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Medicare supplement policies
Finish →Question 1 of 37
What does a Medicare supplement (Medigap) policy primarily pay for?
Reveal answer
Correct answer: Deductibles, coinsurance and copayments left after Original Medicare pays
Medigap is private insurance that fills the cost-sharing gaps in Original Medicare: the deductibles, coinsurance and copayments the beneficiary would otherwise owe.
Question 2 of 37
To be eligible to buy a Medigap policy, a Medicare beneficiary must be enrolled in which parts of Medicare?
Reveal answer
Correct answer: Both Part A and Part B
Medigap supplements Original Medicare, so the applicant must be enrolled in both Part A (hospital) and Part B (medical).
Question 3 of 37
Two insurers each sell a Medigap Plan G. Which of the following may differ between the two policies?
Reveal answer
Correct answer: The premium charged
Medigap plans are standardized under a uniform designation system: every Plan G has the same benefits. What differs between insurers is mainly the premium, along with the insurer's service.
Question 4 of 37
Which of the following is a basic benefit included in every standardized Medigap plan?
Reveal answer
Correct answer: The first three pints of blood each year
Every Medigap plan includes the basic benefits: Part A hospital coinsurance plus 365 extra hospital days, Part B coinsurance or copays, the first three pints of blood, and Part A hospice cost-sharing. The other choices are additional benefits that vary by plan letter.
Question 5 of 37
A client's mother will likely need years of custodial care in a nursing home. The client asks which Medigap plan would pay for it. Which response is accurate?
Reveal answer
Correct answer: No Medigap plan covers long-term custodial care, because it is not among the benefits of any plan letter
Medigap pays cost-sharing on Medicare-covered services plus a few listed extras, such as extra hospital days and foreign travel emergency care. Long-term custodial care is not a Medicare benefit and is not among the benefits of any Medigap plan, so no plan pays for it. A need like this points to long-term care insurance or other planning.
Question 6 of 37
Harold first became eligible for Medicare in March 2024. Which Medigap plan may an insurer NOT sell to him?
Reveal answer
Correct answer: Plan F
From January 1, 2020, insurers may not offer Plans C, F or high-deductible F to people who first become eligible for Medicare on or after that date. Harold became eligible in 2024.
Question 7 of 37
Which Medigap plans were eliminated as of June 1, 2010, because they had contained prescription drug benefits?
Reveal answer
Correct answer: Plans H, I and J
Plans H, I and J carried drug benefits before the Medicare Modernization Act created Part D, and were eliminated in the 2010 modernization. Plan E was also dropped as duplicative.
Question 8 of 37
Which description matches Medigap Plan N?
Reveal answer
Correct answer: It does not pay the Part B deductible and has copays of up to $20 per office visit and up to $50 per emergency room visit
Plan N trades a lower premium for more cost-sharing: it does not cover the Part B deductible and carries up to $20 office and $50 emergency room copays, the ER copay waived on admission.
Question 9 of 37
Which description matches Medigap Plan M?
Reveal answer
Correct answer: It pays 50% of the Part A deductible and none of the Part B deductible
Plan M, added in 2010, has higher cost-sharing and a lower expected premium: 50% of the Part A deductible and no coverage of the Part B deductible.
Question 10 of 37
What is Medicare Select?
Reveal answer
Correct answer: A Medigap policy that requires use of network hospitals, and sometimes network doctors, except in an emergency
Medicare Select is a type of Medigap policy with a provider network requirement for full benefits, except in emergencies. It may cost less, and otherwise must meet all Medigap requirements.
Question 11 of 37
An insured with a Medicare Select policy chooses a non-network hospital for planned, non-emergency surgery. What generally happens?
Reveal answer
Correct answer: Medicare still pays its share of approved charges, but the Select policy generally need not pay its supplemental benefits
Medicare pays its share regardless of provider. A Medicare Select policy is generally not required to pay benefits for non-emergency care outside its network.
Question 12 of 37
Under federal law, when is a person's Medigap open enrollment period?
Reveal answer
Correct answer: The six months beginning with the first month the person is both 65 or older and enrolled in Part B
The federal Medigap open enrollment period is six months long and begins with the first month the person is both at least 65 and enrolled in Part B. During it, insurers cannot refuse or rate up for health.
Question 13 of 37
Ann turned 65 and her Part B coverage began in May. In August she applies for Medigap and discloses that she has diabetes. Under federal open enrollment rules, what may the insurer do?
Reveal answer
Correct answer: It must sell her any Medigap plan it offers and cannot charge more because of her health
August is within the six-month open enrollment period that began in May, so the insurer cannot refuse her or charge more for health. At most, a limited pre-existing waiting period could apply if she lacks creditable coverage.
