When you enroll in Original Medicare, you’ll quickly discover that Parts A and B don’t cover all your healthcare expenses. You’re still responsible for deductibles, copayments, and coinsurance that can add up to thousands of dollars each year. Medicare Supplement Insurance, commonly called Medigap, is designed to fill these coverage gaps and protect you from unexpected medical costs. Keep reading to learn how these supplemental plans work, so you can choose the right coverage for your healthcare needs and budget.
How Medigap Plans Work
Medigap policies are sold by private insurance companies and work alongside your Original Medicare coverage. When you receive healthcare services, Medicare pays its share first, and then your Medigap policy kicks in to cover some or all of the remaining costs. These supplemental plans are specifically designed to work with Medicare Part A and Part B, which means you must be enrolled in Original Medicare to purchase a Medigap policy. It’s important to understand that Medigap plans don’t work with Medicare Advantage plans, so you’ll need to choose one path or the other for your coverage.
One of the biggest advantages of Medigap coverage is the freedom it provides when choosing healthcare providers. Unlike many Medicare Advantage plans that require you to use specific networks, Medigap allows you to see any doctor or visit any hospital in the United States that accepts Medicare patients. You won’t need referrals to see specialists, and you can travel anywhere in the country knowing your coverage travels with you. This flexibility makes Medigap particularly attractive if you spend time in multiple states or prefer having unrestricted access to healthcare providers.
Another key feature of Medigap policies is guaranteed renewability. As long as you continue paying your premiums, your insurance company cannot cancel your coverage due to changes in your health status. This protection gives you peace of mind knowing that even if you develop a serious illness, your supplemental coverage will remain in place. However, keep in mind that Medigap plans don’t include prescription drug coverage. If you want help paying for medications, you’ll need to enroll in a separate Medicare Part D plan.
Standardized Plan Options
Medigap plans are standardized by the federal government and identified by letters: A, B, C, D, F, G, K, L, M, and N. Each lettered plan offers a specific set of benefits that remains the same regardless of which insurance company sells it. This standardization makes comparing plans much easier because a Plan G from one insurer provides identical coverage to a Plan G from another insurer. The only difference between the same lettered plans from different companies is the premium you’ll pay, so shopping around for the best price makes sense.
Plan F has historically been the most comprehensive Medigap option, covering all Medicare-approved out-of-pocket costs including the Part B deductible. However, federal law changed the availability of certain plans starting January 1, 2020. If you became eligible for Medicare on or after that date, you can’t purchase Plan C or Plan F. These plans remain available only to people who were eligible for Medicare before January 1, 2020. This change was implemented to encourage beneficiaries to have some financial responsibility for their healthcare decisions.
If you became eligible for Medicare in 2020 or later, Plan G offers the most comprehensive coverage available. Plan G covers everything that Plan F covers except the annual Medicare Part B deductible, which is $283 in 2026. Many Medicare beneficiaries find that Plan G provides excellent value because the premium savings compared to Plan F often exceed the cost of paying the Part B deductible out of pocket. Plan N is another popular choice that typically comes with lower monthly premiums but includes some cost-sharing requirements. With Plan N, you may pay copayments of up to $20 for certain office visits and up to $50 for emergency room visits that don’t result in hospital admission.
What Medigap Doesn’t Cover
While Medigap plans provide valuable coverage for many healthcare costs, they have significant limitations you should understand before enrolling. Medigap policies generally don’t cover services that Original Medicare itself doesn’t cover. This means you won’t receive benefits for long-term care services such as extended stays in nursing homes or assisted living facilities. If you’re concerned about the potentially devastating costs of long-term care, you’ll need to explore separate long-term care insurance policies or other financial planning strategies.
Routine dental care, vision services, and hearing aids are also excluded from Medigap coverage. You won’t be able to use your Medigap policy to pay for dental cleanings, eyeglasses, contact lenses, hearing exams, or hearing devices. These exclusions can represent significant out-of-pocket expenses for many seniors who need regular dental work, new glasses, or hearing assistance. Some beneficiaries address these gaps by purchasing separate standalone dental and vision insurance plans. Others choose Medicare Advantage plans specifically because many of them include dental, vision, and hearing benefits that Medigap doesn’t offer.
