What Supplemental Insurance Covers for Part B Deductibles

Supplemental insurance (also called Medigap) can cover your Medicare Part B deductible, but only if you buy a plan that includes that benefit. Not all Medigap plans do. Plans C, D, G, M, and N cover the Part B deductible in full. Plans A, B, K, and L do not cover it at all. Plans F and High Deductible F cover it, but High Deductible F requires you to pay a separate deductible first before the plan pays anything.

The Part B deductible changes each year. In 2024, it is $240. Your Medigap plan will pay this amount directly to Medicare or to your doctor's office once you meet it, so you do not have to pay it out of pocket if your plan covers it.

The catch is that you must enroll in a Medigap plan during your open enrollment window to get this coverage. If you miss that window, you may face higher premiums or be denied coverage altogether, depending on your state and your health history.

Key Takeaways

  • Medigap plans C, D, G, M, and N cover the Part B deductible in full; plans A, B, K, and L do not.
  • The Part B deductible amount changes yearly and must be met before Medicare begins to pay its share of covered services.
  • You must enroll in a Medigap plan during your initial enrollment window (usually within six months of turning 65 or enrolling in Medicare Part B) to avoid higher premiums.
  • High Deductible Plan F covers the Part B deductible but requires you to pay a separate deductible before the plan begins paying.

Which Medigap Plans Cover the Part B Deductible

Medigap plans are standardized by the federal government, which means the same plan letter offers the same benefits no matter which insurance company sells it. The difference is in price and customer service, not in what is covered.

Plans that cover the Part B deductible are C, D, G, M, and N. Plan G is the most popular choice among people who want deductible coverage because it covers nearly everything Original Medicare does not, including the Part B deductible and copayments. Plan M covers the Part B deductible but requires you to pay 50 percent of the Part B excess charges (charges above what Medicare allows). Plan N covers the Part B deductible but charges you a copayment for some doctor visits and emergency room visits.

Plans A, B, K, and L do not cover the Part B deductible at all. If you choose one of these plans, you will pay the full deductible yourself when you see a doctor or have a test done. Plan F and High Deductible Plan F do cover it, but Plan F is no longer sold to people new to Medicare as of 2020.

How the Part B Deductible Works with Supplemental Insurance

When you see a doctor or have a test covered by Medicare Part B, Medicare does not pay anything until you have paid the Part B deductible. Once you reach that amount out of pocket, Medicare then pays its share (usually 80 percent), and you pay the remaining 20 percent as a copayment.

If your Medigap plan covers the Part B deductible, the plan pays that deductible for you. This means you do not have to save up money to meet it before Medicare starts paying. The insurance company may pay the deductible directly to Medicare, or it may reimburse you after you pay it. Either way, the deductible is covered.

Without supplemental insurance, you would pay the full Part B deductible yourself, plus the 20 percent copayments on all covered services for the rest of the year. This can add up quickly if you see multiple doctors or have tests or procedures done.

When You Can Enroll in a Medigap Plan

Your best chance to enroll in a Medigap plan without facing higher premiums is during your initial enrollment period. This is a six-month window that starts the month you turn 65 and enroll in Medicare Part B. During this time, insurance companies cannot deny you coverage or charge you more based on your health history.

If you miss this window, you can still enroll in a Medigap plan, but the rules change. Some states allow you to enroll at any time, but most states allow insurance companies to charge you higher premiums based on your age and health conditions. A few states have limited open enrollment periods each year. Check your state's rules before you miss the important date.

If you already have employer health insurance when you turn 65, you may have a different enrollment window. Talk to your employer's benefits office or your state health insurance counselor to find out when you can enroll without penalty.

The Cost of Medigap Plans That Cover the Part B Deductible

Plans that cover the Part B deductible cost more than plans that do not. Plan G, which covers the deductible and most other out-of-pocket costs, typically costs between $100 and $200 per month, depending on your age, location, and the insurance company. Plan M and Plan N are usually cheaper because they do not cover all costs.

The price you pay depends on three things: your age when you enroll, where you live, and which insurance company you choose. The same plan letter costs different amounts from different companies. It is worth calling three or four companies to compare prices before you decide.

Some people find that the monthly premium for a plan that covers the deductible is worth it because they avoid the surprise of having to pay $240 or more out of pocket at the start of the year. Others prefer a cheaper plan and accept that they will pay the deductible themselves. The right choice depends on your budget and how often you see doctors.

What Happens If You Do Not Have Supplemental Insurance

If you have Original Medicare but no Medigap plan, you are responsible for paying the Part B deductible yourself. You also pay 20 percent of the cost of most covered services after you meet the deductible. For some services like hospital stays, you may owe even more.

Medicare Part B also has no annual out-of-pocket limit, which means your costs can keep growing throughout the year if you have many medical needs. This is one reason many people choose to buy a Medigap plan — to cap their costs and know what they will pay each month.

If you cannot afford a Medigap plan, you may be able to get help paying for Medicare costs through your state's Medicare Savings Program. This program pays some or all of your Part B premiums, deductibles, and copayments if your income is low enough. Contact your state Medicaid office or call 1-800-MEDICARE to learn about you may have access to.

Frequently Asked Questions

Can I switch Medigap plans if I want better deductible coverage?

Yes, but the rules depend on when you switch. If you switch within your first year of having Medigap, most states allow you to change plans without medical underwriting. After that, insurance companies can deny you or charge you more based on your health. Some states have annual open enrollment periods for Medigap, usually in the fall.

Does Medicare Advantage cover the Part B deductible?

Medicare Advantage plans (Part C) are different from Medigap. Many Medicare Advantage plans do cover the Part B deductible, but you should check your specific plan's details. Medicare Advantage plans also have different rules about which doctors you can see and how much you pay out of pocket.

What if I enroll in Medigap after my initial enrollment period?

You can still enroll, but you may pay higher premiums. Some states protect you from higher premiums if you enroll within a certain time after losing other coverage. Your state health insurance counselor can tell you what protections explore where you live.

Does the Part B deductible reset every year?

Yes. The deductible resets on January 1 each year. The amount changes annually based on Medicare's cost estimates. Your Medigap plan will cover it again each year if your plan includes that benefit.

Can I use my Medigap plan to cover the Part B deductible if I have not met it yet?

Yes. If your plan covers the Part B deductible, it pays the full amount as soon as you need it. You do not have to wait or meet any other requirement. The plan pays it directly, so you do not have to pay and then get reimbursed.