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.
|Basic Benefits: |
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 — $1,484 in 2021 (per benefit period)
|Skilled Nursing Facility (SNF) Copayment: $185.50 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 $203 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:
* Plans F and G may be offered with a high-deductible option of $2,370 in 2021. 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.
*** In 2021, after you have paid out-of-pocket expenses for plan K ($6,220) or L ($3,110) 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 annual out-of-pocket limit.
Note: Some companies have recently begun selling a Medigap with additional benefits added to one or more of their policies. Under federal law, states can approve the addition of certain “innovative” benefits to a Medigap, but they must be benefits that are not otherwise available and have added value. Those benefits can’t cover an expense for which there is already a Medigap benefit available. For instance, a company couldn’t add an excess charge benefit to one of the Medigap plans that didn’t cover that expense. Innovative benefits are usually such things as hearing, dental, or vision services, or preventive care not otherwise covered. These benefits must comply with all other requirements of a Medigap policy whether provided as an integral benefit within the policy or added by rider. For instance, innovative benefits must meet all other requirements of the underlying coverage of a Medigap such as guaranteed issue rights. In addition, the premium for these innovative benefits must be disclosed to the purchaser separately from the premium for the policy.