Medigap

In addition to covering many Medicare cost-sharing payments, what amount do Medigap policies provide in benefits for some health care expenses not covered by Medicare?

Some

What does it mean to say that an individual applying for a Medigap policy is entitled to guaranteed issue?

The insurer cannot subject the individual to medical underwriting, deny her coverage, make her wait for more coverage, or charge her more than the standard premium.

Can Medigap policies provide prescription drug benefits?

The sale of new policies with drug benefits is prohibited, but old policies can continue to provide them, as long as the policyholder does not enroll in Medicare Part D.

What are the main areas in which Medigap insurance is regulated?

The standardization of plans, guaranteed issue and underwriting, rating, sales, and marketing, claims, loss ratios, agent compensation, replacements, and renewability.

How do Medigap plans K and L differ from other standard plans?

They cover only a portion, not 100%, of most Medicare cost-sharing payments, but they set a limit on a beneficiary's annual out-of-pocket costs.

Who must pay a premium for Medicare Part A? For Medicare Part B?

Those who did not pay into the Medicare system during their working lives by means of payroll deductions enroll in Medicare Part A, but they must generally pay a premium. All enrollees pay a premium for Part B.

Who is eligible for Medicare?

- People age 65 or older - People of any age who suffer from permanent kidney failure - Disabled persons who meet certain criteria

Who is entitled to guaranteed issue when they apply for Medigap insurance?

- Those who apply during their OE period - Those who apply after other health coverage, Medicare Advantage coverage, or another Medigap plan terminates - Those who switch from Medicare Advantage to Medigap (in some circumstances) during their first year of coverage.

Under the 2010 standard Medigap plans, what new benefit is added to the basic benefits package?

A benefit covering hospice cost-sharing.

What is a Medicare Advantage plan?

A private-sector health insurance plan that provides Original Medicare coverage as well as additional benefits.

What is a Medicare SELECT policy?

A type of Medigap policy that operates like a PPO, with a network of providers and incentives to use those providers.

How many states have adopted the NAIC Medigap Model Regulation and comply within the federal minimum standards?

All

With the introduction of the new 2010 standard Medigap plans, what will happen to the old standard plans?

As of June 1, 2010, existing plans may be renewed, but new policies following the old standard plans may not be issued.

What are the main gaps in the coverage of Original Medicare?

Cost-sharing payments, preventive care, care in a foreign country, prescription drugs, long-term care, and other services and products (such as care for dental, vision, hearing, etc.)

What are the main health care services and products not covered by Original Medicare?

Dental care and dentures, routine eye care and eyeglasses, hearing exams and hearing aids, routine foot care and orthopedic shoes, most chirporactic services, health care delivered outside the US, most out-patient prescription drugs and some preventive care services.

According to the text, why is claims administration for Medigap insurance relatively simple?

Insurers do not have to determine eligibility for benefits, they just follow the determination of Medigap and pay any cost-sharing payments covered by the policy.

Give two reasons that different insurers charge different premium amounts for the same standard Medigap plan.

Insurers use different rating methods and offer different discounts.

For health care services it covers, to what extent does Medicare usually pay benefits?

Less than 100%

What is "Original Medicare"?

Medicare Part A and B

In addition to Medicare cost-sharing payments, what do some Medigap policies cover?

Medicare Part B excess charges, foreign travel emergency care, at-home recovery, prescription drugs, and preventive care.

Medigap policies can be sold to which group?

Original Medicare enrollees only.

What are Medicare Parts A, B, C, and D?

Part A - Hospital Insurance Part B - Supplementary Medical Insurance (covering physician services and other outpatient care) Part C - Medicare Advantage program Part D - Prescription drug benefit program

Medigap policies are sold to

individuals and members of associations.

According to the text, Medigap insurers compete on the basis of

price and customer service.

What is the renewability of Medigap policies?

All policies are guaranteed renewable.

What is the benefit portion that Medicare pays for hospice care expenses?

Almost all

What cost-sharing payments apply to most Medicare Part B coverage?

An annual deductible and 20% coinsurance.