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.
|Medicare Supplement Benefits||A||B||C||D||F||G||K||L||M||N|
|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. Plans C and F are not available to new beneficiaries who become eligible for Medicare on or after January 1, 2020.
2. Plans F and G also offer a high deductible plan which has an annual deductible of $2,340 in 2020. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high deductible Plan F is not available to new beneficiaries who become eligible for Medicare on or after January 1, 2020.
3. Plan K has an out-of-pocket yearly limit of $5,880 in 2020. Plan L has an out-of-pocket yearly limit of $2,940 in 2020.
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 $50 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.
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.
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.
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:
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.
As previously mentioned, beneficiaries who are currently enrolled in Medigap Plan J are allowed to remain in the plan. Only 3 percent of all Medigap beneficiaries are 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.
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. 53 percent of all Medicare Supplement Insurance beneficiaries are enrolled in Plan F.2
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 $203 per year in 2021. If you can find a Plan G option that only costs $203 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).
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.
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 had Plan C or Plan F before 2020, you will be able to keep your plan. If you became eligible for Medicare before 2020, you may still be able to buy either Plan C or Plan F if either is available where you live.
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 areaVisit MedicareSupplement.com
1 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
2 AHIP. State of Medigap. (June 2020). Retrieved from www.ahip.org/wp-content/uploads/IB_State_of_Medigap-2020.pdf.