Medicare Supplement Plan D sits in a genuinely odd spot in the Medigap lineup: it’s nearly as comprehensive as Plan G, it’s still fully open to new enrollees (unlike Plan C), and yet almost nobody actually buys it. Here’s why that is — and whether it’s actually a mistake on the broader market’s part or not.
What Plan D Covers
- Medicare Part A coinsurance and hospital costs, plus up to 365 extra days after Medicare benefits run out
- Medicare Part B coinsurance or copayment
- The first 3 pints of blood each year
- Part A hospice care coinsurance
- Skilled nursing facility care coinsurance
- The Medicare Part A deductible
- Foreign travel emergency care, up to plan limits
Notice what’s missing compared to Plan C: the Part B deductible. Plan D asks you to pay that one relatively small annual amount yourself, and covers essentially everything else Original Medicare leaves as a gap.
The One Real Difference Between Plan D and Plan G
This is the detail that actually matters, and it’s easy to miss: Plan G covers everything Plan D covers, plus Medicare Part B excess charges. Excess charges are the extra amount certain doctors are legally allowed to bill above what Medicare approves, if they haven’t agreed to accept Medicare’s payment as full payment. Plan D leaves that gap open; Plan G closes it. That’s the entire difference between the two plans — same deductibles, same coinsurance, same foreign travel benefit.
Whether that particular gap actually matters to you in practice depends heavily on where you live and which specific doctors you regularly see. Some states limit or prohibit providers from charging Medicare excess charges at all, which would make the Plan D vs. Plan G decision almost entirely about premium. We check the specific rules and provider practices in your area before recommending one plan over the other — it’s not something we’d want you to assume either way.
Why So Few People Choose Plan D
In practice, carriers often price Plan G only slightly higher than Plan D for the added excess-charge protection, and most people would rather pay a little more for one less thing to think about than save a small amount and risk an unexpected bill. That’s not a rule, though — pricing varies by carrier and by state, and there are situations where Plan D genuinely comes out ahead on value. It’s worth asking us to run both side by side rather than assuming Plan G is automatically the better deal just because it’s more popular.
Who Plan D Tends to Fit
Plan D can make sense if you live somewhere excess charges aren’t a practical concern, if your specific carrier prices it meaningfully lower than its own Plan G, or if you simply want the broadest coverage available at the lowest premium among the “everything but the deductible” tier of plans. It’s a plan we bring up specifically when the numbers support it, not by default.
How Premiums Are Set
Like other Medigap plans, Plan D premiums are set using community rating, issue-age rating, or attained-age rating, depending on the carrier. Attained-age policies often start cheaper but climb faster as you get older; issue-age and community-rated policies tend to start a bit higher but grow more predictably. Since Plan D has a smaller pool of policyholders than Plan G at most carriers, it’s worth specifically asking how that smaller pool has affected rate increases historically — a thinner book of business can sometimes mean sharper adjustments over time.
Common Questions About Plan D
Is Plan D being phased out?
No — unlike Plans C and F, Plan D was not affected by the 2020 rule change and remains available to anyone newly eligible for Medicare. It’s simply less popular, which is a different thing from being discontinued.
Does the foreign travel benefit have a limit?
Yes. Medigap foreign travel emergency coverage is standardized to pay a percentage of costs after a deductible, up to a lifetime maximum. If you travel abroad frequently or for extended periods, it’s worth understanding that limit rather than assuming it works like unlimited travel insurance.
Can I have Plan D and a Medicare Advantage plan at the same time?
No. Medigap plans, including Plan D, are designed to work alongside Original Medicare, not a Medicare Advantage plan. It’s not legal for an agent to sell you a Medigap policy to supplement a Medicare Advantage plan, and having both wouldn’t actually get you extra coverage — it would just mean paying for a policy that isn’t doing anything.
Plan D vs. Plan N
Plan N is the other plan people often cross-shop against Plan D. Where Plan D asks you to pay the Part B deductible yourself but otherwise covers your Part B coinsurance in full, Plan N covers the Part B coinsurance too but adds small, fixed copays for office visits and emergency room visits (the ER copay is waived if you’re admitted). Plan N also doesn’t cover excess charges, same as Plan D. The practical difference comes down to how you use care: if you see the doctor often for routine visits, those small Plan N copays can add up, whereas Plan D’s flat structure means you know your cost per visit won’t change based on how many times you go. If you rarely go to the doctor, Plan N’s typically lower premium can outweigh Plan D’s flatter cost structure.
A Real-World Scenario
One client we worked with had been paying for Plan G for two years without ever hitting an excess charge — her doctors all accepted Medicare’s approved amount as full payment. When she asked us directly whether she was “wasting money,” we pulled current Plan D rates from the same carrier and found the difference wasn’t as large as she’d assumed once we accounted for how her particular carrier prices the two plans in her ZIP code. She ultimately stayed on Plan G anyway, because the peace of mind was worth the small difference to her — but she made that call with real numbers, not a guess. That’s the exercise we’d walk through with you too, whichever direction the math points.
Getting a Real Comparison
We’ll pull actual Plan D and Plan G quotes from the carriers available in your area, check whether excess charges are even something local providers use, and let you decide with real numbers in front of you rather than defaulting to whichever plan happens to be more heavily advertised. If you’re weighing this alongside Plan G or Plan N, bring both quotes when we talk and we’ll go through the differences together.
What Happens if You Move
Medigap plans, including Plan D, are guaranteed renewable and work the same way nationwide — you’re not tied to Ohio just because you bought the policy here. If you move to another state, your existing Plan D policy continues to work with Original Medicare wherever you go, since Medigap fills gaps in Medicare’s national coverage rather than operating through a local network. That said, premiums for the same plan letter can vary meaningfully by state and even by county, so it’s worth having us re-shop your coverage if you relocate, even though you’re not required to switch.
When Plan D Isn’t the Right Fit
If you’d rather not think about excess charges at all — even in a state or with providers where they’re rare — Plan G removes that variable entirely for a modest premium difference in most cases. And if keeping your monthly premium as low as possible matters more to you than a flat per-visit cost structure, Plan N or a Medicare Advantage plan might fit better than any Medigap option. Plan D tends to make the most sense specifically for people who’ve already ruled out those alternatives for a clear reason, not as a default starting point.
When to Apply for Plan D
The best time to apply for any Medigap plan, including Plan D, is during your 6-month Medigap Open Enrollment Period, which starts the month you’re both 65 or older and enrolled in Part B. During that window, carriers generally can’t deny you coverage or charge you more because of your health history. Apply outside that window, and most carriers can ask health questions and price or decline your application based on the answers — though certain situations, like losing employer or Medicare Advantage coverage, can open a separate guaranteed-issue window regardless of timing. If you’re not sure which situation applies to you, that’s one of the first things we’ll sort out before you fill out any application.
For clients in Bethel, Cincinnati, and the surrounding Hamilton, Clermont, Butler, and Warren County area, we can pull Plan D quotes from the carriers actually licensed and competitively priced in your specific county — rates and even plan availability can shift meaningfully from one county to the next, so a generic quote from a national call center script isn’t always accurate for where you actually live day to day.