AD Banker Comprehensive Practice Exam

A Medicare Supplement Policy must include which core benefit amount for Medicare Part B coinsurance?

1. 10%

2. 15%

3. 25%

4. 20%

The correct answer is: 20%

A Medicare Supplement Policy, often referred to as Medigap, is designed to help cover costs that Original Medicare does not, including deductibles, copayments, and coinsurance. Specifically for Medicare Part B coinsurance, the core benefit that must be included in a Medigap policy is coverage for 20% of the Medicare-approved amounts. Medicare Part B covers services like outpatient care, preventive services, and some home health care. While Medicare typically covers 80% of these costs, beneficiaries are responsible for the remaining 20% coinsurance. Thus, a Medigap policy must provide coverage for this 20% amount, ensuring that policyholders are not left with significant out-of-pocket expenses. This requirement is rooted in federal regulations that dictate the essential benefits that Medigap policies must offer to effectively assist beneficiaries in managing healthcare costs. Since Medicare does not cover 100% of expenses, ensuring that the 20% coinsurance is covered provides a critical safety net for individuals relying on Medicare for their healthcare needs.