- Medicare Supplement (Medigap) Plan J was discontinued on June 1, 2010. People already on the plan may keep it, but no new enrollees are accepted.
- Medicare Supplement (Medigap) Plan J was unique because it had built-in drug coverage, and provided benefits for at-home recovery and preventive services.
- Regulation changes in 2006 and 2010 made these unique benefits obsolete with the creation of Medicare Part D and with Original Medicare now covering at-home recovery and preventive services.
- If you’re on Medigap Plan J, it may be worth noting that premiums are rising due to the lack of new enrollees. Because of this, some people are switching to other Medigap plans.
- Medicare Supplement (Medigap) Plan G is a similar alternative to Medigap Plan J and it is available for all Medicare enrollees today.
Medicare Supplement (also known as Medigap) Plans are always evolving.
20 years ago, Medigap Plan J was widely popular but today, many people haven’t even heard of it!
That’s because the unique coverage Medicare Supplement Plan J provided became obsolete in 2010, and was discontinued. However, people who were already enrolled in Medigap Plan J were allowed to keep their plan, and a lot of people chose to do this.
In this article, we’ll go over everything you need to know about Medigap Plan J including:
- Everything Medigap Plan J covered,
- Why exactly Medigap Plan J was discontinued,
- Why you may want to switch out of Medigap Plan J if you’re eligible, and
- The alternative plans for Medigap Plan J.
We’ve been helping people get out of grandfathered plans for over 14 years.
We’re hoping this article will help you understand everything you need to know about Medigap Plan J.
What is Medicare Supplement Plan J?
Medigap Plan J was a type of Medicare Supplement Plan that people could sign up for to help cover the gaps in Original Medicare. It was considered popular during its time because many people considered it to provide comprehensive coverage.
However, with major changes to Medicare in both 2006 and 2010, Medigap Plan J’s unique coverage became obsolete and the plan was soon discontinued. People already on the plan were permitted to keep it, but no new enrollees were allowed.
People who chose to stay on Medigap Plan J are now generally paying double for coverage that’s already included in Original Medicare. Medigap Plan J’s costs may also be getting higher every year at a rapid rate because Plan J is now considered to be on an insurance “death spiral.”
But to fully understand that, let’s first take a look at what exactly Medicare Supplement (Medigap) plans are.
What Are Medigap Plans?
Original Medicare (Parts A and B) typically covers roughly 80% of your healthcare costs. One way to cover the remaining 20% is to sign up for a Medicare Supplement (Medigap) plan.
When you sign up for Medicare Part A (hospital coverage) and Medicare Part B (medical coverage), there are still six out-of-pocket costs you have to make aside from the monthly costs.
These are:
- Medicare Part A deductible – In 2024, you have to pay $1,632 out-of-pocket at the hospital before Medicare Part A starts covering you.
- Hospital copayments – After 60 days in the hospital, you’ll have to start making copayments. These are $408/day for days 61-90, $816/day for days 91-150 (using your 60 lifetime reserve days) and Medicare Part A will stop covering you after 150 days at the hospital.
- Skilled nursing facility copayments – After 20 days at a skilled nursing facility, you’ll have to start making a $204/day copayment until day 100. After day 100, you pay 100% of the costs.
- Medicare Part B deductible – In 2024, you have to pay $240 out-of-pocket for medical services before Medicare Part B starts covering you.
- Medicare Part B coinsurances – You generally have to pay 20% for your medical services
- Medicare Part B excess charge – Some healthcare providers can charge up to 15% more than the Medicare-approved amount. If they do, you’re responsible for paying this excess charge out-of-pocket.
Medicare Supplement (Medigap) Plans are provided by insurance companies to help you pay for these “gaps” (that’s why they’re called Medigap plans).
Today, there are ten Medigap plans you can choose from – Plan A, B, C, D, F, G, K, L, M, and N. Before June 2010, people could also sign up for Medigap Plan J.
Even though these plans are provided by private insurance companies, Medigap plans are standardized by the government. This means that all Medigap Plan F’s, Plan G’s, or Plan N’s cover the same thing, regardless of which insurance company you get it from.
Now that you know exactly what Medigap Plans are, let’s take a closer look at Medigap Plan J.
