One reason that it’s so difficult to keep up with Medicare is that it’s constantly changing. The government is always adding or taking away restrictions on health care. Not only does Medicare coverage continue to change, but supplemental insurance continues to cover as well.
Medicare is an excellent government program, and it helps provide healthcare coverage to millions of seniors across the nation, but it doesn’t cover everything. In fact, there are a dozen different expense categories that Medicare Parts A and B don’t cover. Those expenses could leave you with massive medical bills and hospital fees.
Those massive bills could turn your retirement dream into a nightmare. It’s important that you get the health care coverage that you need to ensure that you aren’t responsible for hospital bills that would drain your bank account.
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Every year, I get a lot of questions about Medigap Plan J, which is no longer available. It’s important that you understand all of the plans, and if you have a Plan J, you will need to understand your coverage and some other similar options.
What Is a Medicare Supplemental Plan J?
Medigap plans are sold by private insurance companies, and they work together with your original Medicare Parts A and B to give you additional coverage that you wouldn’t get with just your traditional coverage. There are ten different supplemental plans that you can choose from, all of them are going to have different coverages and gaps that they fill.
Some plans are going to be more basic than others. A Medigap Plan A is going to be one of the most basic, and it’s going to leave more gaps in coverage than other plans, like supplemental Plan F, which is the most comprehensive policy.
Plan J was one of the most popular options for Medigap coverage because of the additional insurance protection that it provided to enrollees. If you have a Plan J still, then you have the most coverage that you can buy. In fact, the law no longer allows you to get some of the coverage.
With your Plan J, you will get the basic coverage categories, like Part A coinsurance and hospital costs for an additional 365 days after your original Medicare coverage has expired. If you’ve ever stayed the night in a hospital for whatever reason, you know that it can be an expensive stay.
With traditional Medicare, you will get some hospital fee coverage, but after that coverage ends, you’ll be responsible for all of those bills out-of-pocket. With a Medicare Plan J (or any supplemental plan for that matter), you will get additional coverage that can protect your savings if you’re ever in the hospital for several weeks.
Some of the additional coverage that came with Plan J was paying the Part A and B deductibles. The deductible is the amount that you have to reach before your Medicare coverage kicks in. If you had a Plan J, then you wouldn’t be responsible for paying that bill. Every year, the Part B deductible changes. In 2023, this threshold is $226.
Plan J would also pay for any Part B excess charges. When you go to the doctor or hospital to get any service, there is a pre-determined amount that Medicare B will pay. The doctor is legally allowed to charge 15% more than that amount. Anything about that pre-determined amount is considered excess charges. If you don’t have supplemental coverage, you will have to pay for all of those excess bills out of your pocket.
One of the unique coverage categories of Plan J was the prescription coverage that it provided. Plan J will help cover some of the rising costs of medications. The prescription coverage was one of the main reasons that Plan J was so popular.
What Happened to Medigap Plan J?
As I’ve already mentioned, Medigap Plan J is no longer available. There were several changes in the early 2000s that made these plans unavailable for new enrollees. Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which changed the way that Medicare was structured. When this act was completed, they started Medicare Part D prescription drug coverage.
Once Part D began, it meant that Plan J was providing duplicated coverage and that Plan J was now obsolete. The new law made it illegal for any supplemental coverage to pay for medication expenses, which meant that Plan J was identical to Plan F, and there was no reason for having two identical plans. If you held a Plan J at that point, you could keep your supplemental coverage, and you weren’t required to switch policies.
After that point, nobody else was able to enroll in Plan J, but there were several other quality options that you could choose from. It’s vital that you get the perfect supplemental insurance for your health care needs.
Alternatives
The obvious alternative to Plan J is to purchase a Plan F. The plans are identical minus the prescription coverage that Plan J is no longer allowed to give to its enrollees. Plan F will give you all of the comprehensive coverage that the other plans won’t provide. If you want to get the most coverage possible, then Plan F is going to be the best choice.
On the other hand, if you decide that you don’t want as much coverage, and you would rather save money, then a smaller plan is going to be a much better option. A Medigap Plan A or B will fill in a few of the gaps that Medicare doesn’t pay for. With a smaller plan, you won’t get as much additional coverage, but you are going to save money every month.
