51 Questions
What is the duration of the Medicare Supplement Open Enrollment Period?
6 months
What is the rule regarding pre-existing health conditions during the Guaranteed Issue rights period?
Companies must cover all pre-existing health conditions
What is the exception to the rule of covering all pre-existing health conditions during Guaranteed Issue?
If there was a break in coverage for more than 63 days
What type of policies can companies refuse to sell during the Medicare Supplement Open Enrollment Period?
None of the Medicare Supplement policies they offer
How many circumstances under federal law give a beneficiary the right to buy a policy?
7
What is the purpose of the 'State-Specific GI Rights' tab in the Medicare Supplement Master Reference Guide?
To provide information on guaranteed acceptance determination
What is the primary difference between federal GI rights and state-specific GI rights?
Federal GI rights apply to all states, while state-specific GI rights apply to select states
When can a Humana contracted agent engage in preliminary underwriting discussions?
Before submitting the application
What is required to be answered by the applicant before submitting the application?
Medical questions on the application
What is the purpose of the Medicare Supplement Agent Field Guide?
To provide information on guaranteed acceptance determination
What happens to an application taken outside of an applicant’s Medicare Supplement Open Enrollment Period or Guaranteed Issue rights in states where medical questions are allowed?
It is subject to underwriting.
Which condition would disqualify an application from being submitted if indicated by the applicant?
Height and weight fall into the denial ranges on the BMI chart.
What step follows if an application passes the real-time underwriting process?
It is processed by the enrollment team.
What action is taken if an application requires further review after real-time underwriting?
It is sent to Humana’s Enrollment team for validation.
What must an applicant do if they have suffered from one or more conditions listed on the Medicare Supplement?
Indicate the condition(s) if they occurred in the last 2 years (3 years in California).
What is a required action for applications taken outside of the Medicare Supplement Guaranteed Issue rights?
They undergo the underwriting process in states allowing medical questions.
What occurs if an application submitted electronically is denied during the underwriting process?
A written notification is sent to the applicant with instructions.
What medication-related condition would prevent an application from being submitted?
Being prescribed medications listed on the Medications Related to Uninsurable Conditions in the past 12 months.
What is the primary reason for the Medicare Supplement Open Enrollment Period?
To provide applicants with a guaranteed issue right to buy a Medicare Supplement policy
What happens if an applicant is eligible for Medicare before January 1, 2020, but not yet enrolled?
They may be able to buy Plan C, Plan F, or F (HD)
What is the main difference between the Medicare Supplement Open Enrollment Period and Guaranteed Issue rights?
The rules regarding pre-existing health conditions
What triggers Guaranteed Issue rights?
Certain changes in healthcare coverage for the beneficiary
What is the purpose of requiring proof of coverage to determine Guaranteed Issue?
To determine if the applicant has a break in coverage for more than 63 days
What is the consequence of a break in coverage for more than 63 days during Guaranteed Issue?
The applicant may be subject to a pre-existing condition waiting period
What should be done before enrolling a client into a policy?
Present one policy and disclose all necessary documentation
What factor is crucial in deciding on a policy during the enrollment process?
The decision should be based on the NEADS
What must an agent provide after the close of an enrollment?
A timeline and customer service phone number
What is emphasized as vital for ensuring meaningful conversations with prospects?
Uncovering all of the prospect's needs
What directly affects an agent's commission and residuals?
The accretion rate and retention
Which resource is essential for agents handling Medicare Supplement plans?
Medicare Supplement Agent Field Guide
Under what circumstances can an applicant's Medicare Supplement application bypass the need for further review by the Underwriting team?
If the application passes the real-time underwriting process
What triggers the involvement of Humana’s Enrollment team during the application process?
When the application needs further review after real-time underwriting
What happens to applications that are denied after the real-time underwriting process?
Written notification is sent to the applicant with instructions on how to obtain a copy of their history report
Which of the following will NOT exclude an applicant from submitting their Medicare Supplement application?
Any medical condition not listed in the Medicare Supplement guidelines
Why might an application be sent to Humana's Underwriting team for evaluation?
