Is Medigap worth it? The Pros and Cons of Medigap Insurance

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Russell Noga
by Russell Noga | Updated May 29th, 2023

If you have Medicare Parts A & B, consider bolstering your coverage with Medigap plans to cover the remaining out-of-pocket expenses associated with hospital and medical care. Medigap plans are available from private healthcare insurers in the United States for a monthly premium.

You can pay anywhere from $80 to $450 for your Medigap plan, depending on your chosen plan, where you live, your health status, age, and gender.

So, why spend more on healthcare premiums if you already have Medicare Parts A & B?

Is Medigap worth it?

Or are you just spending your retirement savings on insurance policies you don’t need? If you’re a senior living on a fixed income, you understand the importance of having healthcare insurance, but you also understand how critical financial planning is in your retirement – every penny counts.


Medigap plans

What Do Medigap Plans Cover?

Medigap plans to cover the remaining 20% of inpatient and outpatient out-of-pocket costs not covered by Original Medicare. There are ten plans, each of which has different coverage levels for Medicare Part A & B expenses.


All Medigap plans offer the following benefits.

  • Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
  • Part A hospice care coinsurance or copayment.
  • Part B coinsurance or copayment.
  • Blood transfusion costs for the first three pints of blood.


Plans F*, G, and N are the most popular Medigap plans due to their comprehensive coverage and relatively low premiums.

  • Part A deductible.
  • Part B excess charges (Plan N doesn’t cover these charges).
  • Skilled nursing facility care coinsurance.
  • 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
  • Unlimited coverage for all out-of-pocket costs.


*Plans F & C aren’t available for new Medicare members eligible for Parts A & B after January 1, 2020. You can still take a Plan F policy if you qualify before this date. Plan F covers the Part B deductible of $226 in 2023, which is why it’s the most popular Medigap policy.

However, if you aren’t eligible for Plan F, Plan G is a great option. You get the same benefits for Part A & B as Plan F. However, you have to pay the Part B deductible of $226.

It’s also important to note Plan F & G are available in high-deductible versions. They differ from the standard version in they increase the Part A deductible from $1,600 to $2,700. However, you pay a far lower premium, usually around a quarter to a fifth of the cost of the standard version. Plan F & G HD aren’t available from all providers and in all states.


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Is There Anything Medigap Plans Don't Cover?

Yes. Medigap plans only cover the expenses relating to Original Medicare Parts A & B. So, you don’t have coverage for non-related preventative care expenses. For instance, it doesn’t cover the costs of going to the foot doctor or massage therapist. Medigap will cover the out-of-pocket costs for physiotherapy and chiropractic.

However, these costs must be approved by Medicare. Medicare requires your doctor to provide motivation for your use of these services. For example, Medicare will cover physiotherapy if you’re injured in a car accident, require surgery, and need physiotherapy or chiropractic sessions to recover fully.


Medigap and Prescription Drugs

medicare part dMedigap policies won’t cover the costs of your prescriptions. If you want drug coverage, you’ll need a standalone Part D policy, also available from your Medigap provider.

Medigap also doesn’t cover the costs of vision, hearing, and dental services.


Medigap is a competitive market, with private insurers competing to get your business. As a result, many providers offer dental, hearing, and vision services as part of an add-on policy for a small monthly fee. Typically, these plans are available to Plan F, G, & N beneficiaries, and you’ll pay around $20 to $50 per month for the policy. We can help you find the right plans, so just give us a call today.

Cost Vs. Reward – Are Medigap Plans Worth It?

If we consider the costs of healthcare in the United States, having a Medigap plan is absolutely essential. A Medicare Part A & B policy is great, but it doesn’t cover all your hospital and medical costs. Medicare only usually pays 80%, leaving you with coinsurance and copayment requirements for the balance.

So, let’s say you go into the hospital for an extended stay. Medicare Part A will only pay for the first 60 days of your stay in the facility. You’ll pay $400 per day from day 61 to day 90 and $800 per day from day 91 onwards. If you’re very sick or involved in an accident where you must stay in hospital for four months, you can see how these costs could add up to a small fortune.


Medigap Plans Cost

If you have Medigap, these expenses are covered, and you have no copayments or coinsurance requirements for your care and treatment. So, while Medicare doesn’t cover everything, and Medigap doesn’t offer preventative care like private duty nursing or stays at long-term nursing homes, it does have essential coverage for many medical and hospital expenses.

So, while you might have to pay a bit more for your annual healthcare if you take a Medigap plan, you get peace of mind knowing that you never have to pay anything out of pocket.

Depending on your plan, you could pay zero in coinsurance and copayments. Call our team, and we’ll walk you through the plans and the coverage they offer. We’re here to help you make an informed decision on the right Medigap plan for your situation.



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Frequently Asked Questions

  What is Medigap insurance?

Medigap is a type of health insurance sold by private companies to help pay healthcare costs not covered by Original Medicare, such as copayments, deductibles, and health care if you travel outside the U.S.



  What costs does Medigap cover?

Medigap policies can help cover remaining healthcare costs after Original Medicare has paid its share. These might include coinsurances, copayments, deductibles, and healthcare costs when traveling abroad.



  What doesn’t Medigap cover?

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.



  Is Medigap worth it?

The value of a Medigap policy depends on your individual health needs and financial circumstances. It can be beneficial for those who frequently need medical services, wish to cap their out-of-pocket costs, or want coverage while traveling abroad.



  What is the difference between Medigap and Medicare Advantage plans?

Medigap is supplemental insurance that covers gaps in Original Medicare. In contrast, Medicare Advantage is an alternative to Original Medicare, providing all Part A and B services and often including extra benefits like dental, vision, and prescription drug coverage.



  Can I have both Medigap and Medicare Advantage?

No, it’s not possible to have both a Medigap policy and a Medicare Advantage plan at the same time.



  How much does Medigap cost?

Medigap policies vary in cost based on the plan type, the insurance company, your location, and sometimes your age or health condition.



  Who is eligible for Medigap?

Anyone enrolled in Medicare Part A and Part B is eligible for a Medigap policy. However, the best time to buy is during the Medigap Open Enrollment Period when an insurer can’t use medical underwriting to deny coverage or charge more.



  Can I switch my Medigap policy?

Yes, you can apply to switch Medigap policies at any time. However, unless you have guaranteed issue rights, insurance companies are not required to sell you a policy.



  Is Medicare Advantage or Medigap better?

Both have their strengths and it depends on individual needs. Medicare Advantage can offer more comprehensive coverage at a lower premium but has more limited provider networks. Medigap can be more expensive, but it allows for broader provider choices and may cover more out-of-pocket costs.

Find the Right Medicare Plan for You

Finding the right Medicare plan doesn’t have to be confusing. Whether it’s a Medigap plan, or you have questions about Medicare Advantage or Medicare Part D, we can help.

Call us today at 1-888-891-0229 and one of our knowledgeable, licensed insurance agents will be happy to assist you!

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