Medicare Supplement

Same letter, same coverage: how to read the standardized Medigap chart

PINELLAS PARK, Fla. — If you have ever stared at a Medigap comparison chart and wondered why the same plan letter shows up under insurer after insurer, you have already spotted the most important thing about Medicare Supplement Insurance: the letter, not the logo, defines the coverage. Federal rules require every insurer that sells a Medigap plan to offer the exact same benefits under each letter, so a Plan G from one company pays the same Medicare-covered claims as a Plan G from any other.

That standardization is the whole point of the chart. What changes between insurers is the price, the customer service and whether the company offers a household discount — not what the plan pays.

Why the letter is the coverage

Medigap policies are sold by private insurers, but the benefit design is set by the federal government. According to CMS's Medigap rules on medicare.gov, an insurer that offers a lettered plan must include every benefit assigned to that letter — no more, no less, on the parts of the chart set by federal standards.

That is why two neighbors in Pinellas Park can hold the same lettered plan through different companies and get the same claim paid the same way. It is also why comparing Medigap plans is largely a matter of comparing prices and service for the letter you have chosen, rather than comparing benefit lists.

What Plan G covers, and what it does not

Plan G is the most comprehensive Medigap plan available to people who became eligible for Medicare on or after January 1, 2020. It pays the Part A hospital coinsurance and most of the cost-sharing that Original Medicare leaves behind — including the Part B coinsurance, the first three pints of blood, skilled nursing facility coinsurance, hospice cost-sharing and foreign travel emergency care up to plan limits.

What Plan G does not cover is the annual Part B deductible. You pay that yourself before the plan begins picking up Part B coinsurance. Plan G also does not cover prescription drugs, dental, vision, hearing aids or long-term custodial care. Those sit outside the Medigap framework.

How high-deductible Plan G is different

High-deductible Plan G covers the same benefits as regular Plan G, but only after you meet a separate annual deductible set each year by CMS. Until you reach that deductible with out-of-pocket spending on Medicare-covered services, the plan pays nothing. Once you cross it, coverage kicks in the same way as standard Plan G.

It is the same letter, in other words, with a different cost-sharing structure at the front end.

How Plan N works

Plan N covers most of what Plan G covers, with two everyday differences. You may owe a copay of up to $20 for some office visits and up to $50 for an emergency room visit that does not result in an inpatient admission. Plan N also does not cover Part B excess charges — the amount some providers can bill above the Medicare-approved rate when they do not accept assignment.

Like Plan G, Plan N does not pay the Part B deductible.

Plans K and L: the cost-sharing plans

Plans K and L work on a different model. Instead of paying most Medicare cost-sharing in full, they pay a percentage — Plan K generally pays 50% and Plan L generally pays 75% of certain Medicare-covered costs — until you reach that plan's yearly out-of-pocket limit. After you hit the limit and pay the Part B deductible for the year, the plan pays 100% of covered services for the rest of the calendar year.

That out-of-pocket ceiling is a feature Plans G and N do not have, because those plans already pay most cost-sharing up front.

Plans C and F, and the 2020 rule

Plans C and F used to be the two Medigap plans that paid the Part B deductible. Federal law closed both of those plans to people who became newly eligible for Medicare on or after January 1, 2020. If you were eligible before that date, you may still be able to buy or keep C or F; if you became eligible on or after that date, those two letters are not on your menu.

Where the chart looks different

Three states — Massachusetts, Minnesota and Wisconsin — standardize Medigap policies under their own systems rather than the federal lettered plans. If you move to or from one of those states, the plan names and benefit structures you see will not match the federal chart. Florida follows the federal standardized letters, so shoppers in Pinellas Park will see the same letters described here.

Pinellas Park is in Pinellas County, and Medigap availability and pricing are regulated at the state level in Florida, not the county level.