Private-duty nursing is another service that falls outside Medigap coverage. If you require around-the-clock nursing care in your home, you’ll need to pay for these services yourself or find alternative coverage. Some Medigap plans do offer coverage for emergency medical care when you’re traveling outside the United States, which Original Medicare doesn’t provide. If international travel is part of your lifestyle, make sure to check whether the Medigap plan you’re considering includes foreign travel emergency benefits.
Best Time to Enroll
The timing of your Medigap enrollment can significantly impact both your coverage options and the premiums you’ll pay. Your Medigap Open Enrollment Period is a six-month window that begins the first month you’re both 65 or older and enrolled in Medicare Part B. During this critical period, insurance companies can’t use medical underwriting to evaluate your application. This means they can’t deny you coverage, charge you higher premiums, or impose waiting periods based on pre-existing health conditions. You have guaranteed access to any Medigap plan sold in your state at the standard premium rate.
Missing your Medigap Open Enrollment Period can have lasting consequences. Once this six-month window closes, insurance companies can require you to answer health questions on your application. If you have pre-existing conditions such as diabetes, heart disease, or cancer, you may be charged significantly higher premiums or denied coverage altogether. In some cases, you might not be able to purchase a Medigap policy at any price. This makes it essential to carefully consider your coverage options during your initial enrollment window rather than waiting to see if you’ll need supplemental insurance later.
There are limited situations where you may have guaranteed issue rights to purchase a Medigap policy outside your initial enrollment period. These special circumstances typically involve losing other health coverage through no fault of your own. For example, if your employer-sponsored retiree health plan ends or if you leave a Medicare Advantage plan within the first 12 months of joining, you may have protected rights to buy certain Medigap policies.
Some states also provide additional protection beyond federal requirements. Massachusetts, Minnesota, and Wisconsin have their own standardized Medigap plans with different rules, while states like New York and Connecticut require insurers to sell Medigap policies year-round without medical underwriting.
Medicare Costs in 2026
Knowing the specific costs associated with Original Medicare helps you understand the value that Medigap coverage provides. In 2026, the Medicare Part A inpatient hospital deductible is $1,736 per benefit period. This is the amount you’ll pay if you’re admitted to the hospital, and it applies each time you start a new benefit period. If you have multiple hospital stays in a year, you could pay this deductible more than once. After your first 60 days in the hospital, you’re also responsible for daily coinsurance charges of $434 per day for days 61 through 90, and $868 per day if you need to use your lifetime reserve days.
The Medicare Part B annual deductible for 2026 is $283. After you meet this deductible, you’re generally responsible for 20% of the Medicare-approved amount for most outpatient services. This 20% coinsurance has no cap under Original Medicare, which means your out-of-pocket costs for expensive treatments like chemotherapy, surgeries, or extended therapy can grow substantially. A comprehensive Medigap plan like Plan G covers all of these coinsurance costs after you pay the Part B deductible, effectively eliminating your exposure to unlimited cost-sharing.
When evaluating whether Medigap is right for you, consider your overall health, your tolerance for financial risk, and your healthcare utilization patterns. If you’re generally healthy and rarely visit doctors, you might be comfortable with the cost-sharing requirements of Original Medicare alone. However, if you have chronic conditions requiring regular medical care, or if you simply want the security of knowing your out-of-pocket costs are predictable and limited, a Medigap policy can provide substantial financial protection. The monthly premium you pay for Medigap coverage is often much less than the potential out-of-pocket costs you’d face without it.
Conclusion
Medicare Supplement Insurance offers valuable protection against the gaps in Original Medicare coverage. By covering deductibles, copayments, and coinsurance, Medigap plans can transform unpredictable healthcare costs into manageable monthly premiums. The standardized nature of these plans makes comparison shopping straightforward, and the freedom to see any Medicare accepting provider gives you flexibility that many other insurance options don’t offer.
Choosing the right Medigap plan requires careful consideration of your health status, budget, and coverage preferences. Remember that your Medigap Open Enrollment Period is the best time to secure coverage without worrying about health-related restrictions or premium increases. Taking action during this window ensures you’ll have access to the full range of plan options at standard rates. For more information about supplemental Medicare plans, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
