Medicare Supplement (Medigap) Plans Flashcards

What is a Medicare SELECT plan?

Answer: A type of Medigap policy that requires use of specific network providers to receive full benefits

Medicare SELECT is a type of Medigap policy that requires beneficiaries to use a specific network of hospitals and providers to receive full benefits, typically offered at lower premiums.

What is the 'free-look' period for a newly purchased Medigap policy?

Answer: 30 days from the date of policy delivery, with a full premium refund

Medigap policies include a 30-day free-look period during which a beneficiary can return the policy for a full refund if dissatisfied.

Which Medigap plans include coverage for foreign travel emergency care?

Answer: Plans C, D, F, G, M, and N cover foreign travel emergency care up to plan limits

Medigap Plans C, D, F, G, M, and N cover foreign travel emergency care, generally at 80% after a $250 deductible, up to a $50,000 lifetime limit.

If a Medicare beneficiary has a Medigap policy and receives Medicare-covered services, in what order do the payers pay?

Answer: Medicare pays first as the primary payer, then the Medigap insurer pays the remaining covered costs

Medicare is always the primary payer and pays first; the Medigap policy then pays its share of the remaining covered costs.

A beneficiary wants to leave their Medicare Advantage plan and enroll in Original Medicare plus a Medigap plan outside of a guaranteed issue period. What should they know?

Answer: They may face medical underwriting, and insurers may deny coverage or charge higher premiums

Outside of guaranteed issue periods, insurers may apply medical underwriting when a beneficiary switches from Medicare Advantage to Medigap, potentially resulting in denial or higher premiums.

Medigap Plans K and L have an annual out-of-pocket limit. Once a beneficiary reaches this limit, what benefit applies for the rest of the calendar year?

Answer: The plan pays 100% of covered Medicare costs for the remainder of the calendar year

Once the out-of-pocket limit is reached under Plans K or L, the plan covers 100% of all covered Medicare costs for the rest of the calendar year, protecting against catastrophic expenses.

Which of the following statements about a beneficiary who is eligible for both Medigap and Medicaid is CORRECT?

Answer: A Medigap policy is typically unnecessary when Medicaid is available, as Medicaid covers most Medicare cost-sharing

If a beneficiary qualifies for Medicaid, it typically covers Medicare's cost-sharing gaps, making a Medigap policy unnecessary and potentially redundant; some state programs even pay Medigap premiums for dual-eligible beneficiaries.