Deciding Which Plan
There are several different factors that you will need to consider when you’re shopping for supplemental insurance coverage. The first factor that you will need to look at is your finances. Everyone would love to have a Plan F which gives the most coverage, but not everyone can afford that comprehensive plan. Before you purchase any additional coverage, take a look at your budget and decide how much you can spend every month on that supplemental protection.
The next factor that you need to answer is your medical history and your family tree. The older you get, the more that you’re going to spend on health care, and those expenses could drain your savings account, but that’s where your Medigap plan comes in. If you’re in poor health, then you will need to purchase a comprehensive policy that gives you the most coverage possible.
Medigap Open Enrollment
One of the most important things to realize about Medigap plans is when you should purchase one of these plans. Once the month that you turn 65 begins, your Medigap Open Enrollment Period begins.
During this time, the insurance company can’t decline your application, regardless of your health or any health complications that you may have. If you’re in terrible health, this could be the only chance that you have to get coverage.
Additionally, if you apply during the open enrollment, the company can’t increase your premiums, even if you have health complications. If you want to save money, it’s vital that you apply during the six-month window of open enrollment. After the six months is over, then your application will be treated as a normal application, which means that you could get drastically higher premiums.
Any Questions About Medigap Plan J?
Because Plan J is no longer available, I don’t get a lot of questions about the plan, but there are still people with these plans. It’s vital that you get the perfect supplemental coverage. You’ve worked hard to reach this stage of life, don’t let medical bills wreck your retirement dream.
If you have any questions about Medigap Plan J or any of the alternatives, please contact an experienced Medicare supplemental insurance agent or me today.
Bottom Line: Medicare Supplement Plan J Explained
Medicare Supplemental Plan J, once a popular Medigap choice, offered extensive coverage, including unique prescription benefits. However, post the introduction of Medicare Part D, Plan J became redundant and was phased out. Existing enrollees can retain their Plan J, but new applicants should consider Plan F as the closest alternative.
When choosing a Medigap plan, consider your financial capacity and health needs. Importantly, utilize the Medigap Open Enrollment window post your 65th birthday to benefit from non-rejection and standard premium rates. Ensuring the right supplemental coverage is crucial to safeguarding your retirement against unforeseen medical expenses.
Can an O.D. eye doctor accept medicare, bill medicare and Banker’s Life and still send me a balance bill.
We are living in an extended care retirement community. I need Tom know exactly what our Plan J will cover as our
medical needs are more demanding with age.
Many Thanks
What will my coverage be with plan J
This is confusing about Plan J even though no longer available. I think there are still medi-gap plans available if you do not have an advantage plan and are choosing A, B, and then D separately. It turns out my 89 year old mother has plan J. My understanding now is that there is Plan A (Hospitalization-no charge), Plan B (Doctors and is charged and deducted from the social security check), Plan C is a Senior Advantage Plan and premium charges are decided by the insurer), and Plan D (Prescriptions and a charge if not on an advantage plan). Many advantage plans have prescription coverage. I don’t know what Plan F is-never heard of it at Medicare workshops. At my work, we are offered three types of United Healthcare Senior Advantage Plans with premiums (more expensive than Kaiser) and one Kaiser Senior Advantage Plan with a $155 per month premium (California). So what is better, keeping the Plan J as she is grandfathered in, or switching to a Senior Advantage Plan? Thank you
I have Plan J also I have AARP Medicare RX plans should I have both of them?
Thank You L. Hanke
Dear Sir: I currently have a Medicare Supplement plan J with Bankers Life and Casualty Company and have had it for 20 years. I have been advised that Bankers Life now has a plan D which I’m told is identical to plan J in coverage except you do have an annual $185 co-pay with plan D and plan D is 1/2 the cost of plan J. Seems to me that is hard to believe, that it is 1/2 the cost with the identical coverage, except for the $185 annual co-pay. Could you shed some light on this for me and your suggestions?
Thank you and looking forward to hearing from you.
My wife and I have had plan J thru AARP since 2007. Most recently I went to Mayo Clinic
in Jacksonville, FL who is a medicare non participant. I was informed by medicare that as of April 1 2013 they only reimburse 78% of the approved charge and not the usual 80%.for a non participating provider. Is that true??
