the gaps found in Original Medicare Plan F is the most comprehensive Medigap Plan There are 10 different Medigap Plans
What State has an anniversary rule for GI?
Missouri and you can change to a same letter plan with GI 30 day before and 30 days after anniversary
To qualify for a Medigap plan:
Must pay the Part B Premium You must have Medicare Part A and Part B Must pay the Medigap Premium
If a service is not covered by Original Medicare is it covered by a Medigap Plan?
No, Medigap only covers services covered by Original Medicare
Is there a network?
No, there is no network and you don't need referrals for a specialist
What is OE?
OE stands for Open Enrollment and is based on the effective date of Part B. 6 months. The month of and the following 5 months
Medigap plans are designed to:
Pay for some or all of the medical/hospital expenses not covered by Original Medicare
Bob has a Plan F. He has an outpatient knee replacement surgery for a total cost of $50,000. How much does Medicare Pay, how much does Plan F Pay, and how much would Bob pay for this service?
Plan F Pays: $10,000 Medicare Pays: $40,000 Bob Pays: $0
Which rates increase faster Plan F or Plan G
Plan F's premiums raise at a much larger percentage each year, and will be fazed out in 2020
Which Medigap plans cover Part B Excess Charges?
Plan G Plan F
The value of different Medigap Plans: Plan F has a monthly premium of $160; Plan G has a monthly premium of $130.
Plan G is a better value (will save the client money).
The value of different Medigap Plans: Plan F has a monthly premium of $160. Plan G has a monthly premium of $130. The client is anticipating hip surgery this year.
Plan G results in $360 annual savings in Premium dollars. Even after the surgery, the client will save $175 over 12 months with Plan G.
What do Plans K and L cover?
Plan K covers 50% and Plan L covers 75% of 20% of Part B coinsurance, with the exception of Part A coinsurance and hospital costs, also clients must pay Excess Charges, Part B deductible and cannot use in foreign travel
Which popular Medigap plan(s) does (do) NOT cover the Part B deductible?
Plan N Plan G
Which Medigap Plans do NOT cover the Part B deductible?
Plans A, B, D, G, K, L, M, and N
Which plans don't include a foreign travel benefit?
Plans A, B, K, and L
Attained-Age-Rated policies premiums are based on which of the following?
Premiums are based on current age
Guaranteed Issue is what?
An instance that means that the insurance company cannot ask health related questions or exclude pre-existing conditions. The applicant is guaranteed to be accepted for the plan
What is Trial Right #1?
While one is still 65 and has Part B end enrolled in a MA/MAPD or Program of All-Inclusive Care for the Elderly (PACE) during open enrollment, they can change and enroll in a Medigap plan without underwriting. 60/63
Can a client enroll in any Medigap plan at anytime?
Yes, but they must pass underwriting
During GI can a client enroll in Plans D, G, M, or N?
Yes, but with underwriting
Do all medicare doctors have to accept Medigap plans?
Yes, if they accept Medicare they must accept your Medigap plan
Do Medigap plans have copays and deductibles?
Yes, some have copays, coinsurance, and deductibles
Are Medigap plans accepted nationwide?
Yes, they are universal in the USA and some even work abroad.
Can a client change their Medigap plan during their OE?
Yes, they can change their Plan as many times as they would like during OE
What, besides the premium, do you have to cover with a Plan G?
You must cover the $183 Part B deductible