The government provides standardized Medicare supplement plans which are also referred to as Medigap plans. Once Medicare beneficiaries decide which standardized plans will best meet their needs, they can compare prices offered by insurance companies in their local area. This standardization of benefits makes Medigap easier to shop for than other types of insurance policies with benefits that may vary wildly.
What is Medigap?
Medicare supplement insurance covers expenses for services that Original Medicare doesn’t fully cover or doesn’t cover at all. Many people refer to these insurance plans as Medigap policies because they fill in Original Medicare’s coverage gaps.
Medicare beneficiaries must have Original Medicare, which consists of Medicare Part A and Part B. Original Medicare pays first, and then Medigap supplements Original Medicare by paying its share. Note that neither Original Medicare nor Medicare supplements cover most prescriptions, so most beneficiaries will need Part D for drug benefits. Medicare also does not allow beneficiaries to have a Medigap plan and a Medicare Advantage plan.
According to Medicare.gov, 47 states use the standard Medicare plans that the federal government established. These Medigap plans all have letter names, from Plan A to Plan N. Thus, a beneficiary in Texas will get the same core benefits from Plan G as a beneficiary in California. Three states, Wisconsin, Massachusetts, and Minnesota, have their own standardized plans that provide similar benefits.
How to Compare Medigap Policies
This table should make it easy to see which benefits each plan includes.
|Part A coinsurance plus an extra 365 days of hospital costs after exhausting Part A benefits
|Part B coinsurance and copays
||All Plans *
|First three pints of blood
||All Plans **
|Hospice care coinsurance or copays
||All Plans **
|Skilled nursing copays or coinsurance
||Plan D, F, G, M, N,
Plan K, L **
|Part A deductible
||Plan B, C, D, F, G, N
Plan K, L, M **
|Part B excess charges
|Foreign travel exchange up to 80%
||Plan D, G, M, N
Note that Plans K and L have 2022 out-of-pocket limits of $6,620 and $3,310. Once the policyholder meets this limit, the plan will cover the benefits at 100%.
* Plan K covers this benefit at 50%, and Plan L covers it at 75%. Plan N covers the benefit at 100% but requires a $20 copay for some doctor visits and a $50 copay for ER visits that don’t result in a hospital admission.
** Plan K covers this benefit at 50%, and Plan L covers it at 75%. Plan M covers the Part A deductible at 50%.
What Happened to Plan F and C?
Plan F and Plan C were prevalent Medigap plans a few years ago, but Medicare phased them out for new Medicare beneficiaries at the beginning of 2020. The government decided to do away with any Medigap plans that covered the Part B deductible.
People who already had this coverage could keep it. Also, some people eligible for Medicare before they were phased out but didn’t enroll may have a chance to purchase them. Plan F was almost identical to Plan G, but it covered the Part B deductible. Plan C was like Plan F, but it did not cover excess charges.
What Are Medigap’s Excess Charges and Foreign Travel Exchange Benefits?
Primarily, Medigap plans relieve Medicare beneficiaries of concerns about high out-of-pocket expenses by paying deductibles, copays, or coinsurance. Some plans also offer a couple of benefits that Original Medicare does not provide.
- Part B excess charges: Providers can charge up to 15% more than the Medicare-approved amount, and this benefit covers the difference. Providers who accept Medicare Assignment won’t exceed Medicare-approved rates.
- Foreign travel: Original Medicare only covers foreign healthcare in specific and relatively unusual circumstances. The foreign travel benefit of some Medigap plans will cover 80% of medically necessary emergency healthcare services within the first 60 days of a trip. Plan members need to pay a $250 annual deductible. Medicare imposed a $50,000-lifetime limit for this benefit.
How to Compare Medigap Policies to Find the Best Plan?
There is no single plan that will be best for everyone. The right choice will depend upon the beneficiary’s budget, healthcare needs, and preferences. Some plans may result in more cost-sharing in exchange for lower premiums. Others cost somewhat more but can significantly reduce or even eliminate out-of-pocket costs for covered services.
For instance, consider the highlights of two popular Medigap plans, Plan G and Plan N:
- Plan G provides all of the Medicare-allowed Medigap benefits, so it has the best chance of covering potential out-of-pocket expenses. Because of its broad coverage, Plan G also tends to cost the most.
- Plan N offers a more budget-friendly alternative. This plan has modest copays for doctor visits and some ER trips, but otherwise, it covers everything included in Plan G except for excess charges.
- Both of these plans offer a “high-deductible” option which for 2022 enrollees will pay $2,340 in initial costs for deductibles, copayments, and coinsurance not paid by Medicare before the Medigap policy will begin to pay. Also, enrollees will pay a $250 annual and separate deductible for foreign travel and emergency services.
How to Compare Medigap Plan Rates
Insurance companies must offer standardized plans, but each company can set its own rates. After choosing the best Medigap plan, Medicare beneficiaries can compare premium offers from quality companies to find the best deal. Keep in mind that some policies may increase rates as beneficiaries age and healthcare costs rise.
Insurers may set rates in different ways:
- Community: This policy charges the same amount for everybody in a local area, regardless of age. Prices could still increase because of inflation.
- Issue-age: In this case, the insurer will set prices based on the beneficiary’s age on the first effective date of their policy. Premiums can’t increase with age, but they may rise because of inflation.
- Attained-age: The insurer bases rates on the age of policyholders. Younger buyers pay low premiums initially, but they can increase as the policyholder ages.
Policy shoppers should not just consider today’s premiums, but also potential rate increases in the future. Thus, attained-age policies might appear cheapest for people new to Medicare at age 65 but can increase more over time as the policyholder ages. Because choosing the right Medigap policy and company represents such an important decision, Medicare beneficiaries might seek help from an experienced insurance agent to compare various options from multiple insurers.
- Comparing Medigap Policies, Medicare.
- Medigap Coverage Outside the United States, Medicare.
- Medigap Policy Costs, Medicare.