What Happened to Medigap Plan J? Exploring Other Medigap Options

Medicare Supplement Insurance, also called Medigap, is a type of private insurance that is used alongside your Original Medicare coverage (Medicare Part A and Part B) to help cover certain Medicare out-of-pocket expenses, such as copays and deductibles.

Medigap Plan J was discontinued for new enrollees in 2010. Anyone who enrolled in Medicare Supplement Insurance Plan J prior to 2010 was allowed to keep the plan.

There are 10 Medigap plans that are currently available in most states, however. These plans include Plan A, B, C, D, F, G, K, L, M and N. Each type of Medigap plan offers a different combination of standardized benefits, which are outlined below.

Massachusetts, Minnesota, and Wisconsin have different Medigap standards and plan options.

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What do Medicare Supplement Plans cover?

You can use the Medigap plans comparison chart below to compare the benefits of each type of Medicare Supplement Insurance plan that is still available for new enrollees in 2019.

Medicare Supplement Insurance Plans 2019
Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
Medicare Part B deductible                
Medicare Part B excess charges                
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
View an image version of this table.

Learn more about the Medicare Supplement Insurance plan options that are available in your state.

Why was Medicare Supplement Insurance Plan J discontinued?

Prior to 2003, Medicare did not offer retail prescription drug coverage (medications you’d get at your local pharmacy). At the time, certain Medigap plans – such as Medigap Plan J – covered prescription drugs for people who joined those plans.

But in 2003, Congress passed the Medicare Prescription Drug, Improvement and Modernization Act. This law introduced Medicare Part D plans, which are standalone Medicare prescription drug plans (PDP) sold by private insurance companies. Due to this law, Medicare Advantage plans (Medicare Part C) can also offer prescription drug coverage.

The 2003 legislation also expanded certain Original Medicare benefits. This included adding coverage for at-home recovery care and preventive care, which were previously covered by Medigap Plan J.

These additions – and later changes to Medicare in 2010 – made the benefits offered by Medicare Supplement Insurance Plan J redundant. Therefore, Medicare Supplement Insurance companies were no longer allowed to sell Medigap Plan J to new enrollees as of June 1, 2010.

What does Medicare Supplement Plan J cost?

The average premium cost for Medicare Supplement Insurance Plan J in 2018 was $160.07 per month.1

It’s important to note that Medigap plan costs may vary based on factors such as age, gender, health, how your insurance company rates (prices) its plans and where you live. The average cost listed above includes Medigap Plan J options that may have lower premiums than what is listed, as well as some plans with higher premium costs.

Remember, Plan J is no longer available for purchase for new enrollees.

Does Medicare Supplement Plan J cover prescriptions?

Medigap Plan J no longer covers prescription drugs. Medigap plans can only help cover certain out-of-pocket Medicare costs, such as deductibles and copayments.

If you want to get Medicare prescription drug coverage, you have two options:

  • You can enroll in a Medicare Advantage Prescription Drug plan (MAPD). These plans cover all of the same hospital and medical insurance benefits that are covered by Original Medicare, as well as prescription drug costs. Many plans also offer benefits such as routine hearing, vision and dental

  • You can enroll in a standalone Medicare Part D Prescription Drug plan (PDP).

Please note that Medigap plans and Medicare Advantage plans are very different things. You cannot have a Medicare Supplement Insurance plan and a Medicare Advantage plan at the same time.

Should I switch from my Medigap Plan J to another Medigap plan?

As previously mentioned, beneficiaries who are currently enrolled in Medigap Plan J are allowed to remain in the plan. As of 2016, only 4 percent of all Medigap beneficiaries were enrolled in Medicare Supplement Insurance Plan J.2

So if you currently have Plan J, should you keep it?

The first thing to consider is the plan cost. Because no new members are being accepted into Plan J, the overall plan risk pool can only increase in age and claim frequency. This may cause Plan J premiums to rise at a faster rate than other Medigap plan premiums.

The second factor to consider is benefits. While no other Medigap plan matches the coverage of Plan J, there are a few that come close. In fact, Plan F and Plan J are nearly identical.

Plan J vs. Plan F

The primary difference in benefits between Plan J and Plan F is the level of coverage offered for foreign emergency care.

Plan J covers 100 percent of the costs for qualified emergency medical care when you’re traveling abroad. Plan F covers 80 percent of foreign travel emergency care costs.

If you do a lot of traveling abroad, you might consider keeping your Plan J because of the more generous foreign emergency care benefit. But if you do not have plans to travel outside the U.S., the extra coverage for this benefit area may not serve much of a purpose for you.

Plan F is the most popular Medigap plan currently available. 55 percent of all Medicare Supplement Insurance beneficiaries are enrolled in Plan F as of 2016.2

Plan J vs. Plan G

Plan G offers all of the same benefits as Plan J, except – like Plan F – it only covers 80 percent of foreign travel emergency care costs. Plan G also does not cover the annual Medicare Part B deductible. (Medigap Plan F covers the Part B deductible).

The Medicare Part B deductible is $185 per year in 2019. If you can find a Plan G option that only costs $184 more per year (or less) than your current Plan J, you could save money in the long run by switching to Plan G (provided you don’t need the extra foreign emergency care coverage).

Plan J vs. Plan C

Another Medigap plan that closely matches Plan J is Plan C. Like Plan F and Plan G, Medigap Plan C covers 80 percent of foreign emergency care costs. Plan C also does not cover Medicare Part B excess charges. (Medigap Plan F does cover Part B excess charges).

Medicare excess charges are costs you may face if you receive medical services or items from a provider who does not accept Medicare assignment. This means that the provider does not accept Medicare reimbursement as full payment for their services.

These providers reserve the right to charge you up to 15 percent more than the Medicare-approved amount for your care.

You can avoid Medicare excess charges by visiting health care providers who accept Medicare assignment.

What is happening to Plan C and Plan F in 2020?

Medicare Supplement Insurance Plan F offers more standardized benefits than the other current Medicare Supplement plans. Because of a new federal law, Plan F and Plan C won’t be available for Medicare beneficiaries who became eligible on or after January 1, 2020.

If you already have Plan C or Plan F before 2020, you will be able to keep your plan. If you become eligible for Medicare before 2020, you may still be able to buy either Plan C or Plan F after January 1, 2020, if either is available where you live.

Learn more about Medicare Supplement Insurance plans

While you can’t enroll in Plan J unless you currently have Plan J, there are several Medigap options that can provide you with nearly identical benefits. A licensed insurance agent can help you learn about plans in your area, what they cover and what they cost.

Learn more about Medigap plans in your area

Visit MedicareSupplement.com