Below is a plan comparison chart of the benefits provided by the standardized Medicare supplement insurance plans. This table is for all states except Massachusetts, Minnesota, and Wisconsin, whose policies are structured similarly but different. Medicare supplement benefits in those three states are also standardized.
You can read more on the Medigap benefits offered in these three states in the Medicare Buyers Guide, a free Medicare guide found on Medicare.gov as well as Medigapseminars.org.
Below the table is a more detailed discussion of Medicare supplement plans and how to find the right plan for your needs and your budget. Use the table and the guide below to compare Medicare supplement plans.
Medicare Supplement Plans Comparison Chart 2022
|Benefits||Medicare Supplement Insurance (Medigap) Plans|
|Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)||100%||100%||100%||100%||100%||100%||100%||100%||100%||100%|
|Part B coinsurance or copayment||100%||100%||100%||100%||100%||100%||50%||75%||100%||**100%|
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A hospice care coinsurance /copayment||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Skilled nursing facility coinsurance||-||-||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A deductible||-||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B deductible||-||-||100%||-||100%||-||-||-||-||-|
|Part B excess charge||-||-||-||-||100%||100%||-||-||-||-|
|Foreign travel (up to plan limits)||-||-||80%||80%||80%||80%||-||-||80%||80%|
|Out-of-pocket max limit||NA||NA||##||##||##||##||$6,620||$3,310||NA||##|
NA – Not Applicable
$2,490 in 2022 before your policy pays benefits. (Plans C and F are not available to people who were newly eligible for Medicare on or after January 1, 2020.)
For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
## The Plan G maximum out-of-pocket (MOOP) is equal to the Medicare Part B deductible. The Plan N MOOP is equal to the Part B deductible plus office visit copays when you avoid excess charges. The High Deductible Plans G-HD and F-HD MOOP is equal to the Medigap deductible. That is $2,490 for 2022.
*** Plan N pays 100% of the Part B coinsurance. However, there may be a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in inpatient admission.
- A person can choose to simply keep Medicare A & B and get a Plan D for prescription coverage. These basic benefits are still good coverage but have no out-of-pocket maximum.
- Two Medicare plans come with a high deductible option; Plan F and Plan G.
- Plan’s C, F, and F-high deductible are only available to people who were eligible for Medicare prior to January of 2020.
- In rows marked 100%, it means that between the supplement and Medicare, 100% of the costs associated with that service or procedure will be covered.
- Foreign travel emergency care, where marked “80%,” means the supplement plans will pay 80% of emergency services after a $250 deductible. This feature has a $50,000 lifetime maximum benefit and is for short-term travel only.
- “N/A” Please see our discussion of maximum out-of-pocket below.
What is Medigap Insurance
Every Medicare beneficiary must make one of three choices with their Medicare that starts their journey with the federal Medicare program. They can either:
- Just keep their Original Medicare Parts A & B and do nothing else.
- Trade in their Original Medicare for a Medicare Advantage plan.
- Add to their Original Medicare with Medicare supplement insurance plans.
Of course, they can add Medicare Part D prescription Drug coverage, but that is a topic covered in another article. I discussed Part D Plans in detail in my article “What Is Medicare Part D?” Medigap plans offered today do not cover prescription drugs.
Medicare supplement plans add to the benefits of Medicare Part A and Part B. They pay the deductibles and copays that would otherwise be the Medicare beneficiaries’ obligation. That is why they are also referred to as Medigap plans. They cover the gaps in Medicare.
To be clear, a Medicare supplement and a Medigap plan are the same thing. Medigap plans cover the deductibles, copay, and coinsurance that Medicare alone leaves as the consumer’s obligation.
There is some debate as to how many Medigap Plans are available. There are technically ten different Medigap plans, but two of the plans also come with a high deductible option. That gives the consumer twelve choices even though there are only ten plans. Medicare supplement insurance plans are designated by a letter. For example, there is a Medigap Plan A, Medigap Plan C, Plan G, and so on.
Keep in mind that an insurance company does not have to offer all the plans available. In fact, very few
do. If you wish to compare all Medigap plans, you will need to research plans offered by many different insurance companies.
An independent Medicare Agent like Medigap Seminars Insurance Agency can do that for you. As a licensed insurance agent and licensed insurance agency specializing in Medicare supplement insurance plans and other Medicare plans, we are uniquely qualified to help. We have a team of licensed insurance agents trained to help you with your insurance.
It is important to understand that the benefits of Medigap plans are standardized. That means that all plans of the same type (i.e. all Plan G’s) have the exact same medical benefits regardless of the insurance company or price. In fact, Medicare supplement plan benefits are written into Social Security law.
