Medicare Supplement

Reading the Medigap chart in Henderson: what Plans G, N, K, L and high-deductible G actually cover

HENDERSON, Nev. — If you have ever stared at a Medigap comparison chart and wondered why the same letters keep showing up at every insurance company, there is a simple reason. Medicare Supplement Insurance plans are standardized by the federal government. That means a Plan G sold by one company covers the same Medicare-approved gaps as a Plan G sold by another. The letter, not the logo, sets the benefits.

Medicare SupplementHenderson, NV

That standardization is what makes the Medigap chart useful. Once you understand what each letter is required to cover, you can compare policies on the things that actually vary between companies — like price, customer service and how the insurer handles claims.

Why the letter is the coverage

Medigap policies sold in most states follow a federal grid set by the Centers for Medicare & Medicaid Services (CMS). Each lettered plan — A, B, D, G, K, L, M, N, and the high-deductible versions of G and F — has a fixed list of benefits the insurer must include. An insurer cannot add extras to a lettered plan or take benefits away.

So when a friend in another state tells you their Plan G paid a certain Part A or Part B cost-sharing amount, the same rule applies to a Plan G bought in Henderson. Henderson is in Clark County, and the federal Medigap rules apply here just as they do everywhere else in Nevada. Where insurers compete is on price, service and small extras that sit outside the standardized benefits.

What Plan G covers

Plan G is one of the most comprehensive Medigap options available to people newly eligible today. It covers the Part A hospital coinsurance and hospital costs for an extra 365 days after Medicare benefits are used up, the Part B coinsurance or copayment, the first three pints of blood, Part A hospice coinsurance, skilled nursing facility coinsurance, the Part A deductible, Part B excess charges, and a limited amount of foreign travel emergency care.

The one gap Plan G does not cover is the annual Part B deductible. You pay that yourself before the plan starts paying its share of Part B costs.

What Plan N covers

Plan N covers most of the same categories as Plan G — Part A coinsurance and hospital costs, Part B coinsurance (with a couple of exceptions), blood, hospice coinsurance, skilled nursing coinsurance, the Part A deductible, and foreign travel emergency care.

The differences: Plan N does not cover Part B excess charges, and it may leave you with a copayment 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. Like Plan G, it does not cover the Part B deductible.

What Plans K and L cover

Plans K and L are built on a cost-sharing model instead of full coverage. On Plan K, you pay 50% of most Medicare-approved cost-sharing amounts (things like the Part B coinsurance, the Part A deductible, skilled nursing coinsurance and the first three pints of blood). Plan L works the same way but at 25%.

Both plans have a yearly out-of-pocket limit set by CMS each year. Once you reach that limit and pay the Part B deductible, the plan covers 100% of covered services for the rest of the calendar year. Neither Plan K nor Plan L covers Part B excess charges or foreign travel emergency care.

What high-deductible Plan G covers

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 out of pocket, you pay the Medicare-approved costs the plan would otherwise cover. After you hit it, the plan pays as a standard Plan G would for the rest of the calendar year.

Two important exceptions

Two things are worth knowing before you read any Medigap chart.

First, Plans C and F are closed to people who first became eligible for Medicare on or after January 1, 2020. If you were eligible before that date, you may still be able to buy them; if you became eligible after, they are not on your menu.

Second, Massachusetts, Minnesota and Wisconsin standardize Medigap plans differently. If you move to or from one of those states, the letter system described here does not translate the same way.

Also remember: Medigap policies work with Original Medicare, not with Medicare Advantage. And Medigap does not include Part D prescription drug coverage, which is a separate enrollment.