Medigap plans, also known as Medicare Supplement plans, are health insurance plans that are designed to help cover the out-of-pocket costs associated with Original Medicare. Medigap plans are offered by private insurance companies and can help pay for certain expenses that are not covered by Original Medicare, such as deductibles, coinsurance, and copayments.
There are ten standardized Medigap plans, labeled by letters (Plan A, B, C, D, F, G, K, L, M, and N), and each plan offers a different set of benefits. The four most extensive Medigap plans, in terms of the benefits they offer, are Plans F, G, C, and N.
Standardized plans: What does it mean?
When we say that Medigap plans are standardized, it means that the coverage provided by each plan is the same regardless of which insurance company is offering the plan. For example, if you enroll in Plan F with one insurance company, the benefits you receive will be identical to the benefits you would receive if you enrolled in Plan F with a different insurance company.
The standardization of Medigap plans was introduced by the federal government to make it easier for Medicare beneficiaries to compare plans and make informed choices. This way, you can compare plans based on price and customer service without worrying about variations in the actual benefits being offered.
Each standardized Medigap plan has a different set of benefits, but the coverage for each plan is the same across all insurance companies offering that plan. This means that Plan F from one company will provide the same benefits as Plan F from another company.
The Four Most Extensive Medigap Plans
As we mentioned earlier, the four most extensive Medigap plans are Plans F, G, C, and N. We will now introduce you to all of them so you can get a picture of why these plans are considered the most comprehensive ones.
Medigap Plan F
Medigap Plan F is a type of Medicare Supplement Insurance, also known as Medigap, that provides additional coverage to help fill the “gaps” in Original Medicare (Part A and Part B) coverage. Medigap Plan F is one of the most comprehensive and popular Medigap plans, as it offers the most coverage of all the standardized plans available in most states.
Here are some of the benefits that Medigap Plan F typically provides:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
- Medicare Part B coinsurance or copayment.
- The first three pints of blood for a medical procedure.
- Part A hospice care coinsurance or copayment.
- Skilled Nursing Facility (SNF) care coinsurance.
- Medicare Part A deductible.
- Medicare Part B deductible.
- Medicare Part B excess charges.
- Foreign travel emergency coverage.
Note that as of 2020, Medigap Plan F is no longer available to new Medicare beneficiaries. This is due to changes in federal law that eliminate coverage of the Part B deductible for new enrollees in Medigap plans. However, if you already have Medigap Plan F, you can keep it, and if you’re newly eligible for Medicare, you may be able to enroll in other Medigap plans that offer similar coverage. It’s important to compare plans and their costs carefully to determine which plan best meets your needs and budget.
High Deductible Plan F
It is important to mention that other than the basic Medigap Plan F, a high deductible Plan F exists as well which is a high deductible version of this popular and comprehensive plan.
Here are some of the benefits that High Deductible Plan F typically provides:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
- Medicare Part B coinsurance or copayment.
- The first three pints of blood for a medical procedure.
- Part A hospice care coinsurance or copayment.
- Skilled Nursing Facility (SNF) care coinsurance.
- Foreign travel emergency coverage.
However, unlike standard Plan F, High Deductible Plan F has a high deductible that you must pay out of pocket before the plan begins to pay for your healthcare expenses. In 2023, the deductible for High Deductible Plan F is $2,700. Once you meet the deductible, the plan provides the same coverage as standard Plan F, including coverage for Medicare Part A and Part B coinsurance and deductibles, as well as excess charges for Medicare-approved services.
Not all insurance companies offer High Deductible Plan F, and availability may vary depending on your location and the insurance company you choose. Additionally, because High Deductible Plan F is a high deductible plan, you will need to carefully consider your healthcare needs and ability to pay the deductible before enrolling.
High Deductible Plan F is also subject to certain restrictions under federal law. For example, if you have a High Deductible Plan F, you cannot purchase a separate plan that covers the Medicare Part B deductible. Additionally, High Deductible Plan F may not be available to new Medicare beneficiaries after 2020, due to changes in federal law that eliminate coverage of the Part B deductible for new enrollees in Medigap plans.
Medigap Plan G
Medigap Plan G is a type of Medicare Supplement Insurance, also known as Medigap, that provides additional coverage to help fill the “gaps” in Original Medicare (Part A and Part B) coverage. Medigap Plan G is a popular choice for many Medicare beneficiaries because it offers comprehensive coverage at a lower cost than some other Medigap plans, such as Plan F.
Here are some of the benefits that Medigap Plan G typically provides:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
- Medicare Part B coinsurance or copayment.
- The first three pints of blood for a medical procedure.
- Part A hospice care coinsurance or copayment.
- Skilled Nursing Facility (SNF) care coinsurance.
- Medicare Part A deductible.
- Medicare Part B excess charges.
- Foreign travel emergency coverage.
The main difference between Medigap Plan G and Plan F is that Plan G does not cover the Medicare Part B deductible, which is an annual out-of-pocket cost that Medicare beneficiaries must pay before their Part B benefits kick in. However, because the premiums for Plan G are typically lower than those for Plan F, many people find that they can save money with Plan G, even after paying the Part B deductible.
