As you or a loved one begin selecting a Medicare plan, remember you aren’t only choosing it based on current health care needs. Switching plans after the open enrollment period (six months after your 65th birthday) could come with costly fees, so adding supplemental coverage up front can ensure any future medical needs will be met without spiraling you into debt.
Original Medicare (Parts A and B) only pays a limited amount for inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, short-term home health care, and doctor visits. To help fill in “gaps” that aren’t covered, many seniors purchase a Medigap policy to help them afford copays, coinsurance and more.
Twelve Medigap plans are available to new enrollees, so it’s important to carefully consider which one is best for your loved one’s financial and health care needs.
Is Medigap the same as Medicare Advantage?
Harry Lockhart, owner and insurance producer at H&L Senior Benefits, said many seniors looking to supplement Original Medicare plans confuse Medigap with Medicare Advantage.
“Insurance companies can’t sell you a Medigap policy if you have a Medicare Advantage plan,” said Lockhart. “Medigap helps pay for Part A and B costs that Original Medicare doesn’t cover, but an Advantage plan is basically replacing Original Medicare with a ‘bundled’ plan that may include vision, hearing, dental and drugs.”
Lockhart said the main downside to purchasing Medicare Advantage is that you have to use doctors in a designated network, whereas Medigap allows you to choose any doctor or hospital that accepts Medicare.
What are the differences between all the Medigap plans?
In most states, Medigap plans are named by letters A through N. Each policy is standardized by federal law, meaning a policy under the same plan letter must offer the same benefits—no matter which insurance company sells it. Plans E, H, I and J are no longer sold, but if you already have one, you can generally keep it. And plans C and F are not available to those newly eligible for Medicare.
Here is a breakdown of the differences in coverage for each plan available for purchase:
Medigap Plan A
Plan A covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- First three pints of blood
- Part A hospice care coinsurance or copayment
Plan A does not cover:
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charge (the difference between the Original Medicare-approved amount and the amount a health care provider is legally permitted to charge)
- Foreign travel emergency
Medigap Plan B
Plan B covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- First three pints of blood
- Part A hospice care coinsurance or copayment
- Part A deductible
Plan B does not cover:
- Skilled nursing facility care coinsurance
- Part B deductible
- Part B excess charge
- Foreign travel emergency
Medigap Plan D
Plan D covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- First three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- 80% of foreign travel exchange, up to plan limits
Plan D does not cover:
- Part B deductible
- Part B excess charge
Medigap Plan G
Plan G offers a high-deductible plan in some states that requires recipients to pay for Medicare-covered costs (coinsurance, copayments and deductibles) up to the deductible amount of $2,490 in 2022 before the policy pays anything.
Plan G covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- First three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B excess charge
- 80% of foreign travel exchange
Plan G does not cover:
- Part B deductible
Medigap Plan K
After meeting an out-of-pocket yearly limit of $6,620 and yearly Part B deductible, Plan K pays 100% of covered services for the rest of the calendar year.
Plan K covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- 50% of Part B coinsurance or copayment
- 50% of the blood (up to three pints)
- 50% of Part A hospice care coinsurance or copayment
- 50% of skilled nursing facility care coinsurance
- 50% of Part A deductible
Plan K does not cover:
- Part B deductible
- Part B excess charge
- Foreign travel exchange
Medigap Plan L
After meeting an out-of-pocket yearly limit of $3,310 and yearly Part B deductible, Plan L pays 100% of covered services for the rest of the calendar year.
Plan L covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- 75% of Part B coinsurance or payment
- 75% of blood (first three pints)
- 75% of Part A hospice care coinsurance or copayment
- 75% of skilled nursing facility care coinsurance
- 75% of Part A deductible
Plan L does not cover:
- Part B deductible
- Part B excess charge
- Foreign travel exchange
Medigap Plan M
Plan M covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- First three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- 50% of Part A deductible
- 80% of foreign travel exchange, up to plan limit
Plan M does not cover:
- Part B deductible
- Part B excess charge
Medigap Plan N
Plan N covers:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission
- First three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- 80% of foreign travel emergency
Plan N does not cover:
- Part B deductible
- Part B excess charges
Which Medigap policy is best?
Lockhart said the most popular plan is G because it’s the only one available that covers 100% of Plan B excess charges, but there’s a reason Medicare offers so many supplemental options. All seniors are different, with varying budgets, pre-existing conditions and long-term care needs. The best way to choose a plan is to research information at Medicare.gov, shop around for quotes, and speak to a trusted Medicare specialist who can guide you in the right direction.
“The right agent should be able to explain things in a way you can understand, so you can be confident you’ve made the right decision.”