The introduction of Medicare has made it far easier to access the care and support you need if you are over 65 or have a permanent disability.
Unfortunately, the most basic packages lack some serious essentials and have the potential to leave you lacking coverage where you need it most.
Plan J has not been offered since 2010. It became obsolete in 2003, when Medicare Part D became available, which covers prescription drugs.
Without that coverage in Plan J, it became nearly identical to Plan F. So, Plan J was eliminated to wipe out the duplicate.
Plan J Benefits
Comprehensive coverage was one of the most notable benefits of Plan J and is one of the most significant benefits of Plan F.
It fills in coverage gaps left by Plans A and B and bolts on additional extras which make it more complete and better suited to meet any needs.
The two main aspects of Medicare are Parts A and B, which offer different benefits.
What does Part A cover?
The aspects covered by Part A include:
- Hospital care
- Hospice care
- Skilled nursing facility care
- Nursing home care
- Home health services
What does Part B cover?
The coverage from a Part B plan includes:
- Ambulance services
- Durable medical equipment
- Inpatient and outpatient mental health services
- Partial hospitalization for mental health services
- Limited outpatient prescription drugs
- Getting a second opinion before undergoing surgery
Put simply, Plans A and B are ideal for covering the basics of healthcare and medical necessity and would be a good step in getting you well.
However, both plans do include deductibles, exceptions, and conditions, and this means you can still run up a hefty bill if you fall ill. Medigap Plan J was designed to help fill in these gaps, ensuring that you are covered at every stage.
What did Medigap Plan J cover, and how does Plan F differ?
Plan J and F offer—or offered in J’s case—the following coverage:
- Part A deductible
- Part B deductible
- Part B excess charges
- Part B coinsurance or copayment
- Coinsurance and hospital stays lasting up to 365 days after your Medicare benefits are depleted
- First three pints of blood
- Hospice care coinsurance and copayment
- Skilled nursing facility care coinsurance
- Foreign travel up to plan limits (Plan J offered 100-percent coverage, Plan F is 80 percent)
These three benefits were part of Plan J and are not part of Plan F.
- Preventative care ($120 per year)
- At home recovery ($1,600 per year)
- Prescription drug benefits
Further medical expansion after 2003 led to Medicare also covering preventive care and at-home recovery, so along with prescription drug coverage, these coverages were no longer needed.
The aim of plans such as Plan J, of course, is to try and keep costs low wherever possible. Investing in a healthcare plan is a sensible alternative to building up substantial medical bills which can leave you in some serious debt.
The cost you will pay for your plan and supplement depends on several factors:
The plan you choose
The plan you opt for will affect the premiums you pay. As a general rule, Plan F is one of the highest-cost options.
Both Plan F, Plan G, and Plan C offer the most comprehensive coverage, and you can expect to pay a much higher cost for the privilege.
For supplements such as Plan N and Plan K provide fewer services and fewer benefits but offer lower monthly premiums which may be more affordable. This option could lead to you paying more for your care in deductibles or other costs.
Factors such as your age, gender, and eligibility for discounts will all have an impact on the costs, as will whether you smoke.
Your age upon enrollment can also be a factor; the later in life you leave it, the more likely you are to have pre-existing health conditions.
Also, if more than one member of your household is on Medicare, you may be able to claim a household discount. Check with your provider to see which is the best deal for you and your family.
Your zip code
The place you live could have a direct impact on the amount you pay for your premiums.
There is evidence that the prices between state can be dramatic, with prices ranging from super affordable to way out of budget, simply based on the location of your home.
While this is one aspect most can’t easily change—it isn’t easy to move—you can still shop around and locate the most affordable provider for your area.
As we mentioned previously, Plan J is sadly no longer available as an option to purchase. Those who are already enrolled on the plan are entitled to retain all the perks and benefits—many of which are no longer available to new customers.
It is worth remembering, however, that premiums for the Plan J will only continue to increase, and this could be an incentive for existing policyholders to switch.
This increased cost is primarily due to the age range of Plan J holders. Since all new sales ceased, the demographic is aging, and this brings with it a higher likelihood of having to claim.
This, in turn, allows the insurance company to raise premiums, and this plan could quickly become unaffordable for some consumers.
The good news for those looking to change, and those signing up for the first time, is that alternative plans are available.
At present, Plan F offers the best alternative, with many of the same perks and coverage as is provided in Plan J as detailed above.
Recent announcements, however, suggest that Plan F is due to be discontinued to new customers in 2020, and it may, therefore, be sensible to consider Plan G as a viable alternative.
Plan G is identical to Plan F, with the exception of paying the Part B deductible, which does make the plan more affordable.
If you choose to go with Plan F, applications that are approved before 2020 will be grandfathered in as they were with Plan J.
When purchasing one of the medigap plans, it is crucial to take the time to do your research and ensure that you are picking the plan which is the best match for you and your family.