Medicare Supplement

Medigap by the Letter: What Plans G, N, K and L Really Cover

# Medigap by the Letter: What Plans G, N, K and L Really…

FULLERTON, Calif. — If you have shopped for a Medicare Supplement policy, you have probably noticed something odd: every company sells plans with the same letter names, and the brochures all seem to say the same thing. That is not a coincidence. Under federal rules, a Medigap plan with a given letter has to offer the exact same core benefits no matter which insurance company sells it. A Plan G from one carrier covers the same gaps in Original Medicare as a Plan G from any other carrier.

Here in Fullerton, that means the decision is less about hunting for a "better" version of a letter and more about understanding what each letter actually pays for.

Why the letters mean the same thing everywhere

Medigap policies were standardized by federal law so shoppers could compare apples to apples. In most states, insurers can only sell plans labeled A, B, C, D, F, G, K, L, M and N, plus high-deductible versions of F and G. The benefits inside each letter are set by the Centers for Medicare & Medicaid Services (CMS).

What can vary between companies: the monthly premium, how the premium changes as you age, customer service, and small extras like a fitness benefit. What cannot vary: the medical benefits attached to the letter.

Three states — Massachusetts, Minnesota and Wisconsin — use their own standardization system, so the letter chart described here does not apply there.

What Plan G covers

Plan G is the most comprehensive Medigap plan available to people newly eligible for Medicare today. It pays the Part A hospital deductible, coinsurance for hospital and skilled nursing stays, the Part B coinsurance (the 20% that Medicare does not pay for doctor visits and outpatient care), the first three pints of blood, hospice coinsurance, and some foreign travel emergency care.

The one gap Plan G does not fill is the annual Part B deductible. You pay that yourself once a year, and then Plan G takes over.

High-deductible Plan G

High-deductible Plan G covers the same benefits as regular Plan G, but only after you meet a yearly deductible set by federal rule. Until you hit that deductible, you pay Medicare's usual cost-sharing out of pocket. In exchange, the monthly premium is typically lower. It is the same coverage, just structured differently.

What Plan N covers

Plan N covers most of the same items as Plan G, with a few differences. Like Plan G, it does not pay the Part B deductible. In addition, Plan N enrollees pay:

• Up to a $20 copay for some office visits.
• Up to a $50 copay for emergency room visits that do not result in an admission.
• Any "Part B excess charges," which can occur when a provider does not accept Medicare's approved amount as full payment.

What Plans K and L do differently

Plans K and L work more like traditional insurance with cost-sharing. Instead of covering 100% of most gaps, they cover a percentage:

• Plan K pays 50% of most cost-sharing items, including the Part A deductible.
• Plan L pays 75%.

Both plans have a yearly out-of-pocket limit set by federal rule. Once you reach that limit, and once you have paid the Part B deductible, the plan pays 100% of covered services for the rest of the calendar year. Neither pays Part B excess charges.

Plans C and F: closed to newer enrollees

Plans C and F used to be popular because they paid the Part B deductible in full. Federal law changed that. If you became eligible for Medicare on or after January 1, 2020, you cannot buy Plan C, Plan F or high-deductible Plan F. People who were already eligible before that date can generally still keep or buy them.

How to decide which letter fits you

Because the letters are standardized, the real question is how you want to pay for care — steady monthly premium versus more out-of-pocket costs when you use services. Some readers prefer the predictability of Plan G. Others prefer a lower premium with copays, like Plan N, or the shared-cost structure of K or L. High-deductible G appeals to people who rarely use care but want a safety net.

Fullerton is in Orange County, and Medigap is sold statewide in California, so availability of specific letters generally is not a local issue — but pricing and enrollment rules can vary by carrier and by your circumstances. A free, unbiased conversation with California's SHIP program (called HICAP here) can help you sort through it.