Medigap High Deductible Plan G
Medigap Plan G also has a high deductible version. Here are some of the benefits that High Deductible Plan G typically provides:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
- Medicare Part B coinsurance or copayment.
- The first three pints of blood for a medical procedure.
- Part A hospice care coinsurance or copayment.
- Skilled Nursing Facility (SNF) care coinsurance.
- Foreign travel emergency coverage.
High Deductible Plan G also has a higher deductible than other Medigap plans, which means you’ll have to pay a certain amount out of pocket before the plan begins to pay for your healthcare expenses. In 2023, the deductible for High Deductible Plan G is $2,700.
Once you meet your deductible, High Deductible Plan G provides the same coverage as standard Plan G, including coverage for Medicare Part A and Part B coinsurance and deductibles, as well as excess charges for Medicare-approved services.
Medigap Plan C
Medigap Plan C is a type of Medicare Supplement Insurance, also known as Medigap, that provides additional coverage to help fill the “gaps” in Original Medicare (Part A and Part B) coverage. Medigap Plan C is one of 10 standardized Medigap plans available in most states.
Here are some of the benefits that Medigap Plan C typically provides:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
- Medicare Part B coinsurance or copayment.
- The first three pints of blood for a medical procedure.
- Part A hospice care coinsurance or copayment.
- Skilled Nursing Facility (SNF) care coinsurance.
- Medicare Part A deductible.
- Medicare Part B excess charges.
Note that as of 2020, Medigap Plan C is no longer available to new Medicare beneficiaries. This is due to changes in federal law that eliminated coverage of the Part B deductible, which was a key feature of Medigap Plan C. However, if you already have Medigap Plan C, you can keep it, and if you’re newly eligible for Medicare, you may be able to enroll in other Medigap plans that offer similar coverage. It’s important to compare plans and their costs carefully to determine which plan best meets your needs and budget.
Medigap Plan N
Medigap Plan N is one of the ten standardized Medigap plans available in most states in the United States. Plan N provides similar benefits to Plan G, but with some cost-sharing for certain services.
Here are the key features of Medigap Plan N:
- Part A hospital coinsurance and coverage for an additional 365 days after Medicare benefits are exhausted: Plan N covers the coinsurance costs associated with a hospital stay under Medicare Part A, and provides coverage for up to an additional 365 days after your Medicare benefits are exhausted.
- Part A hospice care coinsurance or copayment: Plan N covers the coinsurance or copayment costs for hospice care under Medicare Part A.
- Part A deductible: Plan N does not cover the Medicare Part A deductible.
- Skilled nursing facility care coinsurance: Plan N covers the coinsurance costs for skilled nursing facility care under Medicare Part A.
- Part B coinsurance or copayment: Plan N covers the 20% coinsurance or copayment for Medicare Part B services, except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission.
- Part B excess charges: Plan N does not cover Part B excess charges, which are additional charges that some healthcare providers may charge beyond the Medicare-approved amount.
- Foreign travel emergency: Plan N provides coverage for emergency medical care received outside of the United States.
Plan N is a popular choice for people who want comprehensive coverage but are willing to share some of the cost-sharing responsibilities. It generally has a lower premium than Plan F or Plan G, but you will be responsible for the Part B deductible and certain copayments for doctor visits and emergency room visits. However, these cost-sharing features can help keep premiums more affordable, while still providing substantial coverage.
Medigap Plans Eligibility and Enrollment
To be eligible for a Medigap plan, you must be enrolled in both Medicare Part A and Part B. Medigap plans are designed to supplement Original Medicare coverage by covering some of the out-of-pocket costs that are not covered by Medicare.
Medigap plans are offered by private insurance companies, so eligibility requirements and enrollment procedures may vary depending on the insurance company you choose. However, there are some general guidelines that apply to all Medigap plans:
- You must be enrolled in Medicare Part A and Part B to be eligible for a Medigap plan.
- You can enroll in a Medigap plan during your Medigap Open Enrollment Period (OEP), which begins on the first day of the month that you turn 65 and are enrolled in Medicare Part B. This period lasts for six months, and during this time, insurance companies must sell you a Medigap policy regardless of any pre-existing conditions you may have.
If you miss your Medigap OEP, you may still be able to enroll in a Medigap plan, but you may be subject to medical underwriting and may be denied coverage or charged a higher premium based on your health status. In case you have a Medicare Advantage plan, you can generally only enroll in a Medigap plan if you switch back to Original Medicare during the Annual Enrollment Period (AEP), which occurs from October 15 to December 7 each year. Medigap plans are guaranteed renewable, which means that as long as you pay your premiums on time, your policy cannot be canceled, even if you develop health problems.
When enrolling in a Medigap plan, it’s important to compare plans and costs carefully to determine which plan best meets your needs and budget. Additionally, it’s important to understand the rules and costs associated with each plan before enrolling. With all this information, you can then decide which plan you would like to enroll in and start to process of upgrading your health insurance by purchasing an adequate Medigap plan.