Medicare Supplement Insurance Flashcards

In DC, which agency oversees Medicare Supplement (Medigap) policy forms and ensures they comply with federal NAIC model standards?

Answer: DC Department of Insurance, Securities and Banking (DISB)

DISB regulates Medicare Supplement insurance sold in DC, including approving policy forms to ensure compliance with federal NAIC model regulations.

A DC resident newly eligible for Medicare at age 65 has a guaranteed issue right during which period?

Answer: The first 6 months after enrolling in Medicare Part B

The Medigap open enrollment period is the 6-month window beginning the month a beneficiary is both age 65 or older AND enrolled in Medicare Part B, during which guaranteed issue applies.

Which standardized Medigap plan in DC offers the most comprehensive coverage, including all gaps in Original Medicare?

Answer: Plan G (for those newly eligible after Jan 1, 2020)

For beneficiaries newly eligible for Medicare after January 1, 2020, Plan G is the most comprehensive Medigap plan available, covering all gaps except the Part B deductible.

What is the 'Medicare Part B excess charges' benefit covered by Medigap Plan G in DC?

Answer: The amount a non-participating doctor can charge above Medicare-approved rates (up to 15%)

Part B excess charges are the additional amounts (up to 15% above Medicare rates) that non-participating providers may bill; Plan G covers these charges.

Under DC Medigap regulations, what is the 'birthday rule'?

Answer: A rule allowing Medigap policyholders to switch to a plan with equal or lesser benefits during their birthday month without new underwriting

Some states have a birthday rule allowing Medigap policyholders to switch plans (equal or lesser benefits) during a window around their birthday without medical underwriting. DC has considered similar consumer protections.

Which of the following is TRUE about Medigap policies sold in DC?

Answer: They supplement Original Medicare (Parts A and B) only, not Medicare Advantage

Medigap policies only supplement Original Medicare (Parts A and B) and cannot be used with Medicare Advantage plans.