Medicare Supplement Policy AKA Medigap - Answer-Also known as a Medigap Policy, is a health insurance policy sold by private insurance companies to fill in the coverage gaps in Original Medicare. The coverage gaps include deductibles and coinsurance requirements.
The policies must follow federal...
Module 6 - Medicare Supplement
Policies (Medigap) Exam Questions and
Answers
Medicare Supplement Policy AKA Medigap - Answer-Also known as a Medigap Policy,
is a health insurance policy sold by private insurance companies to fill in the coverage
gaps in Original Medicare. The coverage gaps include deductibles and coinsurance
requirements.
The policies must follow federal and state laws. Medicare Supplements do NOT cover
gaps in Medicare Advantage (MA) plans (Part C) or provide coverage for Medicare-
approved Prescription Drug Plans (Part D).
Medicare Supplement policies CANNOT cover anything that Medicare would NOT
approve payment for such as elective cosmetic surgery.
Enrollment in Original Medicare Required when Purchasing Medigap - Answer-
Medicare Supplements cannot be purchased or sold (by an insurer) unless the applicant
for the policy is enrolled in Parts A and B. Individuals enrolled in a MA Plans (Part C)
cannot enroll in or keep an existing Medicare Supplement policy.
Note: Remember that most people will not have a premium for Part A but will have a
premium for Part B. Also, Medicare Supplements are issued as individual policies - they
are not issued as Family Plans or Joint Policies.
Standard Plans - Answer-Federal regulations limit the number of Medigap policies
available to be sold. There are currently 10 plans available. Each plan has a core of
benefits common to all of the plans. Each plan after Plan A (Basic Plan) will have
varying benefits.
Note: Some people may have old plans referred to as plans E, H, I, and J that are no
longer sold. Individuals that purchased these policies are currently allowed to keep
them.
Core Benefits - Answer-The core benefits found in Medigap plans are:
a) Medicare Part A Coinsurance hospital costs up to an additional 365 days after
Medicare Benefits are exhausted,
b) Medicare Part B Coinsurance or co-payment (Plan K pays 50%, Plan L pays 75%,
and Plan N pays 100% of the Part B coinsurance except up to a $20 co-payment for
office visits and up to a $50 co-payment for emergency department visits.),
c) Medicare 3-pint annual blood deductible (Plan K pays 50% and Plan L pays 75%),
d) Medicare Hospice Care coinsurance or co-payment (Plan K pays 50% and Plan L
pays 75%), and
, e) Medicare Preventive Care coinsurance.
Foreign Travel Emergency Care Coverage - Answer-Emergency medical care is
covered outside of the U.S. by Medigap policies C, D, F, G, L and N (after a $250
foreign travel deductible) providing 80% of the Medicare beneficiary medical costs. The
emergency must occur in the first 60 days of the trip. The policy has a $50,000 lifetime
benefit.
Other Points about Medigap Plans - Answer-Medigap Plan F also offers a high-
deductible plan (in place of the regular F plan). This means the insured must pay out-of-
pocket for Medicare-covered costs up to the deductible amount of $2,240 in 2018
before the Medigap plan pays anything. The advantage of the high deductible plan is a
lower monthly premium.
Other Points about Medigap Plans - Answer-Medigap Plans K, L, and M pay only a
percentage of some of the benefits listed. If a person has a Medigap Plan K, the most
that he or she will pay out-of-pocket in 2018 is $5,240. If he or she has a Medigap Plan
L, the most out-of-pocket will be $2,620 in 2018. After the out-of-pocket limit is met and
the Medicare Part B 2018 annual deductible of $183 is paid, the policy will pay 100% of
the Medicare approved costs.
Other Points about Medigap Plans - Answer-As mentioned earlier in the text, Medigap
Plan N pays 100% of the Part B coinsurance except for a co-payment of up to $20 for
some office visits and up to a $50 co-payment for emergency room visits that don't
result in an inpatient admission.
**NOTE** - Answer-Insurers may NOT change any of the benefits in any of the plans.
The plans are sold as is. The only difference between insurers would be the premiums
charged.
Medicare SELECT - Answer-Medicare SELECT is a type of Medigap policy that
requires the insured to use hospitals, and in some cases, doctors within its network to
be eligible for full insurance benefits (except in an emergency). Medicare SELECT can
be any of the standardized Medigap Plans A through N. Medicare SELECT policies
generally cost less than other Medigap policies. However, if the insured does not use a
Medicare SELECT hospital or doctor for non-emergency services, he or she will have to
pay some or all of what Medicare doesn't pay. Medicare will pay its share of approved
charges no matter which hospital or doctor is chosen.
Insurers must offer Medigap Plan A - Answer-Insurers operating in the Medicare
Supplement market in North Carolina must offer Plan A. Insurers are not required to
offer the other plans. All of the other plans may be offered at the discretion of the
insurance company. If an insurer offers other Medigap plans, then it must also offer
plans C and F.
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