Medigap Plan J stopped being available to new enrollees in 2010. Medigap Plan F provides many of the same benefits as Plan J, with some differences.
Medigap supplement insurance plans, known as Medigap, help people pay out-of-pocket Medicare expenses. Private insurance companies provide Medigap plans to cover the gaps from original Medicare coverage.
This article discusses Medigap policies, coverage, and compares Plan J and Plan F. It also looks at enrollment and costs.
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.
According to the Kaiser Family Foundation (KFF), one in four Medicare beneficiaries has a Medigap plan. People can choose from 10 Medigap policies.
Medigap is optional health insurance that people can buy from private health insurance companies. A Medigap policy helps someone with original Medicare pay their copays, coinsurance, and deductibles. It also covers emergency health care if someone requires treatment outside the United States.
The government standardizes Medigap policies. Each plan of the same letter must offer the same benefits, irrespective of the location, or provider, although the premiums may differ. In Massachusetts, Minnesota, and Wisconsin, Medigap policies have different standardizations.
Insurance companies provide 10 different Medigap plans, all of them with varying coverage levels. The plans are identified by a letter: A, B, C, D, F, G, K, L, M, and N.
Medigap policies do not cover the following:
- long-term care
- dental care
- vision care
- hearing aids
- private-duty nursing
In addition, Medigap policies do not generally cover prescription drugs. A person must enroll in a Medicare drug coverage (Part D) plan if they want prescription drug coverage.
If a person is enrolled in a Medicare Advantage plan, they cannot also have a Medigap plan.
The 2010 Medicare Modernization Act prevented new sales of Medigap Plan J. After this date, no new beneficiaries could enroll. However, those who already have the plan can continue receiving benefits.
Medigap Plan J is a full-coverage plan. It offers the highest level of coverage including $120 per year for preventive care, and $1600 per year for at-home recovery, plus foreign travel benefits, and prescription drug coverage.
Plan J also covers the Medicare Part B deductible — other Medigap plans do not provide this coverage.
As Medicare evolved, some Plan J coverage became redundant. For example, Medicare Part B now covers parts of preventive care and at-home recovery.
A person enrolled in Medigap Plan J can switch to a different Medigap plan.
Medigap Plan F pays for the remaining part of the healthcare bill that original Medicare does not cover. Plan F provides similar coverage to Plan J.
Changes in the law have affected people’s eligibility for Plan F.
A person can only enroll in Plan F if they were eligible for Medicare before January 1, 2020. People can check their Medicare Part A start date on their Medicare card to see when they became eligible for Medicare. If Part A started in 2019 or earlier, they can apply for Plan F.
If an individual already has Plan F, they can keep the plan with the current provider, switch to a Plan F with a different provider, or switch to a different Medigap plan.
Insurance providers may offer a high-deductible version of Plan F, which means a person must reach the 2021 deductible of $2,370 before the plan begins to pay.
Medigap Plan J provides comprehensive coverage, which means enrollees paid a minimal amount towards their healthcare costs. The option for a high level of coverage exists with Medigap Plan F for those with eligibility.
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|
While coverage is similar for both plans, there are some differences:
- Both plans provide coverage for foreign travel emergency care. Plan F provides 80% cost coverage, whereas Plan J provides 100% coverage.
- Medigap Plan J also covers at-home recovery care.
The cost of a Medigap plan varies according to the insurance provider.
According to the U.S. government’s Medigap policy finder tool, these are some average costs for Medigap Plan F:
- New York, zip code 13225, male, age 65, non-smoker: $304-$409 or $53-$62 on the high-deductible plan
- California zip code 90210, female, age 70, smoker: $190-$469 or $46-$116 on the high-deductible plan
- North Carolina zip code 27120, female, age 80, non-smoker: $156-$513 or $45-$96 on the high-deductible plan
Medigap supplement insurance policies help people to pay for their out-of-pocket original Medicare expenses.
Medigap Plan J is a Medigap policy that stopped accepting new enrollees in 2010. This full coverage Medigap plan continues to provide benefits for existing members.
Medigap Plan F provides a similar coverage level to Plan J. However, only a person who became eligible for Medicare before January 1, 2020, can apply to be enrolled in the plan.
We will update the 2021 costs as soon as possible after the Centers for Medicare and Medicaid Services (CMS) have released them.
We last updated the costs on this page on October 8, 2020
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