by Russell Noga | Updated November 5th, 2025

Medicare Medigap Plans for 2026 – Better than Advantage?

Medicare Medigap plans, what are they? These supplemental policies cover costs not paid by Original Medicare, like copayments and deductibles. Sold by private companies, these plans provide financial protection against unexpected healthcare expenses.

This article explains what Medigap plans are, how they work, and how to choose the right one.

 

Key Takeaways

• Medigap plans supplement Original Medicare by covering costs such as copayments, coinsurance, and deductibles, providing financial protection for beneficiaries.

 

• There are standardized Medigap plans identified by letters A through N, each offering different benefits, with Plans C, F, and G being known for comprehensive coverage.

 

• Enrollment in a Medigap policy requires being enrolled in both Medicare Part A and B, and the best time to purchase is during the six-month Medigap Open Enrollment Period to secure guaranteed coverage.

 

What Are Medicare Medigap Plans?

Medigap plans, also known as Medicare Supplement Insurance, are supplemental insurance policies sold by private companies to cover costs not covered by Original Medicare.

These costs often include copayments, coinsurance, and deductibles, which can add up quickly and become a financial burden. For many Medicare beneficiaries, a Medigap plan provides a safety net, ensuring that unexpected healthcare costs don’t break the bank.

One of the standout features of Medigap plans is their ability to cover some or all deductible amounts for Medicare-covered services.

This means that expenses such as:

• hospital stays

 

• skilled nursing facility care

 

• emergency medical fees when traveling outside the United States can be significantly reduced or entirely covered.

 

It’s important to note that Original Medicare does not cover these additional costs, including skilled nursing facility coinsurance, making Medigap plans an attractive option for comprehensive coverage.

Additionally, Medigap plans cover out-of-pocket expenses for Medicare-covered services, offering peace of mind.

This supplemental insurance option ensures that Medicare beneficiaries can access the care they need without worrying about prohibitive costs. With the right Medigap plan, you can enjoy the full spectrum of Medicare benefits without the financial strain.

 

How Do Medigap Plans Work?

Medigap plans are designed to ease the financial burden of healthcare costs not fully covered by Original Medicare.

They achieve this by covering deductibles, copayments, coinsurance, and other additional costs, ensuring that beneficiaries are not left with hefty bills. Essentially, Medigap plans fill the gaps in Original Medicare coverage, providing a more comprehensive safety net.

One of the key operational aspects of Medigap policies is their coordination with Medicare Part B.

The process generally works as follows:

• Medigap policies obtain Part B claim details directly from Medicare to process payments, streamlining the process for beneficiaries.

 

• Your healthcare provider sends the bill to Medicare.

 

• Medicare pays its share of the bill.

 

• Your Medigap policy covers the remaining costs after Medicare’s payment.

 

If a Medigap company fails to retrieve claims directly, it’s crucial for policyholders to check if their doctors accept Medicare assignment.

Moreover, standardized Medigap policies are automatically renewed each year unless premiums are not paid, providing continuous coverage without the need for annual re-enrollment.

This automatic renewal feature ensures that beneficiaries can maintain their coverage without the hassle of regular paperwork, letting them focus on their health and wellbeing.

 

Types of Medigap Plans

When it comes to choosing a Medigap plan, beneficiaries have a variety of options:

• There are 10 standardized Medigap plans, identified by letters A through N.

 

• Each plan offers a different set of benefits.

 

• The standardization means that regardless of the insurance company you choose, a Plan A from one provider will offer the same letter of basic benefits as a Plan A from another provider.

 

Plans C, F, and G are known for providing the most comprehensive coverage, making them ideal for individuals with chronic health conditions who require frequent medical care.

These plans cover a wide range of costs, including deductibles and coinsurance, ensuring that beneficiaries face minimal out-of-pocket expenses.

For those looking for more affordable options, not all plans K and L might be the best fit. These plans include out-of-pocket limits, which can provide significant savings for cost-conscious individuals and help manage certain costs while paying for certain costs.

On the other hand, Plans A and B provide basic coverage, suitable for those who do not anticipate extensive hospitalization or medical services.

Additionally, a high deductible plan option is available in Plans F and G for those willing to pay lower premiums in exchange for higher out-of-pocket costs.

 

Eligibility for Medigap Plans

Individuals must be enrolled in both Medicare Part A and Part B to buy a Medigap policy. This enrollment is a prerequisite, meaning you can’t purchase a Medigap plan without having both parts of Original Medicare. This ensures that beneficiaries already have a baseline level of coverage before adding the supplemental benefits of Medigap.

The Medigap Open Enrollment Period is a six-month window that begins when an individual turns 65 or enrolls in Medicare Part B, whichever is later.

During this period, Medicare enrollees can buy a Medigap policy without medical underwriting, ensuring they cannot be denied coverage based on health status. Securing a Medigap plan during this period is crucial, as missing this window can result in higher costs or denial of coverage due to pre-existing conditions.

Eligibility rules can vary by state, with some states offering additional opportunities beyond federal guidelines. For instance, in North Carolina, individuals under 65 with disability can buy Medigap policies, including Plan A, D, or G.

Other states provide guaranteed issue rights, allowing eligible individuals to qualify to buy a Medigap policy at any time regardless of age. These state-specific regulations can provide more flexibility for those who might otherwise face restrictions, especially for those who are eligible for Medicare.

