DC Medicare Supplement Insurance 2 — Questions and Answers
Question 1: What does Medicare Part A cover for DC beneficiaries?
- Outpatient services, doctor visits, and preventive care
- Hospital inpatient care, skilled nursing facility care, and hospice (Correct answer)
- Prescription drugs
- Dental and vision coverage
Correct answer: Hospital inpatient care, skilled nursing facility care, and hospice
Medicare Part A covers inpatient hospital care, skilled nursing facility (SNF) care following a qualifying hospital stay, hospice, and some home health care.
Medicare Part A is the hospital insurance portion of Medicare, funded by payroll taxes. It covers inpatient hospital stays, SNF care (up to 100 days following a 3-day hospital stay), hospice, and limited home health. DC residents with sufficient work history receive Part A premium-free.
Question 2: A DC resident on Medicare incurs a $3,000 hospital bill for a 2-day stay. With only Original Medicare, what does the patient owe?
- Nothing—Medicare covers 100% for hospital stays
- The Part A deductible per benefit period (approximately $1,632 in 2024) (Correct answer)
- 20% coinsurance with no deductible
- A flat $250 copay per hospital day
Correct answer: The Part A deductible per benefit period (approximately $1,632 in 2024)
Original Medicare Part A requires the beneficiary to pay the Part A deductible (approximately $1,632 for 2024) for each benefit period before Medicare pays.
The Medicare Part A deductible applies per benefit period (which begins when admitted to a hospital and ends after 60 consecutive days out of the hospital). For 2024, this deductible is approximately $1,632. Medigap plans can cover this deductible.
Question 3: Which Medigap plan covers 50% of the Medicare Part A deductible for DC policyholders?
- Plan A
- Plan K (Correct answer)
- Plan G
- Plan N
Correct answer: Plan K
Medigap Plan K covers 50% of the Part A deductible and other gaps at 50%, with an annual out-of-pocket maximum, making it a lower-premium option.
Plan K is one of two cost-sharing Medigap plans (along with Plan L). It covers 50% of most gaps (Part A deductible, Part B coinsurance, skilled nursing coinsurance) and includes an annual out-of-pocket limit after which Medicare pays 100%. It has lower premiums than comprehensive plans.
Question 4: In DC, how must Medigap premiums be structured to prevent discriminatory pricing?
- Premiums must be the same for all policyholders regardless of age
- Premiums may be community-rated, issue-age rated, or attained-age rated, but the method must be disclosed (Correct answer)
- Premiums must decrease each year the policy is in force
- Premiums must be approved by CMS before being charged
Correct answer: Premiums may be community-rated, issue-age rated, or attained-age rated, but the method must be disclosed
DC allows community-rated, issue-age, and attained-age rating methods for Medigap, but the rating methodology must be clearly disclosed to the applicant.
Medigap pricing methods include: community-rated (same premium for all, regardless of age), issue-age rated (based on age at first purchase, doesn't increase with age), and attained-age rated (increases as you age, typically lowest initial premium). DC requires disclosure of the rating method.
Question 5: Under federal and DC Medigap law, what is the 'free-look' period for a newly purchased Medigap policy?
- 5 days
- 10 days
- 30 days (Correct answer)
- 60 days
Correct answer: 30 days
Federal Medigap regulations require a 30-day free-look period, during which the policyholder may return the policy for a full refund.
Federal law mandates a 30-day free-look (right to examine) period for Medigap policies. During this time, the policyholder can review the policy and return it for a full premium refund if dissatisfied. This is longer than the typical 10-day free-look for life insurance.
Question 6: What does Medicare Part B cover?
- Inpatient hospital stays
- Outpatient medical services, doctor visits, preventive services, and durable medical equipment (Correct answer)
- Long-term nursing home care
- Prescription drugs under Medicare Part D
Correct answer: Outpatient medical services, doctor visits, preventive services, and durable medical equipment
Medicare Part B covers outpatient medical services including doctor visits, lab tests, preventive care, and durable medical equipment (DME).
Medicare Part B covers physician services, outpatient hospital services, diagnostic tests, ambulance services, durable medical equipment (wheelchairs, walkers), and preventive screenings. Beneficiaries pay a monthly premium (income-adjusted) and are responsible for the annual deductible and 20% coinsurance.
DC Medicare Supplement Insurance 2
What does Medicare Part A cover for DC beneficiaries?