Does Medigap Cover the Part B Deductible?

Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, provides substantial coverage, but it does not cover all healthcare costs. Beneficiaries often face various out-of-pocket expenses, including deductibles, copayments, and coinsurance. Supplemental insurance options, such as Medigap policies, can help manage these costs by covering some of what Original Medicare does not, particularly the Medicare Part B deductible, a common financial concern for many.

Understanding Medicare Part B and its Deductible

Medicare Part B primarily covers medically necessary services and preventive services. Medically necessary services are those required to diagnose or treat a medical condition, including doctor visits, outpatient hospital care, and some home health services. Preventive services, such as flu shots and certain screenings, are also covered to help prevent illness or detect it early.

Beneficiaries are responsible for an annual deductible under Medicare Part B before Medicare begins to pay its share of approved services. For 2025, this deductible is set at $240. After this annual amount is met, Medicare typically pays 80% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. This initial out-of-pocket payment can represent a significant expense for many individuals, especially those with frequent medical appointments or procedures.

Medigap Plans and Part B Deductible Coverage

Medigap, also known as Medicare Supplement Insurance, consists of policies sold by private companies designed to help pay some of the healthcare costs that Original Medicare does not cover. These policies work with Original Medicare by covering expenses like copayments, coinsurance, and deductibles. Medigap policies are standardized across most states, meaning that each plan letter, such as Plan A or Plan G, offers the same basic benefits regardless of the insurance company selling it.

Several Medigap plans specifically cover the Medicare Part B deductible. Plans C, F, and High-Deductible F historically covered this expense, but they are no longer available for purchase by individuals new to Medicare on or after January 1, 2020. Those eligible for Medicare before this date, or who already have these plans, may still be able to buy or keep them.

For individuals new to Medicare on or after January 1, 2020, Medigap Plan G and High-Deductible Plan G are relevant options that cover the Part B deductible. Plan G covers the Part B deductible directly. High-Deductible Plan G covers the Part B deductible only after the plan’s own high deductible is met. Once the Part B deductible is satisfied, these plans generally pay 100% of the remaining Part B costs, such as the 20% coinsurance for doctor visits and outpatient care, up to Medicare-approved amounts.

Key Considerations When Selecting a Medigap Plan

When choosing a Medigap plan, focusing solely on the Part B deductible coverage may not provide a complete picture of a plan’s value. Beyond the Part B deductible, it is important to consider other costs a plan might cover, such as the Part A deductible, Part B excess charges, or foreign travel emergency care. Evaluating these additional benefits helps ensure comprehensive coverage tailored to individual healthcare needs.

While the benefits for standardized Medigap plans are consistent across insurers, premiums for the same plan can vary significantly between different insurance companies. Factors like the company’s pricing method, available discounts, and the applicant’s age or health at the time of application can influence these differences. Therefore, comparing rates from multiple providers is beneficial.

The Medigap Open Enrollment Period is a 6-month window that begins the month an individual turns 65 and enrolls in Medicare Part B. During this period, individuals have a guaranteed right to purchase any Medigap policy offered in their state, irrespective of their health conditions, and insurers cannot charge more due to health status. This is generally the most advantageous time to buy a Medigap policy.

Outside of this open enrollment period, insurance companies can use medical underwriting to determine whether to sell a Medigap policy and at what price. This means they can deny coverage or charge higher premiums based on health, unless a guaranteed issue right applies. Guaranteed issue rights are specific situations that allow individuals to buy a Medigap policy without medical underwriting, such as losing employer-sponsored health coverage. Medigap policies do not cover prescription drugs; a separate Medicare Part D plan is necessary for this coverage.