The only difference between insurance companies is what you will pay for those benefits today and what you will pay tomorrow. Some Medicare supplement insurance companies also offer additional services, but those services are not contractual and can change or be discontinued at any time.
Why Buy a Medicare Supplement Plan?
Having helped over 10,000 individuals with their Medicare choices over the years, I understand very well why people choose to add a Medigap plan rather than a Medicare Advantage plan.
Because Medicare supplement plans are secondary insurance to Original Medicare. You get to keep the benefits of the federal Medicare program when you add supplemental insurance. The primary benefits of Medicare are:
- You can see any medical professional in the U.S. or territories as long as they accept Medicare.
- No insurance company has a say in your treatment. Your healthcare is between you and your doctor. An insurance company cannot delay or deny coverage. Medicare’s intent is to cover everything that is medically necessary, and they rely on your doctor to determine medical necessity.
- Medicare supplement insurance plan coverage never changes. Once you have a supplement, no one can change your benefits. It is a guaranteed renewable policy, meaning the benefits will remain the same for as long as you pay the premium.
That’s it. It’s a powerful option because you have the freedom to get healthcare coverage anywhere in the U.S. At the same time, you keep control over your healthcare. This is part of what makes Medicare the best health insurance available in the U.S.
With Medicare Advantage plans, you lose both of those benefits. In a separate blog post, I go into more detail on the Differences Between Medicare Advantage and Medigap plans. Although a Medigap policy is administered by private insurance companies because they are secondary to Medicare, they have no say in your insurance coverage.
Medicare Supplement Maximum Out-of-Pocket
I published a video not long ago on the controversy around the idea that Medicare supplement plans have an annual maximum out-of-pocket limit. It was amazing how often we found that insurance agents and the public thought there was no out-of-pocket maximum for Medigap plans. Many still do.
Why? It was the result of a very poorly designed Medicare supplement plans comparison chart that Medicare published for years. Rather than re-write all I said, I have embedded the video below. I am sure you will enjoy this. The information in this video will come in handy as you compare Medigap plans.
Medigap Plan F Out of Pocket Maximum
As mentioned above, Medigap plan F is available only to those who qualified for Medicare prior to January 2020. You can see on the plan comparison chart that it has 100% coverage for all but Foreign travel emergency treatments, which has a separate maximum benefit. This is the most coverage of any Medicare supplement plan. People with a Plan F will have no out-of-pocket expenses for Medicare inpatient and outpatient covered services. Thus their out-of-pocket maximum is $0 (zero).
This Medigap Plan covers all inpatient and outpatient Medicare bills.
Medigap Plan G Out of Pocket Maximum
Medigap Plan G also pays 100% of all covered services. However, Plan G does not cover the Medicare Part B annual deductible. It’s important to distinguish the difference. Plan G does not have a deductible. It simply does not insure you against the annual deductible for Medicare Part B. The plan covers all other Medicare inpatient and outpatient expenses not paid for by Medicare.
For new Medicare enrollees, the Medigap coverage offered by Plan G is the most supplement plan coverage available. The out-of-pocket maximum for a person with a Plan G is simply the amount of the Pat B deductible. That is currently less than $250 a year. That’s it.
The High Deductible Plan G Option
Plan F and Plan G are the only two Medicare supplement insurance plans that have a high deductible plan option. With a high deductible plan, the supplement plan deductible is equal to your annual out-of-pocket maximum. Simply put, your primary insurance is Medicare Plan A and Plan B. Your out-of-pocket costs will be the deductibles and coinsurance of Medicare.
Once your out-of-pocket costs reach the high deductible plan limit, your supplement plan coverage kicks in. Your supplement and Medicare will pay all inpatient and outpatient Medicare options.
While the benefits of the full Plan F and Plan G differ by the amount of the Part B deductible. The high deductible plan versions do not differ in benefit. Plan F covers the Part B deductible, and the Plan G high deductible plan credits the beneficiary for the amount of the outpatient deductible. The benefits are identical, and the premium should be as well.
Medigap Plan N Out of Pocket Maximum
The Medicare benefits offered by Medigap Plan N are often the best value of all the Medigap Plans. That said, in order to define an annual out-of-pocket maximum, Medicare beneficiaries need to avoid Part B excess charges. That is easy to do, as detailed in the linked blog post.
As long as the medical providers accept Medicare assignment, they cannot charge an excess charge. Doctors that accept Medicare assignment can only charge the Medicare approved amount for their service.
