Final view - private insurance for senior - Medicare supplemental

Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the

ABuyer's Guide.

BCertificate of Coverage.

CNotice Regarding Replacement.

DPolicy application.

Correct! The Notice Regarding Replacement must inform the applicant of the 30-day free-look provision of the replacing policy.

8: Which of the following provisions must be included on the first page of a Medicare supplement policy, which states the insurer’s right to change premium amounts?

A Premium provision

B Insurer's rights

C Coverage limitations

D Continuation provision

The renewal provision, also known as a continuation provision, must be included on the first page of Medicare supplement policies. This provision explains the right of the insurer to alter premium amoun

Chapter Recap

This chapter explained health insurance available to senior citizens and special needs individuals: Medicare, Medicare Supplements, Medicaid, and Long-term Care. Let's recap some of the key points:

MEDICARE
Basics	Federal medical expense insurance program for people who:  Are age 65 or older  Have been entitled to Social Security disability income benefits for 2 years Have a permanent kidney failure (ESRD)  4 parts:  Part A, Hospital Insurance, financed through payroll tax (FICA)  Part B, Medical Insurance, financed by insureds and general revenues  Part C, Medicare Advantage, allows for receipt of health care services through available provider organizations  Part D, Prescription Drugcoverage
Part A	Enrollment:  Initial enrollment period -when an individual first becomes eligible for Medicare (starting 3 months before turning age 65, ending 3 months after the 65th birthday)  General enrollment period -between January 1st and March 31st each year  Special enrollment period -at any time during the year if the individual or his/her spouse is still employed and covered under a group health plan Coverage:  Inpatient Hospital Care  Skilled Nursing Facility Care Home Health Care Hospice Care
Part B	Optional; offered to everyone who enrolls in Part A Coverage:  Doctor Services  Outpatient Hospital Services  Home Health Visits  Other Medical and Health Services Prescription Drugs (limited coverage)  Outpatient Treatment of Mental Illness Yearly wellness visit
Part C	Medicare Advantage: requires enrollment in Parts A and B Provided by an approved Health Maintenance Organization or Preferred ProviderOrganization
Part D	Prescription drug benefit Optional coverage through private prescription plans that contract with Medicare
Primary, Secondary Payor	For individuals eligible for Medicare coverage who continue to work, the employer’s health plan would be primary coverage while Medicare would be secondary coverage
MEDICARE SUPPLEMENT POLICIES
Basics	Referred to as Medigap Policies issued by private insurance companies to fill in gaps in Medicare Open enrollment period of 6-months
Coverage	Plan A: core benefits, such as coinsurance/copayment; additional Part A hospital costs; hospice care coinsurance / copayment; Part B coinsurance/copayment; 3 pints of blood under Parts A and B Plans B – N: core benefits + various additional benefits
OTHER OPTIONS FOR INDIVIDUALS WITH MEDICARE
Employer Group Health Plans	Disabled employees: coverage for disabled individuals under age 65 Employees with kidney failure: primary coverage for 30 months for end-stage rental disease, prior to Medicare Individual age 65 or older:  Requires employer to continue offering coverage if Medicare is deferred Employer cannot offer incentives for switching plan Medicare is primary if employer has no more than 20 employees
Medicaid	Medical care for those whose income and resources are insufficient Federal and state funded
LONG-TERM CARE
Policies	Available as individual policies, group policies, or as riders to life insurance policies  Coverage for individuals who require living assistance at home or in a nursing home facility Must provide at least 12 months of consecutive coverage in a setting other than an acute care unit of a hospital Guaranteed renewable, but insurers may increase premiums
Levels of Care	Skilled care - daily nursing and rehabilitative care provided by medical personnel Intermediate care - occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care  Custodial care - care for a person's activities of daily living provided in an institutional setting or in the patient's home Home health care - provided by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice in one’s home Residential Care - provided while the insured resides in a retirement community Adult day care - provides for functionally impaired adults on less than a 24-hour basis  Respite Care - provides relief to the family caregiver; adult day care centers may also provide this type of relief Assisted living - provides help with nonmedical daily activities
Coverage and Benefits	12 consecutive months Elimination period of 30 days or more Benefit period of 2-5 years; some offering lifetime coverage Longer benefit periods result in higher premium Trigger: inability to perform ADLs (usually 2 - 3)
Required Provisions	Must be guaranteed renewable Must offer inflation protection Free look period - 30 days Pre-existing conditions exclusion - no more than 6 months Must cover Alzheimer's disease Disclosure requirements - outline of coverage and policy summary