Medicare Supplement

Plan G, Plan N, high-deductible G in Kirkwood: what each Medigap letter actually covers

KIRKWOOD, Mo. — If you have shopped for a Medicare Supplement policy around Kirkwood, you have probably noticed something odd: two insurers will quote you very different prices for what looks like the same "Plan G." That is not a mistake. Under federal rules, every Medigap plan sold by the same letter covers the exact same things — no matter which company puts its name on the envelope.

Medicare SupplementKirkwood, MO

Here is what the letters actually mean, and where the real differences show up.

Why the same letter means the same coverage

Medigap, also called Medicare Supplement Insurance, was standardized by Congress decades ago. Kirkwood is in St. Louis County, Missouri, and Missouri follows the federal standardized letter system. That means the benefit chart for Plan G is identical from one carrier to the next — same hospital coinsurance, same skilled nursing coinsurance, same foreign travel emergency benefit.

What is not identical: the monthly premium, the company's customer service, how often they raise rates, and whether they offer extras like gym memberships as a separate perk. Those are the fair things to compare. The covered benefits are set by CMS.

Plan G, in plain English

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

• The Part A hospital deductible and coinsurance
• Part B coinsurance (typically the 20% Medicare does not pay)
• The first three pints of blood
• Skilled nursing facility coinsurance
• Part B excess charges (when a provider bills above the Medicare-approved amount)
• Foreign travel emergency care, up to plan limits

What Plan G does not cover: the annual Part B deductible. You pay that yourself before Plan G kicks in on outpatient costs.

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 CMS. Until you hit that deductible, you pay Medicare's normal cost-sharing out of pocket. In exchange, the monthly premium is typically lower. It is the same coverage, just structured with more upfront risk to you.

Plan N

Plan N covers most of what Plan G covers, with a few trade-offs:

• You may pay up to a $20 copay for some office visits.
• You may pay up to a $50 copay for an emergency room visit that does not lead to admission.
• Plan N does not cover Part B excess charges.
• Like Plan G, it does not cover the Part B deductible.

For people who do not mind small copays at the visit, Plan N is often priced lower than Plan G.

Plans K and L: cost-sharing plans

Plans K and L work differently. Instead of covering the gaps in full, they pay a percentage — Plan K pays 50% of many Part B costs, Plan L pays 75% — until you hit an annual out-of-pocket limit set by CMS each year. After that limit, the plan pays 100% of covered Part B costs for the rest of the year.

Both cover the Part A hospital deductible only partially (50% for K, 75% for L). Neither covers the Part B deductible. Neither covers Part B excess charges. These plans tend to have lower premiums in exchange for that shared cost.

What about Plans C and F?

Plans C and F were popular because they covered the Part B deductible. Federal law closed them to anyone whose Medicare eligibility began on or after January 1, 2020. If you were eligible before that date, you can still buy them in most states. If you became eligible later, they are simply not on the menu.

Three states that do it their own way

Massachusetts, Minnesota and Wisconsin standardize their Medigap plans under different rules and different labels. If you move to or from one of those states, do not assume "Plan G" means the same thing there. Contact that state's SHIP office for the state-specific chart.

What to compare when the coverage is identical

Because the benefits are locked in by the letter, the useful things to compare between insurers are:

• Monthly premium
• How the insurer sets rates (community-rated, issue-age-rated, or attained-age-rated)
• Rate-increase history
• Household discounts
• Underwriting rules if you are outside your Medigap Open Enrollment Period

Your Medigap Open Enrollment Period is the six months that starts the month you are 65 or older and enrolled in Part B. During that window, insurers cannot turn you down or charge more based on health.