If it requires further review after initial submission
In states where medical questions are allowed, what is true about applications taken outside of an applicant’s Open Enrollment Period or Guaranteed Issue rights?
They will be underwritten
How quickly do agents typically receive a response to their application submission if it goes through the real-time UW process?
Within minutes
Which part of the application process involves sending the application to Humana's Enrollment team for validation?
When the application requires further review after real-time underwriting
What is the primary purpose of Medigap plans?
To supplement Original Medicare coverage and pay for out-of-pocket expenses
What is the minimum coverage required for all Medigap plans?
Medicare Part A coinsurance and hospital costs, Medicare Part B coinsurance and copays, blood transfusions, hospice care, and skilled nursing facility care
During which period can Medicare beneficiaries enroll in a Medigap plan without being subject to medical underwriting?
Initial enrollment period, guaranteed issue period, and special enrollment period
What is a requirement for enrolling in a Medigap plan?
Residing in the plan's service area
What is the consequence of not enrolling in a Medigap plan during the initial enrollment period?
Medicare beneficiaries may be subject to medical underwriting
What is the purpose of the guaranteed issue period?
To allow Medicare beneficiaries to enroll in a Medigap plan during certain times
What is the difference between the initial enrollment period and the guaranteed issue period?
The initial enrollment period is for Medigap plans, while the guaranteed issue period is for special circumstances
What is the main difference between Medigap plans and Medicare Advantage plans?
Medigap plans are designed to supplement Original Medicare coverage, while Medicare Advantage plans are designed to replace Original Medicare coverage
What is a factor that affects Medigap premiums?
Type of policy
Which of the following is a basic benefit of Medigap plans?
Medicare Part A coinsurance
What can cause Medigap premiums to increase over time?
Inflation, age, or other factors
What is a benefit that may be offered by some Medigap plans, depending on the type of policy?
Medicare Part A deductible
What is a factor that may qualify certain groups for premium discounts in some states?
Disability
Study Notes
Medigap Plans
- Medigap plans are private insurance policies that supplement Original Medicare (Part A and Part B) coverage, helping to pay for out-of-pocket expenses
- 10 standardized Medigap plans are available, labeled A, B, C, D, F, G, K, L, M, and N, each offering a different level of coverage
- All Medigap plans must cover certain benefits, including:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance and copays
- Blood transfusions (first 3 pints)
- Hospice care coinsurance and copays
- Skilled nursing facility care coinsurance
Enrollment
- Initial enrollment period for Medigap plans is typically within 6 months of turning 65 and enrolling in Medicare Part B
- Outside of the initial enrollment period, Medicare beneficiaries may enroll in a Medigap plan during certain times, including:
- Annual open enrollment period (Oct 15 - Dec 7)
- Special enrollment period (e.g., losing employer-sponsored coverage)
- Guaranteed issue period (e.g., moving to a new state)
- To enroll in a Medigap plan, Medicare beneficiaries must be:
- Enrolled in Medicare Part A and Part B
- Residing in the plan's service area
- Not enrolled in a Medicare Advantage plan
- Meeting any additional eligibility requirements set by the insurance company
Medicare Supplement Cost
Premiums
- Medigap policies have standardized plans, but premiums vary by insurance company and location.
- Premiums are influenced by age, location, and insurance company.
- Premiums increase over time due to inflation, age, or other factors.
- Some states offer premium discounts for certain groups, such as disabled beneficiaries under 65.
Coverages
- Medigap plans offer varying levels of coverage, including plans A, B, C, D, F, G, K, L, M, and N.
- Basic benefits of Medigap plans include Medicare Part A coinsurance, Medicare Part B coinsurance, and blood transfusions (first 3 pints).
- Additional benefits vary by plan, and may include Medicare Part A deductible, Medicare Part B deductible, excess charges, foreign travel emergency care, at-home recovery care, preventive care, and out-of-pocket limits.
Learn about the Medicare Supplement Open Enrollment Period, including when it starts, how long it lasts, and the rules insurance companies must follow during this period.
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