State RegulationsNY specificDifficulty 3/5
A New York Medicare beneficiary applies for a Medicare supplement policy several years after enrolling in Medicare. Which statement about the transaction is correct?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under Reg 193 (11 NYCRR Part 58) and 11 NYCRR 360.4(h), year-round open enrollment governs access, not the fine print: the insurer must issue the Medicare supplement policy whenever the beneficiary applies and cannot rate her for health, but the policy may still contain a preexisting-condition exclusion capped at 6 months. Guaranteed issue and the exclusion ceiling are two separate protections, and the exam rewards knowing both halves - the door is always open, though a short waiting period may still apply.
Why the other options are wrong
- B) The closed federal enrollment window is the classic trap; New York's open enrollment never closes, so there is no deadline to have missed.
- C) The 6-month ceiling shows that a limited preexisting-condition exclusion is tolerated; the law does not abolish such exclusions outright.
- D) Rating the applicant for a late application or her health is barred during New York's year-round open enrollment.
Memory hook
Door always open; up to six months of waiting room.