A Medicare beneficiary who already owns a comprehensive Medicare supplement policy asks a New York agent to also sell the richest benefit plan the issuer offers. Which response complies with New York's appropriateness standards for Medicare supplement recommendations?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under New York's appropriateness standards for Medicare supplement insurance, an agent must make reasonable efforts to determine whether recommended coverage is appropriate for the applicant's needs, and issuers must establish marketing procedures to ensure that excessive insurance is not sold or issued. Reviewing the applicant's existing comprehensive Medicare supplement policy and declining to recommend duplicative coverage is the compliant course. Standardization of plan benefits does not eliminate the suitability review, because duplication and cost remain live concerns for the applicant.
Why the other options are wrong
- A) Standardized benefit plans do not eliminate the appropriateness review; the agent must still consider existing coverage and the risk of excess coverage.
- B) That the issuer would issue the policy does not satisfy the agent's independent duty to determine appropriateness before recommending it.
- D) A liability release from the applicant cannot substitute for the agent's appropriateness determination.
Memory hook
A second Medigap on top of a comprehensive one? Review first; duplicate coverage is the red flag.