Alphabet Soup – Medigap Lingo Spelled Out

It’s open enrollment time for Medicare and Medicare Supplement plans (Medigap). After a brief glance at this menagerie, you may be seeing stars (or letters!). Here’s a quick cheat sheet to get you started.

Medicare supplemental insurance (Medigap) policies are sold to cover some or all of the expenses that Medicare doesn’t cover (the “gap”).

There are 10 standardized types of Medigap policies across the country. They are identified by a letter (Plan A to Plan N). If a plan is offered in your elder’s state, it will be the same plan (no matter which insurance company they choose) across the country. There are some exceptions in MA, MN and WI. {Why are there always exceptions???}

Medigap policies differ in the amounts of coverage they provide in these areas:

  • Medicare Part A/Part B deductibles and coinsurance
  • Skilled nursing facility coverage,
  • Excess medical charges (above Medicare approved amount),
  • Foreign emergency care.

For quick reference:

  • Plan F generally offers the most comprehensive coverage and, usually, is the most expensive.
  • Plan N is comparable to Plan F but with an office visit and ER visit copay, which lowers the premium. (I think this deserves a second look, from a value perspective.)
  • Plan K is a cost-sharing plan with most costs being shared 50/50 with the plan and the patient. Plan L is similar but covers 75% plan/25% patient. Both have out-of-pocket limits on how much a patient will have to pay annually.
  • Plan A is a basic plan that covers most of Medicare Part A/B coinsurance, but not the deductibles, skilled nursing facility coinsurance or foreign coverage.
  • There is a version of Plan F with a high deductible, meaning a lower monthly premium.
  • Plans B, C, D, G and M offer different combinations of the above.

The best place to start, in my opinion, is on Medicare.gov. Click on Find Plans and enter your senior’s zip code. Their options will be shown (by Plan letter) from the different insurance companies that are offering plans in that area.

EHealthInsurance.com has a nice chart showing the difference in coverage between Medigap plans. Go here https://www.ehealthinsurance.com/medicare/compare-supplement-plans.

AARP/UnitedHealthcare also has a good summary of each of the plans offered. Just click on the letter of the plan to open a coverage chart.   Their website is https://www.aarpsupplementalhealth.com

This is not a comprehensive guide, nor should you consider this gospel on the subject. It’s just a summary of what I’ve found to be helpful in evaluating what the options are in Medigap coverage. Now, start with a large latte and go from there.

A personal note: I’m not a fan of Medicare Advantage plans.  They offer lower/no premiums with HMO-type coverage but I’ve often found the choices in medical providers are very limited.  Once you are in an Advantage plan, it can be challenging to change back to Original Medicare – if you find it doesn’t work for you. You’ll usually have a trial period – just make sure you decide during that trial period whether or not it is right for you. Medicare Advantage plans should get a good deal of investigation before you make that choice. Just my two cents.

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