Medigap Plan B is one of the 10 Medicare Supplement insurance plans available in most states. It covers more than the base level Plan A, but less than the other Medigap options. Medigap Plan B helps to cover Original Medicare’s out-of-pocket costs, such as deductibles and coinsurance. This can help make coverage more affordable overall.
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How Medigap Works
Medicare Supplement insurance, also known as Medigap plans, are optional insurance policies for people with Original Medicare. They’re designed to help pay for the out-of-pocket costs, such as Original Medicare’s deductibles, copayments, and coinsurance.
Deductibles
Deductibles are a set amount of money people with Medicare need to pay out of pocket before their coverage kicks in. The annual deductibles for Original Medicare are:
- Part A deductible: $1,600 in 2023
- Part B deductible: $226 in 2023
For example, a beneficiary must pay the initial $226 for their Part B covered healthcare costs out of pocket in 2023 before Medicare begins paying its share.
Copayments and Coinsurance
Copayments and coinsurance are the shares you must pay as a patient for covered services, expressed as a percentage or a fixed dollar amount. For example, Original Medicare Part A requires a coinsurance fee of $400 per day for your 61st through 90th days of hospitalization in 2023. A Medigap plan can reduce or eliminate these out-of-pocket expenses, depending on the plan you select.
Bear in mind that Medigap plans work with Original Medicare, not Medicare Advantage. Original Medicare, also called Medicare Parts A and B, is the traditional Medicare program administered by the federal government. Medicare Advantage, also known as Part C, is a private health plan that replaces Original Medicare and provides Medicare-covered benefits — and oftentimes has additional benefits, such as Part D drug coverage.
Medigap Plan B is one of the 10 standardized Medicare Supplement policies available nationwide, with the exception of Wisconsin, Massachusetts, and Minnesota, which have their own state-specific plans. The others are Plans A, C, D, F, G, K, L, M, and N. Each lettered plan covers a different set of benefits, allowing Medicare beneficiaries to choose an option that best suits their needs.
What Does Medicare Supplement Plan B Cover?
Benefits | Plan B | Plan A | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|---|---|
Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | 100% coinsurance; but copays may still apply |
Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Part A deductible | Yes | Not covered | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
Part B deductible | Not covered | Not covered | Yes | Not covered | Yes | Not covered | Not covered | Not covered | Not covered | Not covered |
Part B excess charge | Not covered | Not covered | Not covered | Not covered | Yes | 100% | Not covered | Not covered | Not covered | Not covered |
Out-of-pocket limit | N/A | N/A | N/A | N/A | N/A | N/A | $6,940 in 2023 | $3,470 in 2023 | N/A | N/A |
Blood (first three pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Skilled nursing facility care coinsurance | Not covered | Not covered | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Foreign travel exchange up to plan limits | Not covered | Not covered | 80% | 80% | 80% | 80% | Not covered | Not covered | 80% | 80% |
Medicare Supplement Plan B offers coverage for the following out-of-pocket costs in Original Medicare:
- Part A deductible: For 2023, the deductible is $1,600 per benefit period. Medigap plan B covers this cost so you do not have to pay for it out of pocket.
- Part A hospitalization coinsurance: For inpatient hospital stays, Medicare charges $0 coinsurance for days 1-60, but then begins charging $400 per day for days 61-90 in 2023. Medigap Plan B covers costs for up to 365 additional days.
- Part A hospice coinsurance and copayments: Under Medicare’s hospice benefit, you may pay a copayment of up to $5 per drug and a 5% coinsurance for inpatient respite stays. These costs are covered under Plan B.
- Blood: Medigap Plan B will cover the first three pints of blood each year.
- Part B coinsurance: For Part B-covered services, you generally pay 20% of the Medicare-approved amount. Medigap Plan B covers these payments.
What Does Plan B Not Cover?
Medigap Plan B does not cover some of the benefits that may be included in other Medigap plans, such as:
- Skilled nursing facility coinsurance: A coinsurance of up to $194.50 per day applies to days 21 through 100 of a skilled nursing facility stay. Plan B does not cover this. This benefit is available from Medigap plans C, D, F, and G, with partial coverage from Plan K.
