Medicare Supplement

Plan G vs. N vs. High-Deductible G: What Each Medigap Letter Actually Covers

MORENO VALLEY, Calif. — If you've started shopping for a Medicare Supplement policy, you've probably noticed the plans go by single letters — G, N, K, L — and wondered whether the letter from one insurer means the same thing as the letter from another. The short answer, under federal rules, is yes. What changes between companies is the price and the service, not the benefits inside the letter.

Moreno Valley is in Riverside County, where retirees weighing Original Medicare often add a Medigap policy to help with the out-of-pocket costs Medicare Part A and Part B leave behind. Understanding what each letter does — and does not — cover is the first step in comparing apples to apples.

Why the same letter means the same coverage

Under federal law, Medigap policies sold in most states are grouped into standardized plans labeled A, B, C, D, F, G, K, L, M and N. Every insurer that sells Plan G, for example, must include the exact same set of benefits inside that plan. That's a rule set by the Centers for Medicare & Medicaid Services and the National Association of Insurance Commissioners, and it's meant to make shopping easier.

What insurers can change is the premium, the customer service experience, whether they offer household discounts, and whether they add small extras like dental or vision perks outside the standardized benefits. But the core medical coverage inside "Plan G" is fixed.

Three states — Massachusetts, Minnesota and Wisconsin — standardize their Medigap plans on their own systems, so the letter labels work differently there.

What Plan G covers

Plan G is currently the most comprehensive Medigap policy available to people newly eligible for Medicare. It picks up:

• Part A hospital coinsurance and 365 additional hospital days after Medicare benefits are used up
• Part B coinsurance and copayments
• The first three pints of blood each year
• Part A hospice care coinsurance and copayments
• Skilled nursing facility coinsurance
• The Part A deductible
• Part B excess charges (the amount some providers can bill above Medicare's approved rate)
• 80% of foreign travel emergency care, up to plan limits

What Plan G does not cover is the Part B deductible. You pay that once a year yourself before Plan G kicks in for outpatient care.

What high-deductible Plan G changes

High-deductible Plan G has the same benefits as regular Plan G, but you pay a yearly deductible — set by CMS and adjusted annually — before the plan starts covering costs. Once you meet it, coverage is identical to standard Plan G. The tradeoff is a lower monthly premium in exchange for more out-of-pocket exposure early in the year.

How Plan N is different

Plan N covers most of the same things as Plan G, with three key differences:

• You may owe a copay of up to $20 for some office visits and up to $50 for emergency room visits that don't result in an inpatient admission.
• Plan N does not cover Part B excess charges, so if a provider doesn't accept Medicare assignment, you could owe the difference.
• Like Plan G, Plan N does not cover the Part B deductible.

Plan N generally has a lower premium than Plan G in exchange for those small cost-shares at the point of care.

What Plans K and L do

Plans K and L are cost-sharing plans. Instead of paying most Medicare gaps in full, they cover a percentage — K pays 50% of many Part A and Part B cost-sharing amounts, and L pays 75%. In exchange, both plans include an annual out-of-pocket limit set by CMS. Once you hit that limit, the plan pays 100% of covered Part A and Part B costs for the rest of the calendar year.

Premiums for K and L tend to be lower than for G or N, but you take on more of the cost-sharing until you hit the yearly cap.

Plans closed to newer enrollees

If you became eligible for Medicare on or after January 1, 2020, you cannot buy Plan C or Plan F. Those plans covered the Part B deductible, and federal law now prohibits new Medigap policies from doing that. If you were eligible before that date, you may still be able to buy or keep C or F where they're offered.

A note for Moreno Valley readers

Medigap policies in California are regulated by the California Department of Insurance, and the federally standardized letters apply here. California also has a "birthday rule" that gives current Medigap policyholders an annual window to switch to an equal or lesser plan from any carrier without medical underwriting. If you want personalized help sorting through the letters, California's free counseling program — the Health Insurance Counseling and Advocacy Program (HICAP), which is California's SHIP — can walk you through it.