Plan D mirrors Plan G but drops Part B excess coverage. For beneficiaries whose doctors accept Medicare assignment (most do), the dropped coverage rarely matters.
Best for
- Beneficiaries whose providers all accept Medicare assignment
Watch out for
If a provider charges over Medicare-approved amount, you pay it.
What Plan D covers
- Part A coinsurance & 365 extra hospital daysCovered in full
- Part B coinsurance or copaymentCovered in full
- Blood (first 3 pints)Covered in full
- Part A hospice coinsurance / copayCovered in full
- Skilled nursing facility coinsuranceCovered in full
- Part A deductibleCovered in full
- Part B deductibleNot covered
- Part B excess chargesNot covered
- Foreign travel emergency (up to plan limits)Covered in full
Compare to other Medigap plans
- Plan AThe minimum-coverage Medigap plan - basic benefits only.
- Plan BPlan A plus the Part A deductible.
- Plan CComprehensive coverage - closed to anyone newly eligible after Jan 1, 2020.
- Plan FThe 'everything' plan - closed to newly eligible after Jan 1, 2020.
- Plan GToday's most popular Medigap plan - comprehensive coverage minus only Part B deductible.
- Plan KLower premium, partial coverage with out-of-pocket cap.
- Plan LLike Plan K but covers more - 75% of most cost-sharing.
- Plan MSplits the Part A deductible 50/50 between you and the plan.
- Plan NLower premium than Plan G in exchange for office and ER copays.
What Does Medigap Plan D Cover?
Plan D is nearly a twin of Plan G. It covers seven of the nine benefits on the standardized Medigap chart. Two are left to you, and only one of them is unusual.
What Plan D pays in full
Hospital costs after Medicare stops
Plan D covers Part A coinsurance and adds 365 extra hospital days for life. It also pays the Part A deductible for every benefit period.
Your share of doctor and outpatient bills
Once the yearly Part B deductible is met, Plan D covers your coinsurance and copays.
Skilled nursing coinsurance
Rehab after a qualifying hospital stay is covered in full for the first 20 days by Medicare. Plan D picks up the daily charges that follow.
Blood, hospice, and foreign travel
The first three pints of blood, hospice drug and respite copays, and emergency care abroad up to your policy limits.
The short version
Plan D is Plan G without Part B excess coverage. You pay the yearly Part B deductible under both letters. Everything else on the chart matches.
Are Part B Excess Charges a Real Risk in California?
This is the whole question behind Plan D, so it deserves a straight answer. An excess charge happens when a provider does not accept Medicare assignment.
How an excess charge happens
- 01
Medicare sets an approved amount for the service
Most doctors agree to accept that amount as payment in full. They are called participating providers.
- 02
A non participating provider may bill more
Federal law caps the extra at a limited percentage above the approved amount.
- 03
That extra falls to you or your plan
Plan G pays it. Plan D does not, so the charge lands on your bill.
- 04
Some states ban the practice, California does not
So the risk here is small for most people, but it is not zero.
One question closes the risk
Ask any new provider whether they accept Medicare assignment. Most doctors in California do. If yours all say yes, Plan D's missing benefit costs you nothing in practice.
Who Is Plan D a Genuine Fit For?
Who this is for
Plan D tends to fit you if:
- Every doctor you see accepts Medicare assignment.
- You want rehab and travel coverage without paying for excess charges.
- You found a carrier pricing Plan D clearly below its own Plan G.
- You are on the guaranteed issue list and Plan D is one of your options.
- You want broad coverage and prefer to trim the benefit you are least likely to use.
Plan D is not sold by every carrier, and it is not always priced aggressively. Some companies list Plan D within a few dollars of Plan G. When that happens, the reason to choose Plan D disappears.
The honest tradeoff
You are saving on a benefit you probably will not need, but the savings only count if they are real. Always compare the two letters at the same carrier and across carriers before you decide.
Plan D or Plan G: What Really Separates Them?
One line on the chart. That is the entire difference, and it is worth seeing side by side.
Plan D vs Plan G
Medigap Plan D
Broad coverage minus Part B excess charges. Sold by fewer carriers.
- Part A coinsurance and 365 extra days
- Covered in full
- Part A hospital deductible
- Covered in full
- Part B coinsurance and copays
- Covered in full
- Skilled nursing coinsurance
- Covered in full
- Blood and hospice coinsurance
- Covered in full
- Foreign travel emergency
- Covered up to plan limits
- Part B deductible
- You pay it each year
- Part B excess charges
- Not covered
- Availability
- Fewer California carriers offer it
Medigap Plan G
The most complete letter open to new enrollees today.
- Part A coinsurance and 365 extra days
- Covered in full
- Part A hospital deductible
- Covered in full
- Part B coinsurance and copays
- Covered in full
- Skilled nursing coinsurance
- Covered in full
- Blood and hospice coinsurance
- Covered in full
- Foreign travel emergency
- Covered up to plan limits
- Part B deductible
- You pay it each year
- Part B excess charges
- Covered in full
- Availability
- Offered by nearly every carrier
If you want a lower premium and can accept per visit copays instead, Plan N is the other letter worth pricing. It trades excess coverage for small office and emergency room copays.
How Do California's Birthday Rule and Trial Rights Work?
California protects supplement holders better than most states. Two rules matter, and they solve different problems.
The California birthday rule
- 01
The window opens 30 days before your birthday
It runs 60 days in total and closes 30 days after your birthday. There are no extensions.
- 02
You must already hold a supplement
The rule moves you between Medigap policies. It is not a door out of Medicare Advantage.
- 03
Equal or lesser benefits only
From Plan D you can keep Plan D with another carrier, or step down to a lighter letter. Moving up to Plan G is not part of this rule.
- 04
No health questions
The new company must issue at its standard rate for your age, whatever your health history looks like.
Trial rights and the guaranteed issue list
Joined a Medicare Advantage plan when you first turned 65? You have twelve months to leave and buy any supplement sold in California.
Dropped a supplement to try Advantage for the first time? The same twelve month clock applies, and Plan D sits on the guaranteed issue list you can choose from.
What Happens When You Apply Outside a Protected Window?
Then the carrier reviews your health and decides. Prescriptions are the part people forget, and they often tell the carrier more than the questionnaire does.
- Your prescription history, including start dates and dose changes
- Recent treatment, testing, or surgery, usually looking back two to five years
- Anything still unresolved, such as a scheduled procedure or a pending result
- Use of oxygen, dialysis, insulin, or in home care
- Height and weight measured against the carrier's build chart
Different carriers, different answers
Health rules are not uniform. One company may decline a condition another accepts at a standard rate. We read those rules before you apply, so your application goes where it has a real chance.
How Do You Price Plan D in Orange County?
Since benefits are standardized, the job is finding the carrier that prices Plan D well and raises rates gently. That takes a full board of quotes, not two or three.
- Today's rate for your exact age and ZIP code
- The carrier's rate increase history over recent years
- Household and bank draft discounts you may qualify for
- Whether that carrier's Plan G is close enough to be the better buy
- Your Part D drug plan, priced against your actual medication list
We are an independent agency at 2135 N Pami Circle in Orange, licensed in California under #0718082. Meet us in person, by video, or by phone. Call (714) 922-0043 or request a comparison at no cost to you.