Question 14 of 37
What is the longest waiting period a Medigap policy may impose before covering a pre-existing condition?
Reveal answer
Correct answer: 6 months
A Medigap policy may impose up to a six-month waiting period for pre-existing conditions, and that wait must be reduced by prior creditable coverage.
Question 15 of 37
Leo had three years of employer group health coverage that ended June 30. His new Medigap policy, which has a six-month pre-existing condition waiting period, takes effect 40 days later. How does the waiting period apply to him?
Reveal answer
Correct answer: The wait is eliminated, because his creditable coverage counts and the break was not longer than 63 days
Medigap insurers must reduce the pre-existing wait by prior creditable coverage when no break exceeds 63 days. Leo's group coverage counts, his 40-day gap is under 63 days, and three years more than covers the six-month wait.
Question 16 of 37
Medigap policies are guaranteed renewable. What does that mean for the insured?
Reveal answer
Correct answer: The insurer cannot cancel the policy because of the insured's health, only for reasons such as nonpayment of premium or a material misstatement
Guaranteed renewable means the insurer cannot refuse to renew because of health or claims. It may end coverage for nonpayment or a material misstatement on the application. Premiums can still rise for a whole class of insureds.
Question 17 of 37
How long is the free-look period during which a Medigap buyer may return the policy for a full refund?
Reveal answer
Correct answer: 30 days
Medigap buyers receive a 30-day free-look period to review the policy and return it for a full premium refund.
Question 18 of 37
New York Insurance Law § 3218 directs the superintendent to adopt rules for Medicare supplement insurance. Which of the following is one of those required rules?
Reveal answer
Correct answer: A minimum ratio of benefits to premiums, with annual filing of data showing compliance
Section 3218(b)(3) requires the ratio of benefits to premiums (the loss ratio) to be at least a percentage the superintendent sets, with annual filings to prove compliance.
Question 19 of 37
A client with Original Medicare sees a doctor who does not accept assignment and bills more than the Medicare-approved amount. Which Medigap benefit addresses the extra amount?
Reveal answer
Correct answer: The Part B excess charges benefit
Part B excess charges are amounts a non-participating doctor may bill above the Medicare-approved amount. Some Medigap plans cover them.
Question 20 of 37
In the 2010 Medigap modernization, which benefit was added as a basic benefit in every plan?
Reveal answer
Correct answer: Part A hospice care coinsurance or copayments
In 2010 the at-home recovery benefit was eliminated and a new hospice care benefit was added as a basic benefit in every Medigap plan. The preventive care benefit was also eliminated.
Question 21 of 37
Jim became eligible for Medicare in 2019 and has not yet bought Medigap. Maria first became eligible in 2021. Both now want Plan F. Which statement is correct?
Reveal answer
Correct answer: Jim may buy Plan F because he was eligible before 2020, but Maria may not
The 2020 restriction applies to people who first became eligible for Medicare on or after January 1, 2020. Jim was eligible in 2019, so he is not newly eligible; Maria is.
Question 22 of 37
How does New York Insurance Law define "Medicare supplemental insurance"?
Reveal answer
Correct answer: Any individual or group accident and health policy providing payment or reimbursement for health care services not provided by Medicare
Section 3218(a)(2) defines Medicare supplemental insurance as any individual or group accident and health policy that pays or reimburses health care services not provided by Medicare, subject to a narrow exception for certain multistate group contracts.
Question 23 of 37
A newly eligible client wants a lower-premium Medigap plan and is willing to pay the Part B deductible plus small copays for office and emergency room visits. Which plan fits that description?
Reveal answer
Correct answer: Plan N
Plan N leaves the Part B deductible uncovered and adds copays of up to $20 per office visit and $50 per ER visit in exchange for a lower expected premium.
Question 24 of 37
What are Medicare Part B excess charges?
Reveal answer
Correct answer: The amount a doctor who does not accept assignment may bill above the Medicare-approved amount
Excess charges are the difference between what a non-participating doctor bills (within legal limits) and the Medicare-approved amount. Some Medigap plans cover them.
Question 25 of 37
A client wants a Medigap plan with a lower premium and is willing to share some basic costs, as long as there is a yearly cap on out-of-pocket spending. Which plans fit?
Reveal answer
Correct answer: Plan K or Plan L
Plans K and L pay 50% and 75% of most basic cost-sharing (the hospital coinsurance and extra days in full) and cap the insured's yearly out-of-pocket spending.
Question 26 of 37
After Medicare's hospital benefits are used up, how many additional days of hospital coverage does the Medigap basic benefit provide?
