What Is Medigap and Do You Need It?
What Is Medigap and Do You Need It?
Original Medicare covers a lot — but it doesn't cover everything. After you pay your deductibles and coinsurance, the remaining bills can add up fast. Medigap, also called Medicare Supplement Insurance, is private coverage that fills those gaps. Here's how it works and whether it makes sense for you.
What Medigap Is
Medigap is supplemental health insurance sold by private insurance companies to people enrolled in Original Medicare (Parts A and B). It's designed to cover the out-of-pocket costs that Medicare leaves behind — things like copayments, coinsurance, and deductibles.
Medigap policies are standardized by the federal government. That means a Plan G from one insurer covers exactly the same benefits as a Plan G from another insurer — the only difference is the premium you pay. There are currently 10 standardized Medigap plans, labeled A through N.
Medigap does not work with Medicare Advantage (Part C). If you're enrolled in Medicare Advantage, you cannot use a Medigap policy.
What Medigap Covers
Depending on the plan you choose, Medigap can cover:
- Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits run out)
- Part A deductible ($1,632 per benefit period in 2024)
- Part B coinsurance or copayments (typically 20% of Medicare-approved costs)
- Part B excess charges (what doctors charge above Medicare's approved amount)
- Skilled nursing facility care coinsurance
- Foreign travel emergency care (up to plan limits)
- Blood (first 3 pints)
Medigap does not cover prescription drugs — for that, you'll need a separate Part D plan. It also doesn't cover dental, vision, hearing, or long-term care.
The Most Popular Medigap Plans
With 10 options, the choice can feel overwhelming. In practice, most enrollees choose between a handful of plans.
Plan G — Most Comprehensive for New Enrollees
Plan G covers almost everything: Part A deductible, Part A and B coinsurance, skilled nursing coinsurance, Part B excess charges, and foreign travel emergencies. The only thing it doesn't cover is the Part B deductible ($240 in 2024). For most new Medicare enrollees, Plan G offers the most complete protection available.
Plan N — Lower Premium, Some Cost-Sharing
Plan N covers most of the same things as Plan G, but you pay copays of up to $20 for office visits and up to $50 for emergency room visits (waived if admitted). It also doesn't cover Part B excess charges. The premium is lower than Plan G, making it a good fit for people who don't see doctors frequently.
Plan F — No Longer Available to New Enrollees
Plan F was the most comprehensive plan available and covered the Part B deductible in addition to everything Plan G covers. However, it's no longer available to people who became Medicare-eligible after January 1, 2020. If you were eligible before that date, you may still be able to enroll in Plan F.
How Much Does Medigap Cost
Medigap premiums vary widely based on plan type, insurer, location, age, gender, and whether you use tobacco. A 65-year-old enrolling in Plan G might pay anywhere from $100 to $300+ per month depending on where they live.
Insurers use different pricing methods:
- Community-rated — Everyone pays the same premium regardless of age.
- Issue-age-rated — Premium is based on your age when you buy the policy and doesn't increase as you age.
- Attained-age-rated — Premium starts lower but increases as you get older. Most common, and most expensive over time.
Understanding which pricing method an insurer uses is important — a low premium today under attained-age pricing may not stay affordable 10 or 20 years into retirement.
When to Buy Medigap — The Open Enrollment Window
The best time to buy Medigap is during your Medigap Open Enrollment Period — a 6-month window that begins the month you are both 65 or older and enrolled in Medicare Part B.
During this window, insurers are legally required to sell you any Medigap policy they offer, regardless of your health history, and cannot charge you more because of pre-existing conditions. This is called guaranteed issue.
Outside this window, insurers in most states can reject your application or charge higher premiums based on your health. Waiting too long to buy Medigap is one of the most expensive mistakes new Medicare enrollees make.
There are some situations where you may have a Special Enrollment Period with guaranteed issue rights — such as losing employer coverage or leaving a Medicare Advantage plan — but these windows are narrow.
Medigap vs. Medicare Advantage — The Core Tradeoff
This is the central decision for most new Medicare enrollees:
- Original Medicare + Medigap + Part D gives you broad provider access, predictable costs, and no network restrictions. Total monthly cost is higher, but out-of-pocket surprises are minimal.
- Medicare Advantage (Part C) often has lower premiums and bundles drug and extra benefits, but restricts you to a network and may require prior authorizations.
People who travel frequently, see specialists regularly, or live in areas with limited Medicare Advantage networks often find Original Medicare + Medigap to be the better long-term choice — even if the upfront cost is higher.
The Bottom Line
Medigap isn't required, but for many people on Original Medicare, it provides financial peace of mind that's hard to replicate otherwise. Without it, a serious illness or extended hospital stay can result in tens of thousands of dollars in out-of-pocket costs with no cap. The best time to enroll is during your open enrollment window — waiting costs you negotiating power and may cost you coverage entirely.
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