Standardized Medigap Plans
Federal law requires that Medigap policies be standardized, meaning each plan letter (A, B, C, etc.) must offer the same benefits regardless of which insurance company sells it. The only difference between the same plan letter from different companies is the price.
Understanding Standardization
The Standardization Requirement
| Aspect | Details |
|---|
| Federal law | Plans must be identified by letters A-N |
| Same benefits | Plan G from Company X = Plan G from Company Y |
| Price varies | Companies set their own premiums |
| State regulations | Must be approved by state insurance department |
Available Plan Letters
| Plans | Availability |
|---|
| A, B, D, G, K, L, M, N | Available to all Medicare beneficiaries |
| C, F | Only for those eligible for Medicare before 1/1/2020 |
| High-deductible F and G | Available with $2,870 deductible (2025) |
Key Point: Plans C and F are no longer available to new Medicare beneficiaries (those eligible after January 1, 2020) because they cover the Part B deductible. Congress eliminated this option to reduce Medicare spending.
Plan Benefit Comparison
Core Benefits (All Plans Include)
| Benefit | Coverage |
|---|
| Part A coinsurance | Hospital coinsurance for days 61-90 |
| 365 additional lifetime hospital days | After Medicare benefits exhausted |
| Part B coinsurance | 20% coinsurance or copayment |
| Blood (first 3 pints) | Part A and Part B blood costs |
| Part A hospice coinsurance | Hospice care cost-sharing |
2025 Standardized Plan Benefits
| Benefit | A | B | C* | D | F* | G | K | L | M | N |
|---|
| Part A coinsurance | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part B coinsurance | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓** |
| Blood (first 3 pints) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A hospice | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| SNF coinsurance | — | — | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A deductible | — | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ |
| Part B deductible | — | — | ✓ | — | ✓ | — | — | — | — | — |
| Part B excess charges | — | — | — | — | ✓ | ✓ | — | — | — | — |
| Foreign travel emergency | — | — | 80% | 80% | 80% | 80% | — | — | 80% | 80% |
*Plans C and F only available to those Medicare-eligible before 1/1/2020
**Plan N has copays: up to $20 for office visits, up to $50 for ER visits not resulting in admission
Most Popular Plans
| Plan | Why Popular | Best For |
|---|
| Plan G | Most comprehensive available to new enrollees | Maximum coverage, predictable costs |
| Plan N | Lower premium with copays for visits | Cost-conscious, healthy beneficiaries |
| Plan F* | Covers everything including Part B deductible | Those eligible before 2020 wanting full coverage |
| Plan K | Lower premium, 50% cost-sharing until OOP limit | Budget-conscious, willing to share costs |
Special Plan Features
High-Deductible Plans
| Feature | Details |
|---|
| Available for | Plans F and G only |
| 2025 deductible | $2,870 |
| How it works | Pay deductible first, then plan pays 100% |
| Premium savings | Significantly lower than standard versions |
| Best for | Healthy individuals wanting catastrophic protection |
Cost-Sharing Plans (K and L)
| Plan | Cost-Sharing | 2025 OOP Maximum |
|---|
| Plan K | 50% of most benefits | $7,220 |
| Plan L | 75% of most benefits | $3,610 |
| After OOP met | Plan pays 100% for rest of year | N/A |
Plan N Copayments
| Service | Copayment |
|---|
| Office visits | Up to $20 |
| Emergency room (no admission) | Up to $50 |
| Part B coinsurance | Covered after copays |
| Premium | Generally lower than Plan G |
Exam Tip: Plan N is popular because it offers most of Plan G's benefits at a lower premium, with the trade-off being small copays for office and ER visits.
Pricing Methods
How Companies Set Premiums
| Method | Description | Impact |
|---|
| Community-rated | Same premium for all ages | Higher initial cost, stable over time |
| Issue-age-rated | Based on age when purchased | Lower if bought young, stable after |
| Attained-age-rated | Based on current age | Starts lower, increases with age |
Factors Affecting Premium
| Factor | Impact |
|---|
| Age | Older = higher premium (in most rating methods) |
| Gender | Women often pay less |
| Tobacco use | Smokers pay more |
| Location | ZIP code affects pricing |
| Household discount | Some companies offer discounts |
Key Point: Community-rated plans cost more initially but don't increase with age (only for inflation). Attained-age plans start cheaper but become more expensive each year.
Medicare SELECT
What is Medicare SELECT?
| Feature | Details |
|---|
| Type | Medigap plan with network restrictions |
| Network requirement | Must use specific hospitals and doctors |
| Out-of-network | Emergency only, or higher costs |
| Premium | Generally lower than standard Medigap |
| Availability | Not available in all states |
SELECT Plan Rules
| Aspect | Details |
|---|
| Within network | Full Medigap benefits |
| Outside network | May not pay benefits |
| Emergency care | Covered anywhere |
| Switching | Can change to standard Medigap (guaranteed issue) |
State Exceptions
Massachusetts, Minnesota, and Wisconsin
| State | Difference |
|---|
| Massachusetts | Core plan plus optional riders |
| Minnesota | Basic plan plus optional supplements |
| Wisconsin | Base plan plus cost-sharing options |
Important Notes for These States
| Feature | Details |
|---|
| Not standardized A-N | Use different plan structures |
| Same protections | Open enrollment and guaranteed issue still apply |
| Plan comparison | Must compare benefits carefully |
| Federal minimums | Still meet federal minimum requirements |
Choosing a Medigap Plan
Decision Factors
| Factor | Consider |
|---|
| Budget | Monthly premium vs. potential out-of-pocket costs |
| Health status | Frequent healthcare users benefit from comprehensive plans |
| Risk tolerance | Willing to pay some costs out-of-pocket? |
| Part B deductible | Worth paying separately ($257/year in 2025)? |
| Foreign travel | Need coverage abroad? |
Comparison Strategy
| Step | Action |
|---|
| 1 | Identify which plan letter meets your needs |
| 2 | Get quotes from multiple companies (same benefits, different prices) |
| 3 | Check company ratings and customer service |
| 4 | Ask about discounts (household, non-smoker, automatic payment) |
| 5 | Review premium pricing method (community, issue-age, attained-age) |
Key Point: Once you choose a plan letter, shop for price—the benefits are identical regardless of which company sells it. A Plan G from one insurer is exactly the same as Plan G from another.