Medigap Is Optional, But In 2025 It Could Save You Thousands

Key Takeaways

• In 2025, Medigap can help you avoid thousands in out-of-pocket expenses by covering costs that Original Medicare doesn’t.

• While Medigap is optional, enrolling at the right time—especially during your Medigap Open Enrollment Period—can provide long-term financial protection.

Why Medigap Exists in the First Place

Original Medicare—Parts A and B—provides essential hospital and medical coverage. However, it doesn’t cover everything. You’re responsible for deductibles, coinsurance, and copayments. That’s where Medigap, also known as Medicare Supplement Insurance, comes in.

Medigap is designed to help pay those out-of-pocket costs that can quickly accumulate, especially if you experience a serious illness or require frequent medical care. In 2025, with healthcare costs continuing to rise, Medigap offers a layer of financial security that’s hard to ignore.

What Medigap Covers in 2025

Medigap plans in 2025 are standardized across most states, meaning each plan type (labeled A through N) offers the same core benefits regardless of which insurer offers it. Here’s what Medigap typically covers:

• Part A coinsurance and hospital costs after Medicare benefits are used up (up to 365 additional days)

• Part B coinsurance or copayments

• First three pints of blood for a transfusion

• Part A hospice care coinsurance or copayment

• Skilled nursing facility coinsurance (in certain plans)

• Part A deductible (in certain plans)

• Foreign travel emergency coverage (in certain plans)

While these benefits remain consistent, remember that not all plans cover every category, and your choice should reflect your specific needs.

Enrollment Windows You Don’t Want to Miss

Timing matters a lot when it comes to Medigap. The best time to buy a policy is during your Medigap Open Enrollment Period—a one-time, six-month window that starts when you’re both:

• 65 or older, and

• Enrolled in Medicare Part B

During this window, insurance companies are required to sell you any Medigap plan they offer, regardless of your health status. They also cannot charge you more due to pre-existing conditions.

If you apply after this window, you might be subject to medical underwriting, which means:

• You could be denied coverage

• You could be charged higher premiums

• You might have limited plan choices

This is why many Medicare beneficiaries choose to act as soon as they become eligible.

Medigap Doesn’t Work With Medicare Advantage

One of the most common mistakes people make is assuming Medigap supplements Medicare Advantage (Part C). It doesn’t.

You cannot have both a Medigap plan and a Medicare Advantage plan at the same time. Medigap only works with Original Medicare (Parts A and B). If you decide to switch from Medicare Advantage to Original Medicare, you’ll likely want to consider adding Medigap for the added financial protection.

But be careful: If you’re switching after your initial Medigap Open Enrollment Period, you may not be guaranteed acceptance into a Medigap plan.

2025 Medigap Changes You Should Know

While the core Medigap benefits remain largely unchanged, there are a few updates and trends in 2025 worth noting:

• Standardized Plan Choices: Plans C and F are still not available to those who became eligible for Medicare on or after January 1, 2020. If you were eligible before that, you may still purchase them.

• High-Deductible Options: Some Medigap plans in 2025 continue to offer high-deductible versions, which may lower your monthly premiums in exchange for higher out-of-pocket costs before benefits kick in.

• Inflation and Health Costs: Rising medical costs mean that even common services—like lab work, outpatient visits, or skilled nursing—could result in significant bills without a Medigap plan.

• Foreign Travel: With travel becoming more accessible post-pandemic, plans that offer emergency coverage outside the U.S. are increasingly popular.

Why People Still Skip Medigap—and Why That’s Risky

Some beneficiaries choose not to enroll in Medigap because they feel healthy or want to avoid another monthly premium. However, this can be a short-sighted decision.

Without Medigap, you’re on the hook for:

• The Part A hospital deductible ($1,676 per benefit period in 2025)

• Daily hospital coinsurance for extended stays

• The Part B deductible ($257 in 2025), and then 20% of most Part B services

• Potentially high out-of-pocket costs for skilled nursing, ambulance transport, or outpatient surgeries

One unexpected hospitalization or a chronic condition can make those costs pile up fast. Medigap helps shield you from the unpredictability of these expenses.

When Medigap Makes the Most Sense

Medigap may be especially useful for you if:

• You have multiple chronic conditions

• You want to avoid surprise bills from frequent outpatient care

• You travel often or live in multiple states

• You prefer predictable costs and nationwide access to providers

• You’re not interested in the network restrictions that often come with Medicare Advantage

Medigap offers peace of mind by reducing your financial exposure—something that becomes more valuable as you age and require more healthcare.

Things Medigap Doesn’t Cover

While Medigap fills many gaps, it does not cover:

• Prescription drugs (you’ll need a separate Part D plan)

• Routine dental, vision, or hearing care

• Long-term care (like extended stays in a nursing home)

• Private-duty nursing

If these services matter to you, you’ll need to explore other coverage options to round out your Medicare benefits.

What Happens If You Wait Until Later?

If you delay Medigap enrollment past your Open Enrollment Period, your options narrow. Insurance companies can:

• Require health screenings

• Deny you coverage

• Charge significantly higher premiums

Some states offer limited guaranteed issue rights in special situations (like losing employer coverage), but these are exceptions—not the rule.

It’s also worth noting that you can’t be penalized by Medicare for not buying a Medigap plan. It’s voluntary. But that doesn’t mean it’s not crucial. In 2025, waiting too long could cost you far more in out-of-pocket healthcare expenses than the monthly premiums ever would have.

What If You Want to Switch Medigap Plans in 2025?

You can apply to switch Medigap plans at any time during the year, but:

• Your application may be medically underwritten

• You might be denied based on health history

• You could be charged more

Some states offer annual windows for switching without underwriting, but not all do. Always check your state’s rules before making a change.

Medigap vs. Medicare Advantage in 2025

Deciding between Medigap and Medicare Advantage depends on your personal healthcare preferences and financial situation. Here’s a simple breakdown:

Medigap Pros:

• Greater provider flexibility

• Predictable out-of-pocket costs

• Nationwide coverage with any Medicare provider

Medigap Cons:

• Higher premiums

• Separate prescription drug plan needed

Medicare Advantage Pros:

• Often includes drug coverage

• May offer extra benefits like dental or vision

• Caps on annual out-of-pocket costs

Medicare Advantage Cons:

• Network restrictions

• Prior authorization requirements

• Costs vary depending on usage

Your choice should reflect your medical needs, budget, and lifestyle. There’s no one-size-fits-all answer.

How to Evaluate a Medigap Plan

When comparing Medigap plans, consider:

• How often you visit doctors or specialists

• Whether you prefer fixed, predictable costs

• If you need care in more than one state

• How well you understand and can manage coinsurance and deductibles

While price is an important factor, the true value of a Medigap plan lies in what it helps you avoid: financial strain during a medical crisis.

Avoid Costly Surprises—Plan Now

In 2025, Medigap continues to play a vital role in protecting your retirement finances. Skipping this coverage might save you money short-term, but it exposes you to significant risk in the years to come. The best time to make a decision is when you first become eligible, but it’s never too late to review your options.

Take control of your healthcare coverage by learning about your Medigap choices today. For help comparing plans and understanding enrollment windows, speak with a licensed agent listed on this website.