Medicare Supplement

Why a Plan G in Weslaco covers the same things as a Plan G anywhere else

WESLACO, Texas — If you have been comparing Medigap policies in the Rio Grande Valley, you have probably noticed the same letters keep coming up: Plan G, Plan N, high-deductible Plan G, Plan K, Plan L. Different companies, different prices, same letters. That is not a coincidence. It is the whole point of how Medigap is built.

Under federal rules, each lettered Medigap plan has to cover the exact same set of benefits, no matter which insurance company sells it. A Plan G from one carrier in Weslaco pays the same Medicare-covered bills as a Plan G from any other carrier. What can change is the premium, the customer service, and whether the company is even selling that letter here — but not the coverage itself.

Here is a plain-language look at what the main letters do, and do not, cover.

The idea behind "standardized" plans

Medigap policies are sold by private insurance companies, but the benefits inside each lettered plan are set by the federal government. That is why the official CMS guide "Choosing a Medigap Policy" on medicare.gov lays them out in a grid: Plan A, B, D, G, K, L, M, N — plus C and F for people who were already eligible before 2020, and a high-deductible version of G.

So when you compare two Plan G quotes in Weslaco, you are really only comparing price and company, not coverage. That is a much simpler comparison than most people expect.

Weslaco is in Hidalgo County, and Texas follows the standard federal Medigap chart. Three states — Massachusetts, Minnesota and Wisconsin — use their own systems, so if you move there (or move here from there), the letters will not translate directly.

What Plan G covers

Plan G is one of the most talked-about letters because it is available to people newly eligible for Medicare today. Under the federal standard, Plan G covers:

• Part A hospital coinsurance and an extra 365 days of hospital coverage after Medicare benefits are used up
• Part B coinsurance or copayments
• The first three pints of blood each year
• Part A hospice care coinsurance or copayments
• Skilled nursing facility care coinsurance
• The Part A deductible
• 80% of foreign travel emergency care, up to plan limits

Plan G does not cover the Part B deductible. You pay that yourself each year before the plan starts filling in the Part B gaps.

What high-deductible Plan G covers

High-deductible Plan G covers the same list of benefits as regular Plan G. The difference is timing: you pay a yearly deductible (set by CMS each year) out of pocket before the plan begins to pay. Once you meet that deductible, the coverage works like standard Plan G for the rest of the year.

It is the same coverage — just structured so more of the cost sits with you up front in exchange for a typically lower premium.

What Plan N covers

Plan N covers most of the same items as Plan G, with two differences a reader should know about:

• Plan N may charge a copayment of up to $20 for some office visits and up to $50 for emergency room visits that do not lead to an inpatient admission.
• Plan N does not cover Part B "excess charges" — the amount a doctor can bill above the Medicare-approved rate when they do not accept assignment.

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

What Plans K and L cover

Plans K and L work differently from G and N. Instead of paying most costs in full, they pay a set percentage and put a cap on what you spend in a year.

• Plan K pays 50% of many Part B coinsurance costs, the Part A deductible, skilled nursing coinsurance, the first three pints of blood, and Part A hospice coinsurance. It pays 100% of Part A hospital coinsurance and the extra 365 hospital days. Plan K has a yearly out-of-pocket limit; after you hit it, the plan pays 100% of covered Part A and B costs for the rest of the year.
• Plan L works the same way, but pays 75% of those cost-shared items instead of 50%, and has a lower yearly out-of-pocket limit than Plan K.

Neither K nor L covers foreign travel emergency care, and neither covers the Part B deductible.

What no Medigap plan covers

No Medigap policy — no letter — covers prescription drugs, long-term custodial care, routine dental, vision, hearing aids or private-duty nursing. For prescription drugs, people with Medigap usually add a stand-alone Part D drug plan. In 2026, Part D has a $2,100 yearly out-of-pocket cap, a maximum $615 deductible, and the old coverage gap ("donut hole") no longer exists as a separate phase. There is also an optional Medicare Prescription Payment Plan that lets you spread drug costs across the year.

Why the same letter can cost different amounts

If the coverage is identical, why do premiums vary? A few reasons:

• Different insurers use different pricing methods (community-rated, issue-age-rated or attained-age-rated).
• Underwriting rules differ outside of your Medigap Open Enrollment Period.
• Some carriers offer household or other administrative discounts.
• Company overhead and claims history differ.

None of that changes what the plan pays. It only changes what you pay for it.