A Medigap policy, also known as Medicare Supplement insurance, is a private health insurance policy designed to complement Original Medicare, which is the federally funded health insurance program for people 65 years of age or older and certain disabled individuals. Original Medicare only covers a portion of healthcare expenses (80%), leaving beneficiaries responsible for paying the remaining costs such as deductibles, copayments, and coinsurance.

How Do Medigap Policies Work?

They are offered by private insurance companies and are standardized by the federal government. The federal law mandates that all Medigap policies must follow certain standards, including the use of letter labels (A through N) to identify each plan and its coverage.

Each letter-labeled plan provides a standardized set of benefits, so a Plan F in one state must provide the same benefits as a Plan F in another state. The standardized benefits for each plan are the same, regardless of the insurance company offering the plan. However, in Minnesota, 

It is also important to know that, these policies only cover one individual, so if a couple wants both to be covered, they must each purchase their own policy. Additionally, they do not cover long-term care, vision, hearing, dental, or private-duty nursing.

Plan A coverage

Medigap Plan A is a basic Medicare Supplement plan that covers the minimum benefits required by law. It offers limited coverage for those who want to limit their Original Medicare spending. The plan covers some out-of-pocket costs such as Medicare Part A coinsurance, Medicare Part B coinsurance, the first three pints of blood, Medicare Part A hospice coinsurance, and preventive care coinsurance. With Medigap Plan A, you will still be responsible for paying the Medicare Part B premium and the Medigap Plan A premium, if applicable. However, it does not cover costs such as the Medicare Part A deductible, the Medicare Part B deductible, skilled nursing care coinsurance, excess charges, or foreign travel emergency coverage, and you will be responsible for 100% of these costs if they apply to you.

The cost of Medigap Plan A varies and is estimated to be around $110-$180 per month on average. The premium for this plan depends on various factors such as location, age, gender, and others, making it difficult to provide an exact rate without knowing the specific details of the individual who will receive coverage through the policy.

Plan B Coverage

The benefits offered by this plan are standardized across the United States and include Medicare Part A coinsurance, Medicare Part B coinsurance, the first three pints of blood, Medicare Part A hospice coinsurance, preventive care coinsurance, and the Medicare Part A deductible. Medigap Plan B is not the most comprehensive plan available, but it offers additional coverage for out-of-pocket costs and helps cap your Original Medicare spending. With Medigap Plan B, you will receive coverage nationwide, regardless of where you live or receive care. 

 The monthly premium for Medigap Plan B is estimated to be around $110-$210. The cost of this plan depends on various factors such as age, gender, location, and others. To receive an accurate quote, it’s necessary to provide personal details. Men usually pay more than women, and younger individuals have lower premiums. Some states may charge higher premiums for individuals who use tobacco products.

Plan C Coverage

Medigap Plan C covers all the basic benefits provided by Medicare as well as additional benefits not covered by Original Medicare. This includes the deductibles, copays, and coinsurance of Medicare Part A and Part B, the first three pints of blood, skilled nursing facility coinsurance, and foreign travel emergency care. Plan C offers more comprehensive coverage compared to other Medigap plans.

However, the availability of Medicare Supplement Plan C is restricted, with eligibility limited to those who became eligible for Original Medicare prior to January 1, 2020. If you meet these criteria, you may still enroll in Medigap Plan C. Those who became eligible for Original Medicare on or after January 1, 2020, are not eligible to enroll in this plan. If you already have Plan C coverage, you can keep your policy.

The cost of Medicare Supplement Plan C in 2023 can range from $140 to $420 per month and depends on factors such as your location, age, tobacco usage, gender, and more. The exact price factors depend on the carrier you select. With fewer people enrolling in Plan C due to its phase-out, the premiums are expected to increase over time to compensate for lower enrollment.

Plan D Coverage

Medigap Plan D provides coverage for Medicare Part A coinsurance and copays, Part B coinsurance and copays, and foreign travel emergency coverage. It has similar benefits to Plan G but does not cover Part B excess charges. Most doctors accept Medicare assignments so this coverage is often not needed. However, if you receive care from a doctor who does not accept Medicare assignments, you will be responsible for a 15% additional charge.

Medigap Plan D costs an average of $120-$200 per month and its cost is based on factors like age, location, and gender. It’s best to consult with a licensed Medicare agent to determine the most cost-effective option for you based on your specific circumstances.

Plan F Coverage 

Medigap Plan F covers all services approved by Medicare Parts A and B, including deductibles, coinsurance/copays, excess charges, and foreign travel emergency expenses up to a lifetime limit of $50,000 with a $250 deductible. Medicare Supplement Plan F pays for the rest of the costs after Medicare pays its share and if your doctor accepts Original Medicare.

However, Medicare Supplement Plan F was discontinued for many Medicare beneficiaries due to the Medicare Access and CHIP Reauthorization Act (MACRA), which eliminated first-dollar coverage plans for new Medicare recipients. Only those who were enrolled in Original Medicare before January 1, 2020, are eligible to enroll in Plan F, and they can freely enroll and disenroll in it.

Medigap Plan F costs an average of $230 per month, but this can vary based on various factors such as your location, age, gender, and tobacco usage. Premiums for Plan F can range from $150 to $400 or more per month. Note that while the monthly premium is the only out-of-pocket cost you will pay for your Medigap coverage, it may save you money in the long run as it covers all copays, coinsurance, and deductibles for your services.

High Deductible Plan F Coverage

Beneficiaries can purchase High Deductible Plan F as an alternative to the original version ( Plan F).  With this plan, beneficiaries get the same amount of benefits. Only, in this version, they have to pay the higher deductible before their Medigap policy becomes active. In 2023, the set deductible for this plan is 2700$. After you met the deductible you are fully covered, and because of the higher deductible, your monthly premium will be lower.

