Medicare supplement insurance plan Medigap Plan J stopped being available to new enrollees on June 1, 2010. Medigap Plan F stopped being available to new enrollees on January 1, 2020. People who were already enrolled in either plan were able to keep it.
Medicare supplement insurance plans, known as Medigap, help people with the out-of-pocket expenses associated with Medicare.
Private insurance companies administer Medigap plans to cover the gaps in original Medicare coverage.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Supplement Plan J is no longer available for a person to enroll in or private insurers to offer.
As of June 1, 2010, the implementation of rules originating from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 prevented new sales of Medigap Plan J due to the inclusion of additional benefits in original Medicare.
After this date, no new beneficiaries could enroll. However, those who already had the plan could, and still can, continue receiving benefits.
Plan J coverage
People who enrolled in Medigap Plan J before its discontinuation receive the highest level of supplement plan coverage, including:
- $120 per year for preventive care
- $1,600 per year for at-home recovery
- emergency foreign travel benefits
- prescription drug coverage
Plan J also covers the Medicare Part B deductible. Other Medigap plans do not provide this coverage.
Today, Medicare covers a more comprehensive range of benefits. A person enrolled in Medigap Plan J can compare the coverage against modern supplement plans, with the option to switch to a different Medigap plan should it benefit them.
A person could enroll in Plan F only if they became eligible for Medicare before January 1, 2020. A Medicare membership card displays the date an individual became eligible for Medicare. If Part A began in 2019 or earlier, an individual could apply for Plan F.
If an individual already has Plan F, they can keep the plan with their current plan provider, switch to a Plan F with a different provider, or switch to a different Medigap plan.
Medigap Plan J and Plan F coverage and rules are mainly standardized throughout the United States.
The table below compares Medigap Plan J and Plan F coverage.
|Medigap Plan F||Medigap Plan J|
|Medicare Part A coinsurance and copayments||100%||100%|
|Medicare Part A deductible||100%||100%|
|Medicare Part B coinsurance and copays||100%||100%|
|Medicare Part B deductible||100%||100%|
|skilled nursing facility care coinsurance||100%||100%|
|first 3 pints of blood||100%||100%|
|foreign travel exchange||80%||100%|
|prescription drugs||no||yes, with payment of $250 yearly deductible|
Plan F’s coverage is similar to that of Plan J, including the coverage of the Part B deductible.
Private insurers may offer a high deductible version of Plan F, which means that a person must reach the 2021 deductible of $2,370 before the plan begins to pay. This deductible is the same for Plan J.
Both plans provide coverage for foreign travel emergency care, but Plan F has 80% cost coverage, whereas Plan J has 100% coverage.
Medigap Plan J covers at-home recovery care and some preventive care. Plan F does not cover these costs.
Plan J covers prescription medications with an annual deductible of $250. Plan F does not cover prescription drugs.
Also, Medicare Part D prescription drug plans may provide more comprehensive and cost effective coverage for medications.
The cost of a Medigap plan varies according to the insurer. According to Medicare’s Medigap policy finder, these are some average costs for Medigap Plan F:
- In New York, a male aged 65 years with ZIP code 13225 can expect to pay $304–$409 or $53–$62 on the high deductible plan. This person does not smoke.
- In California, a female aged 70 years with ZIP code 90210 can expect to pay $190–$469 or $46–$116 on the high deductible plan. This person smokes.
- In North Carolina, a female aged 80 years with ZIP code 27120 can expect to pay $156–$513 or $45–$96 on the high deductible plan. This person smokes.
If a person has the high deductible version of Plan F, they must first pay $2,370 out of pocket before the plan pays for eligible care.
Although a person can still enroll in Plan F if they are eligible, there are 10 different Medigap plans available in 2021.
All Medigap plans cover the Medicare Part A coinsurance and any approved but uncovered hospital costs for an additional 365 days.
All plans also cover the 20% Part B coinsurance in full, except for Plan K, which covers 50%, and Plan L, which covers 75%.
A person should consider which Medigap plan would best suit their needs. If they would like impartial advice, the State Health Insurance Assistance Program office can assist.
Medigap supplement insurance policies help people pay out-of-pocket costs associated with original Medicare.
Medigap Plan J is a Medigap policy that stopped accepting new enrollees in 2010. However, this full coverage Medigap plan continues to provide benefits for existing enrollees.
Medigap Plan F provides a similar coverage level to Plan J. However, only people who became eligible for Medicare before January 1, 2020, can enroll in this plan.
Changes to both plans were due to implementations from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which saw more comprehensive coverage and the introduction of prescription drug plans.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products.
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