Medigap Plan D Supplement Insurance
Medigap Plan D is a midrange Medicare Supplement plan — about halfway between the least and most comprehensive Medigap plans. Medigap Plan D covers most Medicare-related out-of-pocket expenses but does not cover the Medicare Part B deductible or Part B excess charges.
What Does Medigap Plan D Cover?
Medigap Plan D — also called Medicare Supplement Plan D — helps pay your out-of-pocket costs if you have Original Medicare.
Medigap policies, such as Plan D, are sold by private insurers. The Medicare Part A and Part B out-of-pocket costs they cover include deductibles, coinsurance and copayments. They do not cover prescription drugs.
- Medicare Part A deductible ($1,484 for each benefit period)
- Medicare Part A coinsurance and hospital costs for up to 365 days after Original Medicare benefits are used up
- Medicare Part B coinsurance (typically 20 percent of the Medicare-approved cost)
- Medicare Part B copayment (typically a dollar amount set by the health care provider)
- First three pints of blood for medical procedures each calendar year
- Up to 80 percent of medical costs for a foreign travel emergency — up to your plan’s limits
As a midrange Medicare Supplement insurance plan, Medigap Plan D covers more than the least comprehensive plan available, but it doesn’t cover all the costs that more comprehensive Medigap policies may cover.
- Medicare Part B deductible
- The Medicare Part B deductible is the amount you have to pay each year for medical services such as doctor visits before Medicare and Medigap Plan D kick in. The deductible is $203 in 2021.
- Medicare Part B excess charges
- Excess charges are the amount a doctor or other health care provider can legally charge you over and above the Medicare-approved amount.
Medigap Plan D is one of eight Medicare Supplement insurance plans available to people who are newly eligible for Medicare. Two plans — Medigap Plan C and Plan F — were phased out and are not available to anyone who became eligible for Medicare beginning on or after January 1, 2020.
All Medigap plans are standardized in most of the United States. But if you live in Massachusetts, Minnesota or Wisconsin, there are different types of standardized Medigap plans. You can talk with your insurer about options similar to Medigap Plan D if you live in one of these states.
What’s the Difference Between Medigap Plan D and Medicare Part D?
Medigap Plan D should not be confused with Medicare Part D prescription drug plans. Both are sold by private insurance companies, but they provide much different coverage.
It is important to be aware of the differences, particularly if you are looking for prescription drug coverage.
- Medigap (Medicare Supplement insurance) Plan D
- Medigap Plan D helps pay certain out-of-pocket costs if you have Original Medicare — such as deductibles, coinsurance and copayments. Medigap Plan D does not help pay for your prescription medications.
- Medicare Part D prescription drug plan
- Medicare Part D plans are specifically designed to help pay for your prescription medications. These plans do not cover any out-of-pocket costs associated with Original Medicare.
Neither Original Medicare nor any Medigap plan covers prescription drugs — outside of a hospital. If you take prescription medications and want help paying for them, you will still need a Medicare Part D plan in addition to Original Medicare and any Medigap plan you purchase.
Part D prescription drug coverage is also included in most Medicare Advantage plans. These are plans you can purchase from private insurers.
Medicare Advantage plans provide the same coverage as Original Medicare but may include additional benefits. Be aware that you cannot purchase both a Medicare Advantage plan and a Medigap policy.
- These premiums are based on your current age, meaning your premiums will go up as you get older.
- Your premium is based on your age when you first purchase your Medigap Plan D policy. The younger you are, the lower your premium, and the premium stays the same as you get older.
- Community rated
- Everyone pays the same monthly premium for the same policy, regardless of age.
Your Medigap Plan D premium has to be paid in addition to any Medicare Part A, Part B and Part D premiums you have to pay.
When Should You Buy a Medigap Plan D Policy?
The best time to purchase a Medigap Plan D is when you are first eligible — during your Medigap Open Enrollment Period (OEP). This is a six month period starting the month you turn 65.
By enrolling during your OEP, you have a guaranteed issue right — meaning insurance companies cannot use medical underwriting to deny you coverage.
- An insurance company must sell you any Medigap plan it offers (not all companies may offer all plans).
- The insurer cannot charge you more for a Medigap policy than it charges someone without health problems.
- The insurance company cannot make you wait for your coverage to start (with certain exceptions).
If you wait beyond this six-month period and are in poor health or have a preexisting condition you may be denied coverage or have to pay higher premiums for a Medigap Plan D policy.
There are, however, certain situations that will allow you to buy a Medicare Supplement Plan at any time without medical underwriting. These include relocating or living in certain states that provide additional Medigap protections.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicare Services. (2020). Medicare & You 2021. Download. Retrieved from https://www.medicare.gov/sites/default/files/2020-12/10050-Medicare-and-You_0.pdf
- Bunis, D. (2020, July 6). Medigap Plans Help Bridge Gap of Original Medicare Costs. Retrieved from https://www.aarp.org/health/medicare-insurance/info-2017/choosing-right-medigap-plan.html
- U.S. Centers for Medicare & Medicare Services. (2020, February). Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare. Retrieved from https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf
- U.S. Centers for Medicare & Medicare Services. (n.d.). How to Compare Medigap Policies. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
- U.S. Centers for Medicare & Medicare Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap