State RegulationsTX specificDifficulty 3/5
Which statement correctly distinguishes a Medicare supplement policy from a Medicare Advantage plan for a Texas consumer?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under the Texas Medicare supplement rules at 28 TAC 3.3301-.3325, a Medicare supplement policy is secondary to Medicare: it pays the beneficiary's Medicare deductibles, coinsurance and copayments while Medicare remains the primary payer. A Medicare Advantage plan is different in kind, because the beneficiary enrolls in a private plan and receives Medicare benefits through that plan instead of through original Medicare. Keeping the two straight is a practical necessity, since confusing them can lead to the sale of duplicative coverage the consumer cannot use.
Why the other options are wrong
- A) The network point is backwards; Medicare Advantage plans commonly use provider networks, while a supplement policy simply follows Medicare's payment.
- B) The two are reversed: it is the Medicare Advantage plan that replaces the way benefits are received, not the supplement policy.
- C) Medicare supplement policies are individually underwritten consumer products and are not restricted to employer groups.
Memory hook
Medigap pays the gaps; Advantage delivers the benefits.