Do I need a scope of appointment for Medigap?
Asked by: Cindy Willms | Last update: August 14, 2025Score: 4.4/5 (10 votes)
Do you need a scope of appointment for Medicare Supplement plans?
A Scope of Appointment (SOA) form is required before discussing specific Medicare plan options with a Medicare sales agent. The SOA form ensures compliance with CMS regulations, protecting beneficiaries from unsolicited sales pitches and maintaining transparency.
In which setting is a scope of appointment not required?
If the meeting was set up as an in-person appointment, a scope of appointment is required. If the meeting is advertised as a sales event open to the general public, a scope of appointment form is not required.
Does Medigap require referrals?
Private insurance companies offer Medigap plans to help people pay for out-of-pocket costs that Medicare does not cover. People with Original Medicare can choose to add this coverage and must pay an additional monthly premium for it. Because Medigap involves only out-of-pocket expenses, it does not require referrals.
What is required for a person to have Medigap coverage?
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium.
Scope of Appointment | Why does Medicare require it?
Do Medigap plans require a physical exam?
A: If you already have Medigap insurance, you have 60 days of "open enrollment" following your birthday each year when you can buy a new Medigap policy without a medical screening or a new waiting period. The new policy must have the same or lesser benefits as your old policy.
What is the downside to Medigap plans?
There are a couple of cons to consider before choosing a Medigap plan: Premiums: Medigap premiums can be pricey. Coverage: Medicare Supplement plans don't cover everything, so you'd still have to pay out of pocket for things like dental care, vision care and long-term care.
Does Medigap require preauthorization?
No prior authorization requirements
With Original Medicare and Medigap, you don't need to worry about getting prior authorization for covered services, making it easier to get the care you need without delay.
Why is a plan G better than an advantage plan?
Medigap Plan G offers more comprehensive benefits than the Medicare Advantage plan and is more widely available. It also provides more freedom for enrollees. For example, a Medigap Plan G enrollee can visit a specialist without a referral.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
When should a scope of appointment be submitted?
At least 48 hours prior to meeting with a potential enrollee into any MA or Part D plan (unless one of two narrow 48-hour exceptions applies, see below), the plan or its sales representative must agree upon and record the scope of appointment with the beneficiary.
What are the rules for scope of appointment for Medicare 2024?
CMS 2024 Final Rule: 48-hour window
The 48-hour SOA rule has returned. The guidelines require a minimum 48-hour window between a Scope of Appointment form being completed and an appointment taking place with exceptions for beneficiary initiated walk-ins and the end of a valid enrollment period.
What are the exceptions to the 48-hour scope of appointment rule?
Exceptions to the 48-Hour Rule
SOAs that are completed during the last four days of a valid election period (AEP, ICEP, IEP, SEP, MA OEP, etc.) for the beneficiary. Unscheduled in person meetings (walk-ins) initiated by the beneficiary, including inbound calls.
What must a person be enrolled in prior to purchasing a Medigap policy?
You must sign up for Medicare before you can buy a Medigap policy. When your employer coverage ends, you'll have a chance to sign up for Part B without paying a late enrollment penalty. Your Medigap Open Enrollment Period will start once you sign up for Part B.
In which of these situations must a scope of appointment form be collected at least 48 hours prior to the interaction between the agent and the beneficiary?
If a sales agent is approached by a beneficiary at a sales/marketing event and the beneficiary indicates that they want to be enrolled into a plan, the agent must collect a valid SOA and can schedule a personal sales/marketing appointment to occur at least 48 hours after obtaining the SOA.
What Medigap plan is most popular?
There are 10 different types of Medigap policies (labeled A through N), each having a different, standardized set of benefits (Appendix Table 3). Plan G is the most popular Medigap policy, accounting for 39% of all policyholders, or nearly 5.3 million people, in 2023 (Figure 3).
What plan G does not cover?
High deductible plan G does not cover the Medicare Part B deductible. However, high deductible F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 2Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit.
Why do people choose Medigap over Medicare Advantage?
Under Advantage plans, the government pays insurers to provide all of the care under a private policy. Medigap also allows retirees to choose their doctors. Advantage plans operate like HMOs, which control the cost of care by requiring policyholders to stay within an approved network of providers.
Can Medigap deny preexisting conditions?
Under current federal law, insurance companies that sell Medigap policies may refuse to sell a policy to an applicant with certain medical conditions, or who has had certain medical procedures or used specific prescription drugs, outside of open enrollment or a guaranteed issue period.
Are Medigap policies being phased out?
For example, Medigap plans C and F will no longer be available to new Medicare recipients after January 1st, 2020.
Which is better, a supplement or advantage plan?
Summary: Medicare Advantage offers broader coverage including prescription drugs and dental care, while Medicare Supplement focuses on covering most out-of-pocket costs. Medicare Advantage plans are managed by private insurers with network restrictions, whereas Medicare Supplement allows freedom of provider choice.
What does Medigap not pay for?
Medigap plans generally don't cover: Long-term care (like care in a nursing home) Vision or dental care. Hearing aids.
Does Plan G cover dental and vision?
Plan G also covers excess costs a physician may charge if you don't live in one of the eight states prohibiting excess charges. However, if you buy Plan G instead of a Medicare Advantage plan, you'll need additional coverage for drugs, vision, dental, and hearing services.
Why is it not a good idea to have supplemental insurance?
One of the most significant drawbacks of supplemental insurance policies is the coverage limits. For instance, with Mechanical Repair Coverage, you'll typically need to pay out of pocket until your deductible is met on your primary policy before supplemental insurance takes over to cover a costly vehicle repair.