Medicare Supplement Plan D — also called Medigap Plan D — is one of the 10 supplement plans regulated by Medicare and sold by private health insurance companies in most states. The standardized Medigap plans are: Plan A, B, C, D, F, G, K, L, M, and N. However, residents of Massachusetts, Wisconsin, and Minnesota have their own Medigap offerings.
Medigap Plan D occupies the middle ground of Medicare Supplement plan options, offering more coverage than Plans A or B, but less than Plans C or F.
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How Medigap Plan D Works
Medigap Plan D works by covering the “gaps” in the out-of-pocket medical costs associated with Original Medicare. For example, Medigap Plan D pays for 100% of Part A coinsurance and hospital costs up to 365 days after Original Medicare benefits have been used. This plan also covers costs such as the Part A deductible and skilled nursing facility care coinsurance.
The cost of a Medigap premium may be significantly less than the out-of-pocket costs for Medicare, depending on the type and frequency of care you need. In this way, Medigap can make Medicare costs more affordable.
As of January 1, 2020, Medigap plans sold can no longer cover the Part B deductible, which means that Plan C and Plan F are not available to new Medicare enrollees. However, those who already have Plan C or F may continue to receive Part B deductible coverage.
It should be noted that Medigap plans only work with Original Medicare. Those with Medicare Advantage plans, which are alternatives to Original Medicare sold by private, Medicare-approved insurance companies, are not eligible for Medigap.
What Medicare Supplement Plan D Covers
Benefits | Plan D | Plan A | Plan B | Plan C | 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% | |
Part B deductible | Not covered | Not covered | Not covered | Yes | 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 | Yes | Not covered | Not covered | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Foreign travel exchange up to plan limits | 80% | Not covered | Not covered | 80% | 80% | 80% | Not covered | Not covered | 80% | 80% |
Medicare Supplement Plan D offers coverage for:
- Part A coinsurance and hospital costs: Plan D covers both coinsurance payments and hospital treatment costs.
- Part B coinsurance or copayments: Plan D provides coverage for Part B coinsurance and copayments for outpatient health services.
- Blood: This plan also covers the first three pints of blood drawn.
- Part A hospice care coinsurance or copayment: Plan D offers coverage for hospice care copayments and coinsurance to help bridge coverage gaps.
- Skilled nursing facility care coinsurance: Medigap Plan D also pays for SNF coinsurance.
- Part A deductible: If your Part A deductible is high, Plan D can cover the cost.
- Foreign travel exchange: Plan D covers up to 80% of emergency care in a foreign country during the first 60 days of your trip if your Original Medicare plan doesn’t cover these costs.
What Medicare Supplement Plan D Does Not Cover
The out-of-pocket costs that Medigap Plan D does not cover include:
Medicare Supplement Plan D Eligibility
You can purchase Medigap Plan D once you are enrolled in both Medicare Part A and Part B. As a result, eligibility criteria are the same as for Original Medicare. People who are 65 or older or who have received disability benefits from the Social Security Administration or the Railroad Retirement Board for 24 months in a row are eligible to enroll in Medicare Part A and Part B. They are also eligible for Medigap plans.
Some states require insurance companies to sell Medigap plans to people under 65 who are eligible for Medicare because they have been diagnosed with end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS), but this may come with an additional cost.
Plan D vs. Other Medigap Options
Plan D generally covers more than most of the other Medigap options still available. Plans C and F cover more than Plan D, but are no longer available unless you purchased them prior to January 1, 2020. Plan G also specifically covers Part B excess charges, which are not covered under Plan D.
Plan D may be a good choice if you have a medical condition that requires recurring hospital stays and care. Its wide range of cost coverage can help cut down on the out-of-pocket expenses once your Medicare benefits are applied.
Plan D vs. Medicare Advantage
Where the premium for Medigap Plan D is generally more expensive than the premium for Medicare Advantage, it may offer better savings for things such as hospital stays, Part A deductibles, and Part B coinsurance. This is because some Medicare Advantage plans offer $0 premiums, but still have their own deductibles, copays, and coinsurance costs. If you need frequent or recurring care, these expenses can add up.
Medigap plans, however, specifically address out-of-pocket costs, which can make Medicare coverage cheaper in the long term if you have regular healthcare needs. In addition, Medicare Advantage plans require you to seek care from in-network physicians and specialists, while you can seek care from any practitioner who accepts Medicare when you have Original Medicare and Medigap Plan D.
Those who are relatively healthy and do not need healthcare services too often may find enrolling in a Medicare Advantage plan to be more beneficial. However, those with conditions that require regular care may find Medigap Plan D a more affordable option.
Plan D vs. Part D
Medigap Plan D and Medicare Part D share the same letter, but differ in what they offer for coverage.
Medicare Supplement Plan D offers coverage for Part A and Part B coinsurance and copayments, along with coverage for Part A deductibles and coinsurance for hospice care or skilled nursing care.
Medicare Part D, meanwhile, provides prescription drug coverage, which is not offered under Medigap Plan D. Different tiers of Medicare Part D coverage offer access to more expensive brand-name prescriptions.
How to Enroll in Medigap Plan D
Enrollment in Medigap Plan D is governed by enrollment periods, which are specific periods of time during which you can enroll in Medigap for the first time or switch from other plans. While it may be possible to obtain Plan D coverage outside of these enrollment periods, it can come with significant costs.
There are three common Medigap enrollment periods: The Individual or Initial Enrollment Period, the Medicare Open Enrollment Period, and the Special Enrollment Period.
Individual Initial Enrollment Period
- When: The first month you have Medicare Part B coverage, and lasting for 6 months
- What You Can Do: Enroll in any Medigap plan in your state
During the Individual Enrollment Period, you can enroll in any Medigap Plan offered in your state. This is the ideal time to purchase a Medigap plan because you are entitled to the same policy rate as people in good health, even if you have preexisting conditions. After this period, you may apply at any time for a Medigap plan, but insurers can use medical underwriting to increase your rates or deny your coverage altogether.
Special Enrollment Periods
- When: Varies
- What You Can Do: Get Medigap Plan D
In specific events, you may be eligible for a special enrollment period and have a guaranteed issue right to buy for a Medigap policy. In these cases, insurers must offer you Medigap plan options and are prohibited from charging you more because of your health status or preexisting conditions.
Some of the events that may trigger a special enrollment period include:
- Losing your employer-sponsored health insurance
- Losing your previous Medigap plan because the insurer went bankrupt
- Switching to Original Medicare after losing your Medicare Advantage coverage