Wondering What Medigap Really Does? Here’s How It Works and When It Pays Off

Key Takeaways

• Medigap helps cover certain out-of-pocket costs that Original Medicare does not, such as deductibles, coinsurance, and copayments.

• The best time to enroll in a Medigap plan is during your six-month Medigap Open Enrollment Period, which begins when you are 65 and enrolled in Medicare Part B.

Understanding What Medigap Actually Is

Medigap, also known as Medicare Supplement Insurance, is private insurance that works alongside Original Medicare (Parts A and B). Its primary purpose is to help you pay for healthcare costs that Medicare doesn’t fully cover. These costs can include:

• Part A coinsurance and hospital costs after Medicare benefits are used up

• Part B coinsurance or copayment

• First three pints of blood for a medical procedure

• Part A hospice care coinsurance or copayment

• Skilled nursing facility care coinsurance

• Part A and Part B deductibles (in some cases)

• Foreign travel emergency care (up to plan limits)

Medigap is not a stand-alone plan. You must have Medicare Parts A and B to buy a Medigap policy, and it only covers one person per policy. If you and your spouse both want Medigap, you will need to purchase separate policies.

When to Consider Getting Medigap

Timing matters a lot with Medigap. You have a one-time six-month Medigap Open Enrollment Period. It starts the month you’re both 65 or older and enrolled in Medicare Part B. During this window:

• You can buy any Medigap policy sold in your state

• You can’t be denied coverage due to preexisting conditions

• You typically get better pricing compared to applying later

After this period, getting a Medigap plan can be harder. You might be subject to medical underwriting, meaning the insurer can look at your health history and potentially charge more or deny coverage entirely.

If you’re under 65 and on Medicare due to disability, some states offer a similar enrollment window, but it varies. Once you turn 65, you get a new Open Enrollment Period.

What Medigap Does Not Cover

While Medigap is helpful, it doesn’t cover everything. You should know what is not included:

• Prescription drugs (you need a separate Medicare Part D plan for that)

• Long-term care (like nursing homes)

• Vision or dental care

• Hearing aids

• Private-duty nursing

Understanding these gaps can help you decide whether you need additional coverage from other Medicare options, depending on your health needs.

Comparing Medigap to Other Medicare Options

Medigap is often compared to Medicare Advantage, but they work very differently. If you’re staying with Original Medicare, Medigap can offer predictable costs and broader provider access. Here are some points to consider:

Medigap

• Pairs with Original Medicare

• Accepted nationwide by any provider that takes Medicare

• Helps reduce out-of-pocket expenses

• Requires a separate Part D plan for prescriptions

Medicare Advantage

• An alternative to Original Medicare

• May include drug coverage and extra benefits like dental or vision

• Usually has provider networks (may be regional)

• You typically pay copayments and have an annual out-of-pocket maximum

You can’t enroll in both a Medicare Advantage Plan and a Medigap policy at the same time. If you’re thinking about switching from one to the other, consider timing and your current health needs carefully.

How Medigap Pays Off Financially

If you have frequent medical visits, chronic conditions, or require regular specialist care, Medigap can save you a considerable amount over time. Here’s how it can make financial sense:

• Predictable Costs: You avoid surprise bills and coinsurance charges, especially under Part B services.

• Hospital Coverage: Medigap often covers all or most of the Part A deductible and coinsurance.

• Out-of-Country Travel: Some plans offer emergency coverage abroad, which Original Medicare does not.

Even though Medigap plans come with monthly premiums, the cost can be balanced out by reduced medical bills over the year. The value becomes more evident if your health needs are complex or ongoing.

How Plan Types Differ

Medigap plans are standardized and labeled with letters (e.g., Plan G, Plan N). Each lettered plan provides a different level of coverage, but the benefits are the same nationwide, regardless of the insurance company offering the plan.

Here’s a simplified look at the most commonly chosen options in 2025:

• Plan G: Covers nearly all out-of-pocket costs except the Part B deductible.

• Plan N: Lower premiums than Plan G but may include copayments for doctor visits and ER trips (if not admitted).

Plans like C and F are no longer available to people newly eligible for Medicare after January 1, 2020. However, those who were eligible before that date can still purchase them if available.

State Rules and Medigap Flexibility

While Medigap plans are federally standardized, states have some flexibility. For example:

• Massachusetts, Minnesota, and Wisconsin have their own versions of standardized plans.

• Some states allow you to switch Medigap plans without medical underwriting during certain periods each year.

• In community-rated states, everyone pays the same premium regardless of age.

Knowing your state’s rules can help you time your enrollment or plan change more effectively.

What Happens If You Delay Enrollment

If you miss your Medigap Open Enrollment Period, you can still apply later. But:

• There is no guarantee of acceptance unless you qualify for a special right (like losing employer coverage).

• Your premiums may be higher, especially if you have health conditions.

• The insurance company may delay coverage for preexisting conditions for up to six months.

To avoid these hurdles, the six-month enrollment window that starts when you enroll in Part B is your best chance to lock in coverage.

Can You Change Medigap Plans Later?

Yes, you can apply to switch Medigap plans at any time. However, you may need to go through underwriting, and your acceptance isn’t guaranteed outside of special circumstances. A few things to keep in mind:

• Check for state-specific open switching periods

• Review your existing benefits and needs before making a move

• Consider whether the new plan offers savings or better coverage

It helps to compare your total medical expenses before and after any switch to make sure it’s financially worth it.

Coordination With Other Coverage

Medigap is designed to fill in the gaps in Original Medicare. But what if you have other forms of coverage? Here’s how Medigap coordinates:

• Employer Coverage: If you have retiree insurance or union benefits, check if Medigap is necessary. It might duplicate existing coverage.

• Medicaid: If you qualify for Medicaid, you likely don’t need Medigap. Medicaid already covers many out-of-pocket Medicare costs.

• TRICARE: Military retirees may not need Medigap due to existing federal coverage.

Before buying a Medigap plan, always check how it will work with your other benefits.

Annual Considerations and Future Planning

Each year, your health needs, plan offerings, and premiums may change. While Medigap plans don’t change benefits annually like Medicare Advantage plans do, costs can go up. It’s smart to:

• Review your Medigap policy around the same time each year

• Consider your changing health, travel needs, or new medications

• Explore other Medicare benefits like Part D drug plans that pair with your Medigap

Staying informed can help you keep coverage aligned with your lifestyle and budget.

Medigap Makes a Difference When You Understand It Fully

Medigap offers an added layer of financial protection when paired with Original Medicare. If you’re someone who values predictable medical costs, the freedom to see any provider, and potential coverage abroad, Medigap is worth serious consideration.

The key is enrolling at the right time and choosing the plan that fits your health profile and budget best. If you’re unsure what plan works for you or how Medigap coordinates with other coverage you have, speak to a licensed agent listed on this website for professional guidance.