- Only 8 plans are available to Medicare beneficiaries who became eligible on or after January, 1 2020.
- Those who were eligible before 2020 can still purchase two additional plans: Plan C and Plan F.
- Medigap premiums, deductibles, and coinsurance costs continue to rise to keep pace with inflation.
- Using Medicare’s Medigap-specific plan finder tool may make it easier to find and choose a plan that works for you.
There are 10 total plans to choose from, although only eight are available to those who are new to Medicare as of 2020. The plans are standardized by state and federal regulations.
If you have a Medicare Advantage (Part C) plan, you can’t purchase Medigap insurance.
Read on to learn about your Medigap options in 2021.
The table below summarizes what each Medigap policy covers in 2021:
|Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan K||Plan L||Plan M||Plan N|
|Does this plan pay coinsurance and hospital costs for an extra 365 days after my Part A benefits have been used?||yes||yes||yes||yes||yes||yes||yes||yes||yes||yes|
|Does this plan pay coinsurance or copay for services covered under Part B?||yes||yes||yes||yes||yes||yes||50%||75%||yes||yes|
|Does this plan pay for the first 3 pints of blood?||yes||yes||yes||yes||yes||yes||50%||75%||yes||yes|
|Does this plan pay coinsurance or copay for hospice care covered under Part A?||yes||yes||yes||yes||yes||yes||50%||75%||yes||yes|
|Does this play pay coinsurance for skilled nursing facility care? ||no||no||yes||yes||yes||yes||50%||75%||yes||yes|
|Does this plan pay my deductible for Part A?||no||yes||yes||yes||yes||yes||50%||75%||50%||yes|
|Does this plan pay my deductible for Part B?||no||no||yes||no||yes||no||no||no||no||no|
|Does this plan pay the excess charge for services covered under Part B?||no||no||no||no||yes||yes||no||no||no||no|
|Does this plan pay for care I receive while traveling outside the U.S.?||no||no||80%||80%||80%||80%||no||no||80%||80%|
|Does this plan have an out-of-pocket limit?||no||no||no||no||no||no||$6,220||$3,110||no||no|
In some states, Medicare plans F and G offer a high-deductible option. If you choose one of these plans in 2021, you are responsible for paying for all your Medicare costs (your copays, coinsurance, and deductibles) up to $2,370. After you’ve met that deductible, your policy will begin to pay benefits.
It’s important to note that plans C and F are not available to anyone who is newly eligible for Medicare as of January 1, 2020.
If you choose Medicare plan K or L, you must pay your annual Part B deductible ($203 in 2021), and you must also meet an out-of-pocket annual limit before your benefits begin. The 2021 out-of-pocket limit for Plan K is $6,220 and the limit for Plan L is $3,110.
After you have paid the deductible and met the out-of-pocket limit, your plan pays 100 percent of the approved cost for covered services for the rest of the calendar year.
The Medicare Access and CHIP Reauthorization Act (MACRA) changed Medigap plans in every state beginning in January 2020.
If you enrolled in Medicare before January 1, 2020, and you have a Medigap Plan C, Plan F, or high-deductible F, you can keep your plan and renew it in the future.
Other changes that may affect you
- Premiums, deductibles, and coinsurance costs for Medicare parts A and Part B increased.
- The “donut hole” in Medicare Part D (prescription drug coverage) has continued to shrink considerably.
- In Medicare Part D, the catastrophic coverage phase (where your prescription costs are drastically reduced) begins once you have paid $6,550.
- Income brackets that trigger premium hikes in Medicare parts B and D have been adjusted to account for inflation.
In Massachusetts, Minnesota, or Wisconsin, Medigap plans are standardized according to different rules. Here’s what you need to know about your options if you live in one of these states.
In Massachusetts, you have guaranteed issue rights to purchase a Medigap plan. Here’s what coverage under these plans looks like in 2021.
|Plan benefits||Core plan||Supplement 1 plan||Supplement 1A plan|
|Does this plan cover my basic Medicare benefits?||yes||yes||yes|
|Does this plan pay my deductible for hospital care covered under Part A?||no||yes||yes|
|Does this plan pay my coinsurance for care I receive in a skilled nursing facility?||no||yes||yes|
|Does this plan pay my Part B deductible?||no||yes||no|
|Does this plan pay for my care if I have a medical emergency while I am traveling outside the U.S.?||no||yes||yes|
|How many days does this plan cover for my inpatient care in a mental health hospital?||60 days per calendar year||120 days per benefit year||120 days per benefit year|
|Does this plan pay for yearly pap tests, mammograms, and other state-mandated benefits?||no||yes||yes|
In Minnesota, you can choose between basic and extended plans.
