State RegulationsTX specificDifficulty 2/5
A Texas agent offers a policy that pays the insured the full Medicare-approved charge for a service already paid by Medicare, so the insured receives more than the service actually cost. Which statement best describes this under the Texas Medicare supplement minimum standards?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under 28 TAC 3.3301-.3325, a Medicare supplement policy exists to fill the gaps Medicare leaves behind, such as deductibles, coinsurance and copayments, and the minimum standards are applied against that purpose. A design that pays the insured again for benefits Medicare already paid duplicates rather than supplements, so it does not fit within the standards. A waiver signed by the insured does not cure a form that fails the minimum standards, because the standards protect the integrity of the product, not just the individual buyer.
Why the other options are wrong
- A) A supplement policy pays after and around Medicare; it is not required or permitted to pay first and duplicate Medicare.
- B) Paying extra premium does not make a duplicative design compliant with the minimum standards.
- D) The insured cannot waive the requirement; the standards bind the form itself.
Memory hook
Supplement the gaps, never duplicate the payment.