Just like with plan F, the higher deductible version of it is not available for beneficiaries who weren’t eligible prior to January 1st, 2020.

Plan G Coverage

Medigap Plan G is a Medicare Supplement plan designed to minimize out-of-pocket costs for Medicare beneficiaries. It covers 100% of the Medicare Part A deductible, hospice copayments and coinsurance, foreign travel emergencies, and Medicare Part B excess charges, except for the annual Part B deductible. This plan is standardized by the federal government and is guaranteed renewable regardless of health status. Premium rates vary by state and carrier, but it is considered one of the most comprehensive plans, second only to Plan F. However, not all beneficiaries are eligible for Plan F and those who received Medicare after 2020 are no longer eligible for it. As a result, many new seniors tend to enroll in Medigap Plan G.

The cost of Medicare Supplement Plan G is determined by several factors such as location, age, tobacco use, and gender. It typically ranges from $100 to $300 per month.

High Deductible Plan G Coverage

Medigap High Deductible Plan G is a Medicare Supplement plan that provides the same coverage as standard Plan G but with lower premiums. To receive full coverage, enrollees must pay a higher deductible, which can be met by the cost-sharing and the Medicare Part B deductible. The lower premiums for the high deductible version come with the trade-off of a higher out-of-pocket cost before full coverage kicks in. The deductible amount is 2700$ in 2023.

Plan K Coverage

Medicare Supplement Plan K offers benefits to help reduce costs for Medicare beneficiaries. This plan covers 100% of the Medicare Part A hospital coinsurance, 100% of the Medicare Part B preventive care coinsurance, and 50% of the cost for Medicare Part B coinsurance, blood, hospice, skilled nursing care, and Medicare Part A deductible.

The average cost of Medicare Supplement Plan K varies based on location, age, and other factors, but it typically ranges from $40 to $100 per month nationally. The plan has a cap on out-of-pocket expenses, known as the Maximum Out-of-Pocket (MOOP) limit, which is set at $6,940 in 2023. Once a beneficiary’s Medicare-covered expenses surpass this amount, the plan covers 100% of the remaining costs.

Plan L Coverage

Medicare Supplement Plan L offers coverage for Medicare Part B preventive care, Part A coinsurance and hospital costs beyond when Medicare benefits run out. Plan L covers 75% of Medicare Part B coinsurance, the first 3 pints of blood, Part A coinsurance for hospice and skilled nursing facilities, and the Part A deductible. Original Medicare covers 80% of Part B services and 100% of allowable charges for the first 60 days of a hospital stay, hospice stay or short-term skilled nursing facility stay after the Part A deductible is met. Medicare Supplement Plan L does not cover the Medicare Part B deductible or Part B excess charges (in states that allow them). This means that Plan L benefits won’t start until the Part B deductible is paid and excess charges must be fully paid by the enrollee.

The monthly cost of Medigap Plan L ranges from approximately $100 to $200 and varies based on factors such as state of residence, age, and gender.

Plan M Coverage

Medigap Plan M offers the best coverage among the three cost-sharing Medigap plans, with only 50% of the Medicare Part A deductible as the only cost-sharing. It covers coinsurances and copays for both outpatient (Medicare Part B) and inpatient (Part A) coverage, potentially saving you significant amounts if you need to stay in the hospital for an extended period. The only expenses you need to cover are the Medicare Part B deductible and rare Part B excess charges, but you should check if your providers accept Medicare assignment. The average monthly premium for Plan M is around $120-$200.

Plan N coverage

Medigap Plan N is a cost-sharing Medicare Supplement plan similar to Plan G. It covers the Medicare Part A coinsurance, deductible, and foreign travel emergency care, but requires policyholders to pay for 20% of the Medicare Part B coinsurance, with a $20 copay for doctor visits and $50 for emergency room visits if not admitted. Policyholders may be responsible for additional charges if they live or receive care in a state that allows Medicare Part B excess charges, which are not covered by Plan N. Most doctors accept Medicare assignment, reducing the occurrence of excess charges.

The average monthly premium for Medicare Supplement Plan N in 2023 is estimated to be between $120-$180, but the actual cost can vary based on factors such as location. Some areas may have monthly premiums as high as $400, while others may have premiums as low as $70.

 How do I know if I need a Medigap policy?

Medigap plans to provide additional coverage to complement Original Medicare and lower out-of-pocket costs. They aim to give enrollees a clearer picture of their annual medical expenses, reduce the risk of unexpected bills, and provide a higher level of coverage. By choosing the right Medigap plan, you may be able to eliminate unexpected costs and find a plan that fits your needs. The amount of care you need is the key factor in determining the best Medigap plan for you, and enrollment also offers extra benefits. Overall, Medigap is a good option for anyone with Original Medicare.

However, it is important to carefully evaluate your healthcare needs and budget before choosing a Medigap policy.

Medicare Health Advisor at Medigap Medicare Insurance | Website | + posts

Dr. Susan Johnson is a Medicare Health Advisor with extensive knowledge and experience in health insurance, particularly Medicare. She has spent over 15 years working in various healthcare settings, including hospitals, clinics, and private practices.

As a Medicare Health Advisor, Dr. Johnson specializes in helping people navigate the complex world of health insurance, including original Medicare, Medicare Advantage, Medicare supplements, and Medicare Part D. She is committed to providing personalized guidance to her clients, helping them make informed decisions about their coverage and reduce their healthcare costs.