Medicare Supplement

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

Simpsonville, South Carolina — If you have been shopping for a Medicare Supplement policy, you have probably noticed something odd: every insurer seems to sell a "Plan G," a "Plan N," and so on. That is not a coincidence. Medigap plans are standardized by federal rule, which means the letter on the policy — not the company name on the envelope — tells you what the plan covers.

Medicare SupplementSimpsonville, SC

Here is a plain-English look at how the most common Medigap letters differ, based on the standardized benefits described by the Centers for Medicare & Medicaid Services (CMS) at medicare.gov.

Why the letter matters more than the logo

Since 1992, federal law has required most Medigap policies sold across the country to follow a standard menu of benefits, labeled by letter. That means a Plan G sold by one insurer must cover the same benefits as a Plan G sold by any other insurer in the same state (outside the three exceptions noted below).

What can differ between companies is the premium, the customer service experience, whether the insurer uses a household discount, and how rates change over time. What cannot differ is the underlying benefit set. If you understand the letters, you understand the coverage.

Simpsonville is in Greenville County, and South Carolina follows the federal standardization framework, so the letter definitions below apply here.

Plan G, in plain terms

Plan G is the most comprehensive Medigap letter available to people who became newly eligible for Medicare on or after January 1, 2020. It pays the coinsurance and hospital costs under Part A after Medicare pays its share, covers Part B coinsurance and copays, the first three pints of blood, hospice coinsurance, skilled nursing facility coinsurance, and Part A deductible. It also covers Part B "excess charges" — the amount some providers can bill above the Medicare-approved rate.

What Plan G does not cover: the annual Part B deductible. You pay that yourself before Plan G begins picking up Part B costs.

High-deductible Plan G

High-deductible Plan G covers the same benefits as regular Plan G, but only after you have paid an annual deductible set by CMS. Until you reach that deductible, you pay out of pocket for the costs the plan would otherwise cover. Once you meet it, the plan behaves like standard Plan G for the rest of the year.

It is the same coverage, structured differently — designed for people who prefer a lower monthly premium in exchange for more upfront cost sharing.

Plan N

Plan N covers most of what Plan G covers, 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 do not result in 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 a small copay at the point of care, Plan N trades a bit of predictability for a different premium structure.

Plans K and L: cost-sharing plans

Plans K and L work differently from G and N. Instead of paying most Medicare gaps in full, they pay a percentage — and then cap your out-of-pocket costs for the year.

• Plan K pays 50% of many covered services (Part B coinsurance, the Part A deductible, skilled nursing coinsurance, hospice coinsurance, and the first three pints of blood), with an annual out-of-pocket limit set by CMS. After you hit that limit, the plan pays 100% of covered services for the rest of the calendar year.
• Plan L works the same way but at 75%, with a lower out-of-pocket limit.

Both plans fully cover Part A hospital coinsurance and the extra 365 days of hospital coverage after Medicare benefits end.

What about Plans C and F?

Plans C and F used to be popular because they covered the Part B deductible. Under federal law, they are closed 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 them; if you became eligible after, you cannot.

The three states that do it differently

Massachusetts, Minnesota and Wisconsin standardize Medigap plans under their own state systems rather than the federal letter framework. If you move to or from one of those states, the plan names and structures will look different, and it is worth talking to the state's insurance department or SHIP counselor.