Section VI - Medicare Supplement
Policies (Medigap) Exam Questions with
Latest Update
Eligibility - Answer-Individual must have both Part A and Part B of Medicare.
It is illegal to sell a Medigap policy to an individual who has a Medicare Advantage plan.
Private plans that are designed to supplement Medicare by supplying coverage for gaps
in Medicare benefits such as deductibles and coinsurance amounts.
Standardized Medicare Supplement Plans - Answer-The Omnibus Budget
Reconciliation Act of 1990 (OBRA) is a law that requires all Medicare supplement
benefits to be standardized.
Core Benefits - all plans must include
Optional Benefits - included in some plans but not others
Standardized Medicare Supplement Plans - Core Benefits - Answer->Payment of the
Medicare Part A coinsurance and hospital costs (days 61 to 90, 60 lifetime reserve
days, and an additional 365 days).
>Payment of the hospice coinsurance for out-patient drugs and inpatient respite care.
The beneficiary must meet Medicare's requirements, including a doctor's certification of
a terminal illness.
>Payment of the reasonable cost of the first 3 pints of blood, or their equivalent, under
Medicare Parts A and B.
>Payment of the beneficiary's portion of the 20% Part B coinsurance of Medicare-
eligible expenses for medical services (doctor bills, hospital or home health care, and
specified higher payments for certain services under the prospective payment system--
after the part B deductible has been met).
Plans generally must cover core benefits at 100%, but Plans K and L cover core
benefits at a lower percentage
Standardized Medicare Supplement Plans - Optional Benefits - Answer-Skilled Nursing
Facility Care - payment of the beneficiary's coinsurance amount from the 21st day
through the 100th day (not custodial care)
, Foreign Travel Emergency Care - payment of 80% of the billed charges for foreign
emergency care that Medicare would have covered if it was provided in the USA. Care
must begin during the insured's first 60 days outside of the USA. The calendar year
deductible is $250. The lifetime maximum benefit is $50,000.
Part A Deductible - payment of the Part A per-benefit-period deductible for inpatient
hospital stays
Part B Deductible - payment of the Part B annual deductible that beneficiaries must
meet before Medicare beings paying Part B benefits
Part B Excess Doctor Charges - Payment of 100% of any excess fees, which are limited
to 15% above the Medicare-approved amount (if most of the beneficiary's doctors take
Medicare assignment, this benefit may not be needed)
Renewability - Answer-Medicare supplement policies and certificates must include a
renewal or continuation provision.
The provision must appear on the first page of the policy under an appropriate caption.
It must state notify the insured if the issuer has reserved the right to change premiums
and must disclose any automatic renewal premium increases based on insured's age.
Renewability - Guaranteed Renewable and Non-cancellable - Answer-Medicare
supplement policies must be guaranteed renewable. The policy cannot be canceled or
non-renewed for any reason other than:
>Nonpayment of premium
or
>Material misrepresentation
An issuer cannot cancel or non-renew a Medigap policy solely on the basis of the
beneficiary's health status.
A policy may not be written to terminate spousal coverage solely because of
deteriorating health, or upon the insured's death, or any other event, except for
nonpayment of premiums.
Pre-existing Conditions - Answer-Medicare supplement policies may not exclude
coverage for any pre-existing conditions that were diagnosed or treated more than 6
months prior to the effective date of coverage.
After a medicare supplement policy has been in effect for 6 months, pre-existing
conditions must be covered by the policy.
Policies (Medigap) Exam Questions with
Latest Update
Eligibility - Answer-Individual must have both Part A and Part B of Medicare.
It is illegal to sell a Medigap policy to an individual who has a Medicare Advantage plan.
Private plans that are designed to supplement Medicare by supplying coverage for gaps
in Medicare benefits such as deductibles and coinsurance amounts.
Standardized Medicare Supplement Plans - Answer-The Omnibus Budget
Reconciliation Act of 1990 (OBRA) is a law that requires all Medicare supplement
benefits to be standardized.
Core Benefits - all plans must include
Optional Benefits - included in some plans but not others
Standardized Medicare Supplement Plans - Core Benefits - Answer->Payment of the
Medicare Part A coinsurance and hospital costs (days 61 to 90, 60 lifetime reserve
days, and an additional 365 days).
>Payment of the hospice coinsurance for out-patient drugs and inpatient respite care.
The beneficiary must meet Medicare's requirements, including a doctor's certification of
a terminal illness.
>Payment of the reasonable cost of the first 3 pints of blood, or their equivalent, under
Medicare Parts A and B.
>Payment of the beneficiary's portion of the 20% Part B coinsurance of Medicare-
eligible expenses for medical services (doctor bills, hospital or home health care, and
specified higher payments for certain services under the prospective payment system--
after the part B deductible has been met).
Plans generally must cover core benefits at 100%, but Plans K and L cover core
benefits at a lower percentage
Standardized Medicare Supplement Plans - Optional Benefits - Answer-Skilled Nursing
Facility Care - payment of the beneficiary's coinsurance amount from the 21st day
through the 100th day (not custodial care)
, Foreign Travel Emergency Care - payment of 80% of the billed charges for foreign
emergency care that Medicare would have covered if it was provided in the USA. Care
must begin during the insured's first 60 days outside of the USA. The calendar year
deductible is $250. The lifetime maximum benefit is $50,000.
Part A Deductible - payment of the Part A per-benefit-period deductible for inpatient
hospital stays
Part B Deductible - payment of the Part B annual deductible that beneficiaries must
meet before Medicare beings paying Part B benefits
Part B Excess Doctor Charges - Payment of 100% of any excess fees, which are limited
to 15% above the Medicare-approved amount (if most of the beneficiary's doctors take
Medicare assignment, this benefit may not be needed)
Renewability - Answer-Medicare supplement policies and certificates must include a
renewal or continuation provision.
The provision must appear on the first page of the policy under an appropriate caption.
It must state notify the insured if the issuer has reserved the right to change premiums
and must disclose any automatic renewal premium increases based on insured's age.
Renewability - Guaranteed Renewable and Non-cancellable - Answer-Medicare
supplement policies must be guaranteed renewable. The policy cannot be canceled or
non-renewed for any reason other than:
>Nonpayment of premium
or
>Material misrepresentation
An issuer cannot cancel or non-renew a Medigap policy solely on the basis of the
beneficiary's health status.
A policy may not be written to terminate spousal coverage solely because of
deteriorating health, or upon the insured's death, or any other event, except for
nonpayment of premiums.
Pre-existing Conditions - Answer-Medicare supplement policies may not exclude
coverage for any pre-existing conditions that were diagnosed or treated more than 6
months prior to the effective date of coverage.
After a medicare supplement policy has been in effect for 6 months, pre-existing
conditions must be covered by the policy.
