Medigap Changes Are Now in Effect

Medigap Changes Are Now in Effect

Medigap policies are a form of private insurance that pay for some or all of Medicare’s coinsurance and deductibles. As of June 1, 2010 several Medigap plan changes took effect, including the elimination of 4 of the standardized plans (E, H,I and J) and the addition of 2 new ones (plans M and N). These changes were required by federal legislation passed in 2005 that took effect on June 1, 2010. Below is a brief review of the changes.

NOTE: People who have an older plan (one bought before June 1, 2010) including one of the 4 plans that were dropped are not affected. The benefits of those plans remain the same, and the plans will stay in effect as long as their premiums are paid. There is no need to switch to a new plan just because of these changes.

The new Medigap changes in policies issued after June 1, 2010 include:

  1. The Hospice benefit has been added to the basic benefits of all Medigap plans
  2. Medigap plans E, H, I, and J (including high deductible Plan J and its rider) can no longer be sold
  3. Benefits for preventive care and home recovery are not included in any of the new plans
  4. The 80% excess charge benefit in Plan G has been changed to 100%
  5. Two new Medigap plans have been added
    • Plan M with 50% benefit for the Part A deductible ($1,100 in 2010)
    • Plan N with $20 copayment for all Part B office visits, and up to a $50 copay for emergency room care when not admitted to the hospital

See a chart of all the Medigap plans and their benefits.

California’s Birthday Rule

People can, if they choose, switch to another Medigap plan for 30 days following their birthday, without health screening or a new waiting period. They can choose a Medigap plan from any company that sells one with benefits that are equal to or fewer than the Medigap plan they currently have. For instance, if a person has a Plan B Medigap, s/he can replace it with another Plan B or Plan A, but not with Plan C or F that has more benefits than the Plan B they are replacing. The Birthday Rule allows older standardized plans to be replaced with a new standardized plan as shown below, or with one that has fewer benefits than a person’s current plan:

  • Plans A, B, C, D, or F have benefits equal to the new plans with the same letter
  • Plans E and H have benefits equal to the new Plan D
  • Plan I has benefits equal to the new Plan G
  • Plan J has benefits equal to the new Plan F
  • High deductible plan J has benefits equal to the new high deductible Plan F

For more information on the Medigap changes, see FAQs on the New Standardized Medigap Policies Available June 2010.

Also see our section on Medigap.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.