NC MEDICARE SUPPLEMENT LONG TERM CARE
2026 ALL QUESTIONS AND ANSWERS SURE A+
✔✔Medicare Advantage (Part C) - ✔✔Managed care alternative to original program.
Offered by Medicare-approved private companies that must follow Medicare rules.
-Beneficiary must be enrolled in both Part A & Part B then elect a managed care plan in
lieu.
-Serviced thru MCO's network of providers.
-Must accept all with Medicare except ESRD
-Additional monthly premium in addition to Part B premium
-Beneficiary must live in the plan's service area. Can elect HMO, PPO, POS or PFFS
systems.
-Can't use a Med Supp (Medigap) policy while participating.
✔✔Medicare Outpatient Prescription Drug Coverage (Part D) - ✔✔Beneficiaries may
choose to participate in a Prescription Drug Plan (PDP) that is offered by private sector
insurance companies for an additional premium.
-Must have Part A & Part B to join
-Premiums based upon the PDP chosen
✔✔Medicare Part D Enrollment - ✔✔-Initial Enrollment Period- can enroll without
penalty
, -Open Enrollment/ Annual Election Period- Oct 15th to Dec 7th- coverage begins Jan 1
of following year
-Late Enrollment- Any time after initial enrollment or a period of 63+ days where doesn't
have Part D coverage. There's a penalty of +1% Part D premium for ea month of delay
in enrollment
✔✔Switching Advantage Part C Plans - ✔✔Can only be during Open Enrollment/
Annual Election Period - Oct 15th to Dec 7th of each year.
✔✔Medicare Supplement Insurance (Medigap) - ✔✔Primarily intending to pay for cost-
sharing feature of Medicare...i.e.. deductibles, coinsurance, expenses after Medicare is
maxxed out.
✔✔Types of Medicare Plans - ✔✔A, B, C, D, F, G, K, L, M
-Do not have E, H, I, J
-All companies marketing Med Supp must also offer plan A (basic/ core benefits)
-Plan F is most popular
✔✔Medicare Supplement - minimum standards - ✔✔Pre-existing coverage may be
excluded from coverage for 6 mos max.
-Impairment riders cannot be added to a Medigap policy.
-Supplement policies may not indemnify sickness losses on a different basis than
accident losses.
-May not duplicate benefits of original plan or Medicare Advantage plan
-Are "Issue Age" based, do not increase premium with age
-Rates may NOT be based on "Attained Age" unless specified.
-Must be either "Guaranteed Renewable" or
"Non-cancelable"
✔✔Insurers selling Medicare Supplement Insurance - ✔✔Required to pay out a certain
percentage of premiums collected each year in benefits.
Insurers are not allowed to make a high profit.
-Group policies- at least 75% of aggregate premiums earned.
-Individual policies- at least 65%
✔✔Med Supp Disclosure Provisions - ✔✔-"Outline of Coverage" must be provided at
time of application & a signed acknowledgement of receipt from applicant must be
collected.
-Must include renewal or continuation provision on first page
-Riders added after issuance that affects policy coverage & premium must have a
signed acceptance from insured
-"Reasonable & Customary" must define the term & explained in outline of coverage.
-ALL supplement policies MUST have a 30 Day Free Look Period
-All applicant must be provided a NC Buyer's Guide from NAIC AND a Medicare
Supplement Buyer's Guide from CMS at time of application.
2026 ALL QUESTIONS AND ANSWERS SURE A+
✔✔Medicare Advantage (Part C) - ✔✔Managed care alternative to original program.
Offered by Medicare-approved private companies that must follow Medicare rules.
-Beneficiary must be enrolled in both Part A & Part B then elect a managed care plan in
lieu.
-Serviced thru MCO's network of providers.
-Must accept all with Medicare except ESRD
-Additional monthly premium in addition to Part B premium
-Beneficiary must live in the plan's service area. Can elect HMO, PPO, POS or PFFS
systems.
-Can't use a Med Supp (Medigap) policy while participating.
✔✔Medicare Outpatient Prescription Drug Coverage (Part D) - ✔✔Beneficiaries may
choose to participate in a Prescription Drug Plan (PDP) that is offered by private sector
insurance companies for an additional premium.
-Must have Part A & Part B to join
-Premiums based upon the PDP chosen
✔✔Medicare Part D Enrollment - ✔✔-Initial Enrollment Period- can enroll without
penalty
, -Open Enrollment/ Annual Election Period- Oct 15th to Dec 7th- coverage begins Jan 1
of following year
-Late Enrollment- Any time after initial enrollment or a period of 63+ days where doesn't
have Part D coverage. There's a penalty of +1% Part D premium for ea month of delay
in enrollment
✔✔Switching Advantage Part C Plans - ✔✔Can only be during Open Enrollment/
Annual Election Period - Oct 15th to Dec 7th of each year.
✔✔Medicare Supplement Insurance (Medigap) - ✔✔Primarily intending to pay for cost-
sharing feature of Medicare...i.e.. deductibles, coinsurance, expenses after Medicare is
maxxed out.
✔✔Types of Medicare Plans - ✔✔A, B, C, D, F, G, K, L, M
-Do not have E, H, I, J
-All companies marketing Med Supp must also offer plan A (basic/ core benefits)
-Plan F is most popular
✔✔Medicare Supplement - minimum standards - ✔✔Pre-existing coverage may be
excluded from coverage for 6 mos max.
-Impairment riders cannot be added to a Medigap policy.
-Supplement policies may not indemnify sickness losses on a different basis than
accident losses.
-May not duplicate benefits of original plan or Medicare Advantage plan
-Are "Issue Age" based, do not increase premium with age
-Rates may NOT be based on "Attained Age" unless specified.
-Must be either "Guaranteed Renewable" or
"Non-cancelable"
✔✔Insurers selling Medicare Supplement Insurance - ✔✔Required to pay out a certain
percentage of premiums collected each year in benefits.
Insurers are not allowed to make a high profit.
-Group policies- at least 75% of aggregate premiums earned.
-Individual policies- at least 65%
✔✔Med Supp Disclosure Provisions - ✔✔-"Outline of Coverage" must be provided at
time of application & a signed acknowledgement of receipt from applicant must be
collected.
-Must include renewal or continuation provision on first page
-Riders added after issuance that affects policy coverage & premium must have a
signed acceptance from insured
-"Reasonable & Customary" must define the term & explained in outline of coverage.
-ALL supplement policies MUST have a 30 Day Free Look Period
-All applicant must be provided a NC Buyer's Guide from NAIC AND a Medicare
Supplement Buyer's Guide from CMS at time of application.
