Medicare Supplement

In Wake Forest, a Plan G is a Plan G: how the Medigap letters really line up

If you live in Wake Forest and you have started shopping Medicare Supplement policies, you have probably noticed something odd: the same "Plan G" shows up at company after company, but the price is different everywhere you look. That is not a mistake, and it is not a trick. It is how the federal Medigap system is designed.

Medicare SupplementWake Forest, NC

Medicare Supplement Insurance — Medigap — is sold by private insurers, but the coverage inside each lettered plan is set by federal rules. A Plan G from one carrier covers the same Medicare-approved gaps as a Plan G from another. What changes is the price, the service and the company behind the policy.

Here is how the main letters most Wake Forest shoppers see actually differ.

Why the letter matters more than the logo

Medigap is unusual in the insurance world. In most states, including North Carolina, insurers can only sell the standardized plans defined by Medicare. That means the benefits inside a lettered plan are fixed. A carrier cannot add a perk to its Plan G or shave a benefit off its Plan N to make it cheaper.

Three states — Massachusetts, Minnesota and Wisconsin — standardize their Medigap plans differently, but that does not apply here in Wake County.

So when you compare Plan G quotes from different companies in Wake Forest, you are comparing the same coverage. The price differences come from how each insurer sets its rates, not from what the policy pays.

What Plan G covers

Plan G is the most comprehensive Medigap policy available to people newly eligible for Medicare today. After you meet the Part B deductible (which Medicare sets each year), Plan G generally picks up:

• Part A hospital coinsurance and an extra 365 days after Medicare benefits are used up
• Part B coinsurance or copays
• The first three pints of blood
• Part A hospice care coinsurance
• Skilled nursing facility coinsurance
• The Part A deductible
• Part B excess charges (when a provider does not accept Medicare's approved amount)
• 80% of foreign travel emergency care, up to plan limits

Plan G does not cover the Part B deductible. That is the main difference between Plan G and the older Plan F.

What Plan N covers

Plan N covers most of the same things Plan G does, but with a few trade-offs meant to keep premiums lower:

• You pay a copay of up to $20 for some office visits
• You pay a copay of up to $50 for emergency room visits that do not lead to an inpatient admission
• Plan N does not cover Part B excess charges

For a Wake Forest reader who rarely sees specialists and uses providers who accept Medicare assignment, those trade-offs may not matter much. For someone who sees doctors often, they can add up.

What high-deductible Plan G is

High-deductible Plan G covers the same benefits as regular Plan G, with one big change: you pay a yearly deductible — set by Medicare and adjusted each year — before the plan begins paying its share. Premiums are typically lower than standard Plan G because you are taking on more upfront risk.

It is the same coverage, structured differently. Whether that structure fits depends on how much medical care you expect to use in a year.

What Plans K and L do differently

Plans K and L are cost-sharing Medigap plans. Instead of paying most gaps in full, they pay a percentage:

• Plan K pays 50% of many Medicare cost-sharing amounts (like the Part A deductible, Part B coinsurance and skilled nursing coinsurance) until you hit a yearly out-of-pocket limit set by Medicare. After that, the plan pays 100% for the rest of the year.
• Plan L works the same way but pays 75%, with a lower yearly out-of-pocket limit.

Neither pays the Part B deductible, and neither covers Part B excess charges.

The plans you may have heard of but cannot buy

If you turned 65 or otherwise 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 closed them to new enrollees. People who were already eligible before that date can still keep or, in some cases, buy them.

That is the main reason Plan G has become the go-to comprehensive option for people newly aging into Medicare in Wake Forest.

How to think about your choice

Because the coverage inside each letter is standardized, comparing Medigap in Wake County comes down to a few practical questions:

• How much predictable monthly premium do you want, versus how much cost-sharing are you willing to handle?
• How often do you expect to use care?
• Do your providers accept Medicare assignment, or do you need Part B excess charge coverage?
• How stable is the insurer's pricing history, and how do they handle rate changes over time?

North Carolina's Seniors' Health Insurance Information Program (SHIIP) offers free, unbiased counseling and can walk you through these questions without trying to sell you anything.