 

Enrollment Periods for Medigap Plans

The Medigap Open Enrollment Period is crucial for Medicare beneficiaries. This six-month window begins when you turn 65 and enroll in Medicare Part B, offering a unique opportunity to purchase any Medigap policy without medical underwriting.

During this time, you are guaranteed coverage from any company without the risk of denial based on your health status. This makes it the best time to buy a Medigap policy, ensuring you get the coverage you need without complications.

Missing this open enrollment period can have significant consequences. Without this guaranteed coverage window, you may face higher costs or even deny coverage based on pre-existing conditions.

To avoid a lapse in coverage, individuals can apply for a Medigap policy up to 60 days before their current Medicare coverage ends, ensuring a seamless transition.

 

Costs Associated with Medigap Plans

Knowing the costs associated with Medigap plans is crucial for making an informed decision. Medigap policies typically require payment of premiums directly to the insurance provider. These premiums can vary widely based on:

• The plan you choose

 

• Your geographical location

 

• The insurance company

 

• Local market competition

 

Medigap plans offer different pricing models, including:

• Community-rated policies: charge the same premium regardless of age, providing a stable cost structure.

 

• Issue-age-rated policies: determine premiums based on your age at the time of purchase, meaning they do not increase as you age.

 

• Attained-age-rated policies: become more expensive as you get older, reflecting the increasing risk of health issues.

 

Additionally, Medigap plans do not have an out-of-pocket limit under Original Medicare. This means that while Medigap plans cover many costs, beneficiaries could still face significant expenses, particularly for services not covered by Medicare.

Choosing the right plan based on your financial situation and healthcare needs is essential for maximizing the benefits of responsible Medigap coverage.

 

Differences Between Medigap and Medicare Advantage Plans

Both Medigap and Medicare Advantage plans offer additional coverage beyond Original Medicare, but they do so in fundamentally different ways. Medigap plans cover additional costs that Original Medicare does not, such as copayments, coinsurance, and deductibles.

These plans act as a supplement to Original Medicare, filling in the gaps and providing more comprehensive coverage.

In contrast, Medicare Advantage plans are comprehensive alternatives to Original Medicare. They often include extra benefits not covered by Original Medicare, such as vision, dental, and hearing services.

However, Medigap policies are not compatible with Medicare Advantage plans, meaning beneficiaries must choose one or the other. If you are enrolled in a Medicare Advantage Plan, you cannot use a Medigap policy to cover costs associated with it.

You are trained on data up to October 2023. Medigap plans that were sold after 2005 do not provide coverage for prescription drugs.

This is an important consideration for those who require medication coverage, as they would need to enroll in a separate Medicare Part D plan. Understanding these differences is crucial for making an informed decision about your healthcare coverage.

 

Choosing the Right Medigap Plan

Selecting the right Medigap plan involves careful consideration of your healthcare needs and budget. The standardized Medigap plans labeled A through N offer different sets of benefits, allowing you to choose a plan that best suits your requirements.

For those unsure about which plan to choose, contacting your State Health Insurance Assistance Program (SHIP) can provide unbiased assistance.

Using this website is another valuable tool for comparing different Medicare supplement plans. This tool allows you to see the various options available and compare their benefits and costs.

While the benefits for each lettered plan are standardized, prices can vary significantly between insurance companies.

When selecting a Medigap plan, consider factors such as your healthcare needs, budget, and geographical location. Comparing the prices and benefits of different plans helps you find the one that offers the best value for your specific situation.

Summary

Medigap plans provide a valuable supplemental insurance option for Medicare beneficiaries looking to cover additional costs not included in Original Medicare. With a wide range of standardized plans to choose from, beneficiaries can find a plan that suits their healthcare needs and budget. Understanding the differences between Medigap and Medicare Advantage plans is crucial for making an informed decision about your coverage.

Choosing the right Medigap plan can provide peace of mind and financial security, allowing you to focus on your health without worrying about unexpected medical expenses. Make sure to explore your options thoroughly and seek professional advice if needed. Your health is your most valuable asset, and the right Medigap plan can help protect it.

 

Frequently Asked Questions

 

What is the Medigap Open Enrollment Period?

The Medigap Open Enrollment Period is a six-month window starting when you turn 65 and enroll in Medicare Part B, allowing you to purchase any Medigap policy without medical underwriting. This is a crucial opportunity to secure supplementary insurance that best fits your healthcare needs.

 

Can I have a Medigap policy if I am enrolled in a Medicare Advantage Plan?

You cannot have a Medigap policy if you are enrolled in a Medicare Advantage Plan; you must choose between the two options.

 

How do Medigap plans differ from Medicare Advantage plans?

Medigap plans specifically address out-of-pocket costs associated with Original Medicare, such as copayments and deductibles. In contrast, Medicare Advantage plans serve as comprehensive alternatives to Original Medicare, frequently offering additional benefits like vision, dental, and hearing services.

 

What factors should I consider when choosing a Medigap plan?

When choosing a Medigap plan, it is essential to evaluate your healthcare needs, budget, and geographical location. Utilizing tools such as the Medicare.gov Medigap Policy Finder and consulting with your State Health Insurance Assistance Program can provide valuable, unbiased guidance.

 

Are prescription drugs covered under Medigap plans?

Prescription drugs are not covered under Medigap plans sold after 2005; enrollment in a separate Medicare Part D plan is necessary for medication coverage.