The chart below outlines the benefits of Standardized Medigap Plans A—N (A, B, C, D, F, G, K, L, M and N). Medigap plans K and L are structured a bit differently; they are both high-deductible plans and cover 50% (K) or 75% (L) of the marked benefits below.
Medigap Plan A, which has the most basic benefits, is often the most affordable policy available. Plans K and L usually have lower premiums than other plans, but they require higher out-of-pocket costs. Plan N has a copayment for each office visit.
All Part A hospital coinsurance
|100% of additional hospital days, for a lifetime maximum of 365||X||X||X||X||X||X||X||X||X||X|
|Part B coinsurance, which is 20% of the Medicare-approved amount||X||X||X||X||X||X||50%||75%||X||copay for office & ER visit**|
|First 3 pints of blood in each calendar year||X||X||X||X||X||X||50%||75%||X||X|
|Part A Hospital Deductible:
First-day deductible — $1,316 in 2017 (per benefit period)
|Skilled Nursing Facility (SNF) Copayment: $164.50 per day for days 21-100 of a Medicare-covered stay in an SNF (per benefit period)||X||X||X||X||50%||75%||X||X|
|Part B Deductible: First $183 of Part B charges each year||X||X|
|Part B Excess Charges: A percentage of the charge, (either 80% or 100%). Doctors cannot charge more than 15% above the Medicare-approved amount.||X||X|
|Emergency Care Outside the USA: 80% of emergency care during the first 2 months of each trip outside the USA, after a $250 deductible, for a lifetime maximum of $50,000.||X||X||X||X||X||X|
Total Out-of-Pocket Limit:
* Plan F may be offered with a high-deductible option of $2,200. The benefits are the same as in the standardized plan, but the deductible must be met each year before any claims are paid.
** You pay up to $20 for each office visit. Plan N pays the remainder of any Part B coinsurance charges. The office visit copayment applies to all office visits by any provider authorized to bill Medicare for those visits. There is no annual limit on this copayment, and it must be paid for each office visit, even if you have several visits on the same day. The copayment for emergency room use is waived only if you are admitted to a hospital and Medicare covers the hospital visit under Part A.
*** After you have paid out-of-pocket expenses for plan K ($5,120) or L ($2,560) for covered benefits during a calendar year, the plan will pay 100% of covered benefits for the remainder of that year. The Part B deductible is not a covered benefit but counts toward the out-of-pocket limit. Part B excess charges are not a covered benefit and their payment does not count toward the anual out-of-pocket limit.