ABC’s of Medigap Policies

Photo credit: jb

Medigap policies come in many flavors. If you’ve done any reading in this area at all, you’ve probably come to realize that the whole thing is a messy alphabet soup… and it’s really, really hard to figure it all out. If you want more details on the choice between Medigap and Medicare Advantage plans, see the article Medicare Supplements versus Medicare Advantage Plans.

What I’ve done here is to pull together a resource that may be helpful as you consider your options for a Medigap plan.

The ABC’s

Unless otherwise noted, the coverages are 100% of the item listed.

Plan A covers:

• Medicare Part A coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up
• Medicare Part B coinsurance or copayments
• Blood (well, the first 3 pints anyhow)
• Part A Hospice Care coinsurance or copayment

Plan B covers:

• Everything covered by Plan A, plus:
• Medicare Part A deductible

Plan C covers:

• Everything covered by Plan B, plus:
• Skilled nursing facility care coinsurance
• Medicare Part B deductible
• Foreign travel emergency (80%, up to plan limits)

Plan D covers:

• Everything covered by Plan B, plus:
• Skilled nursing facility care coinsurance
• Foreign travel emergency (80%, up to plan limits)

(in other words, everything in Plan C except the Medicare Part B deductible)

Plan E is no longer available as of May 31, 2010

Plan F covers:

• Everything covered by Plan C, plus:
• Medicare Part B excess charges
• Plan F also offers a high-deductible plan as well, in some states

Plan G covers:

• Everything covered by Plan D plus:
• Medicare Part B excess charges
• Plan G also offers a high-deductible plan as well, in some states

(in other words, everything in Plan F except the Medicare Part B deductible)

Plans H, I, and J are no longer available as of May 31, 2010

Now we’re getting to some of the more flexible plan options.  These have been developed to provide similar benefits as other plans but with additional participation by the insured in order to reduce the premium costs.

Plan K covers:

• Everything covered by Plan D with the following exceptions:
• Foreign travel emergency is not covered
• There is a 50% coverage on the following:
  • Medicare Part B coinsurance or copayments
  • Blood (again, just the first 3 pints)
  • Part A Hospice Care coinsurance or copayment
  • Skilled nursing care facility coinsurance
  • Medicare Part A deductible
• There is a yearly out-of-pocket maximum for all coinsurance and copayments of $6,940 (for 2023).  After this has been met (along with your annual Medicare Part B deductible), the plan pays 100% of each covered service.

Plan L covers:

• The same coverage as Plan K except a 75% coverage on the items at 50% coverage in Plan K
• The yearly out-of-pocket maximum for Plan L is $3,470 (for 2023), with the same detail as Plan K otherwise

Plan M covers:

• Everything covered by Plan D with the following exception:
• Medicare Part A deductible is only covered at a 50% rate

Plan N covers:

• Everything covered by Plan D with the following exception:
• The Medicare Part B coinsurance or copayment is covered 100% except for copayment for some office visits and some emergency room visits