What Did Medigap Plan J Cover?
To give you a better idea of what Medigap Plan J covered, let’s compare it to Medigap Plan G, which is the most similar Medigap plan to Medigap Plan J available today.
| Medigap Plan J | Medigap Plan G | |
| Medicare Part A coinsurance and hospital costs (up to 365 days after Medicare benefits are used up) | ✅ | ✅ |
| Medicare Part B coinsurance and copayments | ✅ | ✅ |
| Blood transfusion (first three pints) | ✅ | ✅ |
| Medicare Part A hospice care coinsurance and copayments | ✅ | ✅ |
| Skilled nursing facility care coinsurance | ✅ | ✅ |
| Medicare Part A deductible | ✅ | ✅ |
| Medicare Part B deductible | ✅ | ❌ |
| Medicare Part B excess charge | ✅ | ✅ |
| Foreign travel emergencies | ✅ (up to plan limits) | ✅ (up to plan limits) |
| Out-of-pocket limit | ❌ | ❌ |
| At Home Recovery* | ✅ ($1,600/yr) | ❌ |
| Preventive Services* | ✅ ($120/yr) | ❌ |
| Prescription Drugs** | ✅ ($250 deductible) | ❌ |
*Benefits that Original Medicare started covering in 2010
**Benefit phased out in 2006 by the Medicare Prescription Drug, Improvement, and Modernization Act
Many people considered Medigap Plan J as the most comprehensive plan of its time because of all the boxes it checked.
It had higher monthly payments, but it covered all six gaps in Medicare, ensuring that people typically had almost no out-of-pocket costs aside from the drug coverage deductible and the plan’s monthly fee.
Medigap Plan J also included perks for at-home recovery and preventive services, which weren’t covered by Original Medicare before 2010.
It also had a built-in drug plan before the Medicare Prescription Drug, Improvement, and Modernization Act went into effect in 2006, which created Medicare Part D.
Why is Medigap Plan J No Longer Available?
Medicare regulation changes in 2006 and 2010 meant that Medigap Plan J now provided exactly the same coverage as Medigap Plan F. Therefore, Medigap Plan J was officially discontinued on June 1, 2010.
The changes that affected Medigap Plan J were the creation of Medicare Part D in 2006, and the inclusion of at-home recovery and preventive services to Original Medicare in 2010.
The Creation of Medicare Part D (2006)
Medicare Part D (Medicare’s prescription drug coverage plans) didn’t exist before 2006. That’s one reason Medigap Plan J was widely considered a popular Medigap plan at the time since it was one of the only Medigap plans that offered drug coverage.
However, in 2003, the Medicare Prescription Drug, Improvement, and Modernization Act was passed, which is considered one of the biggest overhauls in Medicare of all time. With it, Medicare Part D was created, and Medigap Plan J’s drug coverage was dissolved.
The Act came into effect on January 1, 2006.
People who had drug coverage through their Medigap Plan J before that time were allowed to keep it. For those who are still on the plan, Medigap Plan J’s drug coverage is still honored.
However, many people prefer Medicare Part D’s prescription drug coverage to Medigap Plan J’s drug coverage. If you are using Medigap Plan J’s drug coverage, be sure to compare them and come to your own decision about what’s right for you.
Original Medicare Includes At-Home Recovery and Preventive Services (2010)
The final nail to Medigap Plan J’s coffin was the Medicare changes in 2010.
Regulation changes meant that Original Medicare now covers in-home recovery (including medical devices) and preventive services (like vaccines and other screening services).
These were the only two differences between Medigap Plan J and Medigap Plan F. So, with Original Medicare now covering in-home recovery and preventive services, both plans now provided exactly the same coverage.
That’s why, on June 1, 2010, Medigap Plan J was officially discontinued. People still on the plan were allowed to keep it. However, no new enrollees can sign up for Medigap Plan J anymore.
Should You Keep or Get Out of Medicare Supplement Plan J (If Eligible)?
If you or a loved one are still enrolled in Medigap Plan J, there are some things you should be aware of.
Aside from paying double for perks already included in Original Medicare, Medigap Plan J may also be on an insurance death spiral. If you’ve noticed your Medigap Plan J monthly payments going up every year, this may be the reason why.