I thought that my Plan J picked up all the excess charges including the 2% differential. However AARP assumed I received 80% which I didn’t . I am currently out the 2%. Are they in the wrong and should I fight it??
Thank
Glenn Martin
My mom has plan J. Does plan J cover her deductible of $183?..Last week 1/10/ 2019 her eye Dr charged her $183..She has had this plan J for many years.
Hi Darvin – According to the Medicare website the deductible is $2300 for 2019.
How much is the agent average commission for enrolling people in a Medigap.
Hi JA – It depends on the company issuing the plan, and what their compensation arrangement is. I’m not an expert on the compensation side of these plans, but I believe there may be federally regulated limits on the amount.
Two things apparently have been removed from Plan J since I started Medicare in 2007. Preventative care up to $120 as well as At-Home Recovery coverage (up to plan limits) have both been removed from Plan J. Whether or not I was ever notified of this is questionable.
It appears to me these were removed so that Plan J would be essentially Plan F. I still have Plan J and I can see that Plan J is still less expensive than Plan F. I did speak to an agent who said that Plan J was the Cadilac of plans available at the time. I plan to stay with Plan J for my wife and I at least through 2019. My question: Is Plan J now identical to Plan F? Or is there another plan that would be even better for me than Plan F if I decide to change.
Hi Ned – It’s not an exact replica, but it’s now the highest level of Medicare supplement insurance you can get. So effectively, Plan J is now Plan F.
I have plan j. Question about duplicate coverage j vs f and supplemental coverage for medication expense. Does jpay for supplemental coverage that f no longer covers. How can i know if i am getting more benefit from keeping j in this particular area
Second question. Understand that j offers overseas medical expense and medical evacuation coverage I travel overseas and my credit card offers all the travel related coverage i need but not medical or medical evacuation coverage. I have bought policies which cover all the above. They duplicate and are expensive Will plan j suffice for this medical and evacuation protectionas as a stand alone protection thank you.
Hi Bea – the best I can do on the first question is this link. As to your second question, Medicare will pay on VERY limited foreign expenses:
1.You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or
injury.
2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.
3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of
whether it’s an emergency.
AARP tells me that Plans J and F are not in fact identical. Under F, your at-home recovery is limited to things a visiting nurse can do, like take your blood pressure and check bandages, etc. Under Plan J, you are entitled to paid help with daily activities — whether someone empties the cat litter box for you or does a load of wash. For the difference of a couple hundred bucks a year, is this worth it? Thank you.
Hi Lindsy – You have to determine if you need the specific services provided before making that choice. You certainly don’t want to sign up for benefits you may never need.
My wife and I have Suppoemental Part J with United Health Care on top of A, B and D. Despite our respective ages of 83 and 80, we are in very good health. We are also well of. My guiding priority re Medicare is maximum coverage and cost of coverage is not an issue. NOW: an agent of United Health care would like us to sbandom Part J and move to plan F.By DecemberR 7. I am reluctant to follow his advise. Am I correct?
Hi Eriberto – This is too important to take lightly. Please discuss this with either an elder care lawyer, or a doctor who works extensively with Medicare patients, and is familiar with the difference.
I have read that Plan J due to limited enrollees will eventually have premium increases in the future. Is that possible? Plus, due to the built in prescription drug plan, does the Plan J keep track with Medicare’s 2019 increase of $3820 Initial Coverage Limit?
Thank you,
‘Edward
Hi Edward – It’s not possible to say, since the cost of all things healthcare related are going up in cost. I’m not aware if it will keep track with the 2019 increase.
Jeff,
I am trying to find out how the Plan J prescription coverage works. Was this feature standardized among all companies?
If so, was it just a set dollar amount yearly?
I am looking at this for someone in their 90s who is taking a lot of medications, including 2 insulins and Eliquis. Even with a late enrollment penalty and donut hole on a new drug plan, I am wondering if they would save money by leaving Plan J for Plan F sup and a part D plan.
It all depends on how good or bad the Plan J drug coverage is.
Thanks,
Marcus Lynch
Bristol, VA
Hi,
With Plan J no longer available, is there any way to get a copy of the policy booklet? My mother-in-law has plan J but cant find the booklet.
Thanks,
Anita
Hi Anita – Plan J is no longer available so there is no booklet to be had.