|Benefit||Basic plan||Extended plan|
|Does this plan pay for basic Medicare benefits?||yes||yes|
|Does this plan pay the deductible for inpatient hospital care under Part A?||no||yes|
|Does this plan pay my coinsurance for care I receive in a skilled nursing facility?||yes, 100 days||yes, 120 days|
|Does this plan pay my Part B deductible?||no||yes|
|Does this plan pay for my care if I have a medical emergency while I am traveling outside the U.S.?||80%||80%|
|Does this plan pay for medical care I receive while traveling outside the U.S.?||no||80%|
|Does this plan pay my usual and customary fees?||no||80%|
|Does this plan pay for Medicare-approved preventive care?||yes||yes|
|Does this play pay for physical therapy?||20%||20%|
Does this plan pay for my outpatient mental health care?
|Does this plan pay for diabetic equipment and supplies, routine cancer screening, reconstructive surgery, immunizations, and other state-mandated benefits?||yes||yes|
In Minnesota, you can purchase plans that are very much like plans K, L, M, and N. You may also be able to purchase riders to cover these benefits:
- Part A inpatient hospital deductible
- Part B deductible
- usual and customary fees
- preventive care that isn’t covered by Medicare
You have guaranteed issue rights to plans in Wisconsin. Here’s what Medigap plan coverage looks like in this state.
|Does this plan pay for basic Medicare benefits?||yes|
|Does this plan pay the coinsurance for inpatient hospital care under Part A?||yes|
|Does this plan pay my coinsurance for care I receive in a skilled nursing facility?||yes|
|Does this plan pay my coinsurance for medical care I receive under Part B?||yes|
|Does this plan pay for the first 3 pints of blood every year?||yes|
|Does this plan pay my coinsurance or copay for Part A hospice care?||yes|
|Does this plan pay my Part B deductible?||No, but you may be able to purchase this benefit through a rider. Note that newly eligible Medicare participants are not eligible for this benefit after January 1, 2020.|
|Does this plan pay my Part A deductible?||No, but you may be able to purchase this benefit through a rider.|
|Does this plan pay for my care if I have a medical emergency while I am traveling outside the U.S.?||No, but you may be able to purchase this benefit through a rider.|
|Does this plan pay for inpatient mental health care beyond the benefit provided by Medicare?||yes, 175 days per lifetime|
|Does this plan pay for home healthcare visits beyond those covered by Medicare?||yes, 40 extra visits|
|Does this plan pay excess charges for Part B services?||No, but you may be able to purchase this benefit through a rider.|
|Does this plan pay for state-mandated benefits?||yes|
In Wisconsin, you can also buy “50% and 25% cost-sharing plans” that offer coverage like plans K and L in the standardized plan program. Wisconsin residents can also buy high-deductible plans, where the plan pays benefits after you have met a deductible of $2,370 every year.
If you have enrolled in original Medicare (parts A and B), you are eligible to purchase a Medigap policy. It is a good idea to purchase a Medigap policy during your 6-month Medigap open enrollment period because during that period you can buy any of your state’s available policies. The insurance company cannot refuse to sell you a policy during open enrollment.
If you buy during open enrollment, the insurance company must charge you the same premiums it charges healthy people, even if you have some health issues.
Be sure you are enrolled in original Medicare. If you have a Medicare Advantage (Part C) plan, you’ll have to switch back to Medicare parts A and B before you apply for a Medigap policy.
Use this Medigap plan finder tool to research the pricing of plans in your area.
You can enroll in a Medigap plan during the following time periods:
- Initial enrollment period: the 3 months before, 3 months after, and month of your 65th birthday, when you sign up for Part B
- Medigap open enrollment period: runs until 6 months after your turn 65 years old and have already enrolled in Part B
Contact your insurance company, and apply for the plan you want during your these enrollment periods, if possible. After the enrollment periods end, the insurance company can refuse to sell you a policy, charge you higher rates, or make you wait to start coverage.
Tips for choosing a Medigap plan
- Use the Medicare pan finder tool to see which plans cover what you need.
- Purchase your plan during your initial enrollment period or open enrollment period, when you have more plan choices and better rates.
- Premiums and benefits vary widely from plan to plan. Make sure you understand what’s covered and what you’ll pay each month.
- Some states offer Medigap protections called “guaranteed issue rights” that keep insurers from denying you coverage. Talk to your state’s insurance department or your State Health Insurance Program (SHIP) about your rights.
Premiums, deductibles, and coinsurance costs were adjusted for inflation in 2021 for both Medicare and Medigap. Evaluate your current plan benefits and costs to make sure they still need your needs and budget for the year ahead.
This article was updated on November 17, 2020, to reflect 2021 Medicare information.
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