DC Medicare Supplement Insurance 1 — Questions and Answers
Question 1: In DC, which agency oversees Medicare Supplement (Medigap) policy forms and ensures they comply with federal NAIC model standards?
- Centers for Medicare & Medicaid Services (CMS) exclusively
- DC Department of Insurance, Securities and Banking (DISB) (Correct answer)
- Social Security Administration
- DC Health Benefit Exchange Authority
Correct 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.
Although Medicare is a federal program, Medicare Supplement insurance is regulated at the state level. DISB approves Medigap policy forms, ensures they meet NAIC model standards (standardized Plans A–N), and licenses agents who sell them.
Question 2: A DC resident newly eligible for Medicare at age 65 has a guaranteed issue right during which period?
- Any time they choose, with no deadline
- The first 6 months after enrolling in Medicare Part B (Correct answer)
- Only during the annual Medicare Open Enrollment Period (Oct 15 – Dec 7)
- Only if they can prove medical necessity
Correct 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.
During the 6-month Medigap open enrollment period, insurers cannot use medical underwriting to deny coverage or charge higher premiums based on health status. After this window closes, insurers may use health-based underwriting in most states, including DC.
Question 3: Which standardized Medigap plan in DC offers the most comprehensive coverage, including all gaps in Original Medicare?
- Plan A
- Plan C or Plan F (for those eligible before Jan 1, 2020)
- Plan G (for those newly eligible after Jan 1, 2020) (Correct answer)
- Plan K
Correct 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.
The MACRA Act eliminated Plans C and F for those newly eligible for Medicare after 2020, because they covered the Part B deductible (considered first-dollar coverage). Plan G now covers everything Plan F covered except the Part B deductible and is the most comprehensive option for new enrollees.
Question 4: What is the 'Medicare Part B excess charges' benefit covered by Medigap Plan G in DC?
- The Medicare Part B annual deductible
- The 20% Part B coinsurance
- The amount a non-participating doctor can charge above Medicare-approved rates (up to 15%) (Correct answer)
- The Part A hospital deductible
Correct 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.
Non-participating Medicare providers may charge up to 115% of the Medicare-approved amount. The 15% excess above Medicare's approved rate is the 'excess charge.' Plan G (and Plan F) covers these excess charges, giving DC beneficiaries financial protection if they see non-participating doctors.
Question 5: Under DC Medigap regulations, what is the 'birthday rule'?
- A rule allowing Medigap policyholders to switch to a plan with equal or lesser benefits during their birthday month without new underwriting (Correct answer)
- A rule requiring insurers to offer premium discounts on the policyholder's birthday
- A rule mandating coverage begins on the policyholder's birthday each year
- A federal rule requiring annual rate increases only on policy anniversary dates
Correct 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.
While the birthday rule originated in California and other states, it represents the concept of allowing beneficiaries to change Medigap plans without underwriting during a birthday window. DC consumer protections for Medigap are guided by DISB regulations aligned with NAIC model standards.
Question 6: Which of the following is TRUE about Medigap policies sold in DC?
- They cover the cost of prescription drugs (Part D)
- They must be sold alongside Medicare Advantage plans
- They supplement Original Medicare (Parts A and B) only, not Medicare Advantage (Correct answer)
- They are available to any person regardless of age
Correct 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.
Medigap is designed to fill the gaps in Original Medicare (deductibles, coinsurance, copayments). If a DC beneficiary is enrolled in Medicare Advantage, they cannot use a Medigap policy. Additionally, Medigap plans sold after 2006 no longer cover Part D prescription drugs.
DC Medicare Supplement Insurance 1
In DC, which agency oversees Medicare Supplement (Medigap) policy forms and ensures they comply with federal NAIC model standards?