Reveal answer
Correct answer: 365 days
Every Medigap plan covers Part A hospital coinsurance plus an additional 365 days of hospital care after Medicare benefits are exhausted.
Question 27 of 37
Under New York Insurance Law, what must the superintendent publish and distribute to help consumers choose Medigap coverage?
Reveal answer
Correct answer: A consumer's shopping guide for Medicare supplemental insurance
Section 3218(b)(7) requires rules providing for publication and dissemination of a consumer's shopping guide for Medicare supplemental insurance.
Question 28 of 37
Medicare denies a claim for a routine dental cleaning because routine dental care is not covered by Medicare. The insured has Medigap Plan G. What will Plan G pay?
Reveal answer
Correct answer: Nothing, because Plan G has no benefit for routine dental care
Plan G pays the cost-sharing on services Medicare approves plus a few extra benefits written into the plan, such as foreign travel emergency care. Routine dental care is not among them, so when Medicare denies a routine cleaning, Plan G pays nothing.
Question 29 of 37
For policies sold on or after January 1, 2020, which plans must every Medigap insurer offer, according to New York's Department of Financial Services?
Reveal answer
Correct answer: Plans A and B, plus either Plan D or Plan G
DFS reports that for policies sold on or after January 1, 2020, Medigap insurers must offer Plans A and B and either Plan D or Plan G. Not every company offers every plan.
Question 30 of 37
Which statement best contrasts a standard Medigap policy with a Medicare Advantage plan?
Reveal answer
Correct answer: Medigap supplements Original Medicare, which pays first; Medicare Advantage is a private plan that takes the place of Original Medicare for delivering benefits
Medigap works alongside Original Medicare and pays after it. Medicare Advantage is a federally approved private plan that delivers Medicare benefits instead of Original Medicare. The two are not combined.
Question 31 of 37
A retiree with Original Medicare and Medigap Plan G wants coverage for outpatient prescription drugs. What should a producer recommend?
Reveal answer
Correct answer: Enrolling in a stand-alone Medicare Part D prescription drug plan
No Medigap plan sold today covers outpatient drugs; Plans H, I and J were eliminated. A person with Original Medicare gets drug coverage by joining a stand-alone Part D plan.
Question 32 of 37
Who sells Medicare supplement (Medigap) policies?
Reveal answer
Correct answer: Private insurance companies
Medigap is health insurance sold by private insurance companies to cover some of the gaps in Original Medicare.
Question 33 of 37
Frank, 72, lives in New York, has Original Medicare and no Medigap policy, and has a heart condition. He applies for Medigap in October. Under New York law and regulation, what must an insurer that writes Medigap do?
Reveal answer
Correct answer: Accept his application and not deny coverage or vary the rate because of his health
New York requires any insurer writing Medigap to accept a Medicare enrollee's application at any time of year, without denial or premium distinctions based on health status, claims experience or medical condition.
Question 34 of 37
Starting January 1, 2020, which Medigap plans may not be sold to people newly eligible for Medicare, and why?
Reveal answer
Correct answer: Plans C, F and high-deductible F, because they cover the Part B deductible
The federal MACRA change bars sale of Medigap plans covering the Part B deductible, which are C, F and high-deductible F, to people newly eligible on or after January 1, 2020.
Question 35 of 37
A healthy, newly eligible client who rarely sees doctors is comparing Plan G and Plan N. Which statement correctly describes the trade-off?
Reveal answer
Correct answer: Plan N usually costs less but adds office and emergency room copays; neither plan pays the Part B deductible
Neither Plan G nor Plan N covers the Part B deductible. Plan N trades copays of up to $20 per office visit and $50 per ER visit for a lower expected premium, which can suit someone who rarely uses care.
Question 36 of 37
Under New York Insurance Law § 3218(c), an authorized insurer may issue or deliver a Medicare supplement policy in New York only if the policy:
Reveal answer
Correct answer: Includes the minimum standards approved by the superintendent
Section 3218(c) bars authorized insurers from issuing or delivering any Medicare supplement policy in New York other than one that includes the minimum standards approved by the superintendent.
Question 37 of 37
A 66-year-old with Original Medicare and a Medigap policy is admitted to the hospital for a Medicare-covered stay. How are the costs handled?
Reveal answer
Correct answer: Medicare pays its share of the approved amount first, then Medigap pays the covered cost-sharing, such as the Part A deductible if the plan includes it
Medicare is primary. It pays its share of the approved charge, and Medigap then pays the cost-sharing its plan covers, for example Part A coinsurance and, where included, the Part A deductible.
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This free set is 37 questions from one objective. A plan opens 3465 questions across the whole New York exam, plus mock exams, spoken rationales, and audio you can study while driving.