- Part B deductible: The annual deductible for 2023 is $226. Plan B does not cover this. This benefit is available to those who became eligible for Medicare before January 1, 2020 through Plans C and F.
- Part B excess charges: Some doctors bill up to 15% more than the Medicare-approved rate for Part B services. Plan B does not cover this. This benefit is available from Medigap plans F and G.
- Foreign travel emergency care: Some Medigap plans cover emergency medical care outside the United States, up to a lifetime limit of $50,000. Plan B does not cover this. Partial coverage is available from Medigap plans C, D, F, and G.
Medicare Supplement Plan B Eligibility
The eligibility requirements for Medicare Supplement Plan B are fairly straightforward. In general, Medigap plans are available to people who meet the following criteria:
- Must be enrolled in Original Medicare, not Medicare Advantage
- Must be enrolled in both Part A and Part B
- Must be 65 years old or older
Medicare beneficiaries under 65 may not be eligible for Medigap Plan B depending on where they live. In 33 states, insurers are required to sell one or more Medigap plans to people under 65, but other states may not have Medigap options available until the beneficiary ages into Medicare.
Are Medigap Plan B and Medicare Part B the Same?
Despite their similar names, Medigap Plan B and Medicare Part B are very different coverage options. It is possible to have both at the same time — in fact, you must have Medicare Part B before you may enroll in Medicare Plan B.
Medicare Part B is one half of Original Medicare , with Part A as the other half. It’s the part of Medicare that covers outpatient medical services, such as doctor’s visits and lab tests.
Medigap Plan B is supplemental insurance that helps pay for costs that aren’t covered by Original Medicare.
Plan B vs. Other Medigap Options
Plan B does not cover some benefits that are available in other Medigap plans, such as Part B excess charges, coinsurance for skilled nursing facility stays, and emergency care outside the United States. However, this plan may be a good option for people who do not necessarily travel internationally, or those in good health who want to avoid paying for coverage they likely will not need.
If you want coverage for the benefits excluded by Plan B, you may prefer other plans. For instance, Part B excess charges are covered by both Plan F and Plan G. Plans C, D, F, and G, M, and N cover 100% of the skilled nursing facility coinsurance, while Plans K and L offer partial coverage. Plans C, D, F, G, M, and N offer coverage for out-of-country medical emergencies. Compare options to determine which coverages best suit you based on your current and anticipated healthcare needs.
Plan B vs. Medicare Advantage
People with Original Medicare may choose to buy a Medigap Plan B policy to supplement their coverage, or they may decide to switch to a Medicare Advantage plan. When deciding which option is right for you, consider a few important factors:
- Healthcare budget: Compare healthcare costs for Plan B compared to Medicare Advantage. Medicare Advantage plans typically have additional benefits that Original Medicare and Medigap do not provide, such as Part D drug coverage, vision, and dental coverage. However, Medicare Advantage plans also tend to have more out-of-pocket costs.
- Health forecast: Consider your current health and family medical history to determine what health needs you may have in the future. Compare this to the coverages that Original Medicare and Medicare Advantage plans provide.
- Doctors and hospitals: Original Medicare and Plan B can be used at any provider that accepts Medicare nationwide, while Medicare Advantage plans limit care to a network of participating providers. If you travel often or your preferred doctors and hospitals are not on a Medicare Advantage plan’s network, Original Medicare may be a better choice.
How to Enroll in Medigap Plan B
If you want to enroll in Medigap Plan B or switch from another Medigap plan to Plan B, you may do so at any time. Unlike Original Medicare and Medicare Advantage, Medigap does not follow any enrollment windows except one: your initial enrollment period (IEP).
Your 6-month initial enrollment period begins when you are 65 or older and enrolled in Medicare Part B. For example, if you turned 65 and your Medicare Part B coverage began in April, you would have until the last day of September to enroll in Medigap during your IEP. Some people who are still working at 65 may choose to wait to enroll in Medicare Part B, rather than enrolling right when they are eligible. In this situation, your IEP is delayed until you enroll in Part B.
During your IEP, insurers are not permitted to charge higher premiums or deny your application because of your health history or status. This means you may find lower premiums and more coverage choices during this time. Outside of your IEP, insurers can use medical underwriting to charge higher for premiums or limit your Medigap options, or they may deny coverage altogether.