What are Insurance Death Spirals?
Insurance death spirals happen when the amount a plan spends on claims is greater than the income the plan gets from monthly payments. This often happens when a Medigap plan stops accepting new enrollees – and the pool of people enrolled in the plan starts to age and get sick.
Insurance companies rely on the monthly payments of healthy people in a plan to offset the costs for the claims of sick people.
With no new healthy people entering the plan, insurance companies may feel forced to raise the monthly premium significantly to pay for the rising cost of the insured’s treatment.
That’s why people on discontinued plans like Medigap Plan J may experience the monthly payments going up continuously, whereas they may not experience the same thing in a different plan.
What only cost $157 – $211/month in 2010 might cost much more than that today.(and it’s predicted to only get higher).
That’s why if you’re eligible, switching out of Medigap Plan J might save you a lot of money.
How to Switch Out of Medigap Plan J
If you are healthy, you may be able to switch from Medigap Plan J to any other Medigap Plan at any time. You do not have to wait for any Enrollment Period to do this.
One way to do this would be to call a licensed insurance agent. They can help you learn about all the options in your area and get any extra help you may need at no cost to you.
Note: Need help reassessing your Medicare situation? Call or text our team of licensed insurance agents at +1 877-360-6565 (TTY: 771)!
However, keep in mind that you may no longer be eligible to switch from Medigap Plan J to another Medigap Plan if you have a pre-existing health condition.
This is because most Medigap Plans have a medical underwriting process before you can enroll.
When you first enrolled for Medicare Part B, there was a six-month Open Enrollment Period that allowed you to get into a Medigap Plan without this medical underwriting process.
But if you’re enrolled in Medigap Plan J, this Open Enrollment Period should be already long gone. That’s why if you have any health condition, most Medigap companies will reject your application.
However, some states allow you to switch anytime, regardless of your health condition:
This means that if you live in California, Connecticut, Idaho, Illinois, Maine, Massachusetts, Nevada, New York, or Oregon, you can switch out of Medigap Plan J regardless of your health as long as you meet the state’s requirements or timeframes.
In Louisiana, you can switch to a plan from the same insurance company.
While in all other states, you must undergo medical underwriting before you can change your Medigap plan.
Popular Alternatives to Medigap Plan J
If you’re healthy, or you live in one of the states mentioned above, here are your other coverage options:
- Medigap Plan G – Medigap Plan G is considered a popular alternative for Medigap Plan J today. It has an average cost of $100 – $300/month depending on the state you live in, according to the pages of information on Medicare.gov. Aside from Medigap Plan J’s perks that are now obsolete, the only difference between Medigap Plans J and G is that Medigap Plan G doesn’t cover the Medicare Part B deductible (which is $240 in 2024).
- Medigap Plan N – Medigap Plan N has less coverage than Medigap Plan G but also typically has lower monthly payments with an average of $80 – $250/month. (We sifted through all the numbers so you don’t have to.) Aside from the Medicare Part B deductible, Medigap Plan N also doesn’t cover the Medicare Part B excess charge and has a copay (up to $20) for office visits and ER visits (up to $50).
- Medicare Advantage Plans – Medicare Advantage Plans are different from Medigap Plans. They are provided by private insurance companies, and they aren’t standardized – so insurance companies can offer as much or as little coverage as they want. Medicare Advantage Plans usually offer low to $0 premiums. They also typically partner up with local hospitals and doctors in your area to provide low-cost healthcare within their network.
Conclusion: Medicare’s Ever-Evolving Nature
Medicare is always changing, and Medigap Plan J is an example of this.
From one of the most popular plans 20 years ago, to most people not knowing it today, Medigap Plan J shows us that Medicare can change very fast.
If you’re not aware of these changes, you can end up spending a LOT more than you have to. People who are still on Medigap Plan J today are likely spending hundreds of dollars unnecessarily to keep their grandfathered plan.
That’s why Medicare education is critical!
Hopefully this article has cleared up any questions you might have had about Medigap Plan J.
If you have any more questions, or if you need help finding the best plan fit for you, call or text our team of licensed insurance agents today. Our services are no cost to you and we’re happy to help!