The first thing to note about Plan N is that, like Plan G, the policyholder will need to pay the annual Part B deductible when seeing a doctor for the first time during any calendar year. Assuming Medicare beneficiaries avoid excess charges, the only other expenses with a Medicare supplement insurance Plan N is the copay for office visits and emergency room visits.
The Plan N copay can be no more than $20 for an office visit and no more than $50 for an emergency room visit. The copay is only charged for visits consisting of diagnosis or evaluations. For example, there is no copay for physical therapy or chemotherapy. The emergency room copay is waived if you have an inpatient admission.
Urgent Care and Telehealth Copays
It used to be that there were no office visit copays associated with Urgent Care visits or telehealth visits. However, in recent years as these services have become common practice, Medicare has allowed Urgent Care and telehealth visits to be billed as office visits eligible for the Plan N copay.
Other Medicare Supplement Insurance Plans
The most popular Medicare supplement insurance plans offered today are Plan G and Plan N. However, you should familiarize yourself with the other plans because only you can decide which Medicare supplement insurance plan is right for you.
It’s worth noting as you view the plan comparison chart that all Medigap plans except Plan K and L have 100% coverage for Part B coinsurance and hospice care coinsurance. The same can be said of Medicare Part B coinsurance.
Medigap Plan A
Any Insurance company that desires to offer Medigap plans must at least offer a Plan A. Plan A is minimum coverage because it has no insurance for a skilled nursing facility, but it does cover the hospice care coinsurance and hospital costs. Even though Plan A is just basic benefits compared to the more popular Plan G, it’s excellent health insurance. It is simply not as robust as the more popular plans.
Most notably, Plan A has no insurance coverage for the Part A hospital deductible. This is important because the Part A deductible is a per-event deductible of over $1,500. It resets when you are out of a hospital for 60-days. Other than the deductible, Plan A has full hospital coverage covering all hospital costs for up to a year.
When you compare Medigap Plan B to Plan A, you find it is just like Plan A, except it does pay the Part B deductible. These are the only two supplements with no skilled nursing facility coverage. Keep in mind, Medicare Part A covers the first 20-days in a skilled nursing facility with a per-day copay of up to 100-days.
Medigap Plan C
Medigap Plan F and Plan C are the only two plans whose covered benefits include paying the annual Medicare Part B deductible. That is why both plans were discontinued for new medicare enrollees as of 2020. Medicare found that by making sure a beneficiary has some financial obligation per office visit, frivolous visits were reduced.
You must have been eligible for Medicare prior to January 2020 to be eligible for Plan C.
Medigap Plan D vs Plan N
Medigap Plan D is often compared to Plan N. When you compare Medicare supplement plans, you will note the two are almost identical. The only difference is that Plan D does not have the office visit copays.
Unfortunately, the price of Medigap plan D is often more than Plan G. It’s often simply not a good value.
Medigap Plans K & L
Medigap plans K and L are the only two Medicare plans with partial coverage. Because they have partial coverage, they also have maximum out-of-pocket plan limits listed on the plan comparison chart.
We often discourage the use of these plans because they have less coverage and higher costs than a high deductible plan. We find that the insurance companies that promote these two plans do so because they do not offer a high deductible Medicare supplement insurance plan. This is just one reason why you must look at more than one insurance company when shopping for plans.
Where Can I Get Medicare Supplement Insurance Plans
The best place to shop for and get a Medicare supplement insurance plan is through a licensed insurance agent who specializes in Medicare. A licensed insurance agent who is independent (i.e. does not work for an insurance company) will have experience with several insurance companies and can help you compare Medicare options.
It’s hard to go wrong with a standardized Medicare supplement, no matter which one you choose. But a good licensed insurance agent can help you compare prices and find the plan and insurance company that best fits your needs and your budget.
At Medigap Seminars Insurance Agency, you can find a licensed insurance agent you are comfortable with to help you make the best decision for your health insurance.
Can I buy Medicare Supplemental Plan Anytime?
Medicare beneficiaries can apply for a Medicare supplement insurance plan at any time. There is no annual Medigap Open Enrollment period like there is with a Medicare Advantage Plan. As long as you have both Medicare Part A and B, you can apply for a Medicare supplement.
During your first six months (180-days) of having Medicare Part B, you can choose any supplement available to you without any medical health questions or qualification. After the first 180-days, you can still apply for or switch Medigap plans, but you may have to qualify medically to be accepted for a new plan.
If you have a Medicare Advantage plan, you must wait for the Annual or Open Enrollment or a Special Enrollment period to change to a supplement.
Some states have special rules that allow for annual open enrollment periods. Check with your state or a licensed insurance agent for the rules in your state.
You can find more information in the free Medicare guide titled Choosing A Medigap Policy.