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11.7 Standardized Medicare Supplement Coverage Requirements

The NAIC Model Law with respect to Medicare supplement policies was amended to revise the standardized Medicare Supplement plans delivered or issued for delivery in any state. Plans A, B, C, D, F, F with High Deductible, G, K, L, M, and N are available.

Plan A – Core Benefits​

Plan A is the basic Medicare Supplement (Medigap) plan and must be offered by all insurers that sell Medigap policies. It includes the core benefits, which are also required in all other Medigap plans. These core benefits include:

  • Coverage of Medicare Part A eligible hospitalization expenses for days 61 through 90 of a benefit period that are not fully covered by Medicare
  • Coverage of hospitalization costs for each lifetime reserve day used under Medicare Part A
  • After Medicare hospital benefits (including lifetime reserve days) are exhausted, coverage of 100% of Part A eligible hospitalization expenses for up to an additional 365 days (lifetime limit)
  • Coverage of the reasonable cost of the first three pints of blood under Medicare Parts A and B
  • Coverage of Part B coinsurance for Medicare-approved services, subject to the Part B deductible Hospice Care: Covers the cost-sharing amounts for all Medicare Part A–eligible hospice and respite care services.

Additional Benefits​

In addition to the core benefits provided by Plan A, Plans B through N include additional benefits in varying combinations and with certain limitations. Key benefits include:

  • Plans C and F cover the Medicare Part B deductible
  • All plans except Plans A and B provide coverage for skilled nursing facility care, including coinsurance for days 21–100 following a qualifying hospital stay under Part A
  • Plans F and G cover Medicare Part B excess charges, paying 100% of charges above the Medicare-approved amount
  • High-Deductible Plan F offers the same benefits as standard Plan F, but requires the insured to meet an annual deductible before benefits are paid; this deductible is set and adjusted annually by Medicare
  • Plans K and L provide similar benefits to other plans but with cost-sharing: Plan K pays 50% and Plan L pays 75% of covered services. Both plans include annual out-of-pocket maximums, after which the plan pays 100% of covered expenses for the remainder of the year
  • Plans C, D, F, G, M, and N include foreign travel emergency coverage, subject to a $250 annual deductible and a $50,000 lifetime maximum benefit

The following chart summarizes the available plans and their respective coverages:

Plan BenefitsABCDF*GKLMN
Part A Coinsurance✓✓✓✓✓✓✓✓✓✓
Hospital Costs (Up to 365 days)✓✓✓✓✓✓✓✓✓✓
Part B Coinsurance or Copay✓✓✓✓✓✓50%75%✓✓
Blood (1st 3 pints)✓✓✓✓✓✓50%75%✓✓
Part A Hospice Care Coinsurance or Copay✓✓✓✓✓✓50%75%✓✓
Skilled Nursing Coinsurance✓✓✓✓50%75%✓✓
Part A Deductible✓✓✓✓✓50%75%50%✓**
Part B Deductible✓✓
Part B Excess Charges✓✓
Foreign Travel Emergency (Up to Plan Limits)✓✓✓✓✓✓
Out-of-pocket LimitOut-of-pocket LimitOut-of-pocket Limit

Notes:

  • Plan F offers a high-deductible option
  • Plan N includes a $20 copayment for certain office visits and a $50 copayment for emergency room visits that do not result in hospital admission

Quiz​

1. Which Medicare Supplement plan is required to be offered by all insurers?

A. Plan F

B. Plan G

C. Plan A

D. Plan N

Correct Answer: C

Rationale: Plan A is the basic Medigap plan and must be offered by all insurers. It includes the core benefits that are also included in all other Medigap plans.

2. Which of the following benefits is included in all Medigap plans (core benefit)?

A. Part B deductible

B. Skilled nursing facility coinsurance

C. Part A coinsurance for hospital days

D. Foreign travel emergency care

Correct Answer: C

Rationale: All Medigap plans include core benefits, such as Part A coinsurance and hospital costs, while other benefits (like Part B deductible or foreign travel) vary by plan.

3. Which plans cover Medicare Part B excess charges?

A. Plans A and B

B. Plans C and D

C. Plans F and G

D. Plans K and L

Correct Answer: C

Rationale: Plans F and G pay 100% of Part B excess charges, meaning they cover costs above the Medicare-approved amount.

4. What is a key feature of Plans K and L?

A. They cover 100% of all services immediately

B. They include prescription drug coverage

C. They use cost-sharing and have annual out-of-pocket limits

D. They eliminate all deductibles

Correct Answer: C

Rationale: Plans K (50%) and L (75%) require cost-sharing but include annual out-of-pocket maximums, after which they pay 100% of covered services.

5. Which plans include foreign travel emergency coverage?

A. Plans A and B only

B. Plans C, D, F, G, M, and N

C. Plans K and L only

D. All Medigap plans

Correct Answer: B

Rationale: Foreign travel emergency coverage is included in Plans C, D, F, G, M, and N, subject to a deductible and lifetime maximum limit.