Medigap
Medicare Supplement (Medigap)
A Medigap policy is private insurance that sits beside Original Medicare and pays part or all of the deductibles, copays and coinsurance Medicare leaves to you — so your costs become predictable, and you can use any provider in the country who accepts Medicare.
Who it’s designed for
- People who want to keep Original Medicare and see any doctor or hospital nationwide that accepts it
- People who would rather pay a steady monthly premium than variable copays
- People who travel, spend part of the year in another state, or split time between our Nevada and Illinois service areas
- People managing a serious or ongoing condition, where 20% coinsurance with no cap is the real risk
- People who don’t want prior authorization standing between them and a specialist
Plans are standardized by letter
Medigap plans are labeled with letters — Plan G and Plan N are the most commonly sold to people new to Medicare, and Plan F is only available to those eligible for Medicare before January 1, 2020. The benefits of a given letter are set by federal law and identical from company to company. What differs is the premium, the carrier’s rate history, and its service. That’s the whole comparison, and it’s why shopping it matters.
What it generally covers — and generally doesn’t
Generally covered
- Part A hospital coinsurance, plus an extra 365 days after Medicare’s benefits end
- The Part A deductible — $1,736 per benefit period in 2026 — on most letter plans
- Part B coinsurance, the 20% Original Medicare leaves you
- Blood, hospice coinsurance and skilled nursing facility coinsurance
- Foreign travel emergency care, at 80% after a deductible, on several plans
Generally not covered
- Prescription drugs — you add a stand-alone Part D plan
- The annual Part B deductible ($283 in 2026) on plans sold today
- Routine dental, vision and hearing aids
- Long-term custodial care
- Anything Medicare itself doesn’t cover — Medigap follows Medicare’s decisions
Eligibility considerations
You must have Part A and Part B. You cannot use a Medigap policy alongside a Medicare Advantage plan — it’s one or the other.
Premiums vary by age, ZIP code, tobacco use, gender and carrier, and by how the carrier rates: community-rated, issue-age or attained-age. That rating method shapes what you’ll pay ten years from now, not just today.
People under 65 on Medicare through disability can buy Medigap in some states but not all, and pricing is often much higher. We’ll tell you plainly what’s available where you live.
Enrollment considerations
Medigap does not work like Medicare Advantage. There is no annual open enrollment for it — timing is everything.
Your 6-month open enrollment
Starting the month your Part B takes effect, you have six months to buy any Medigap policy sold in your state with no health questions. This is the most valuable window in Medicare, and it does not come back.
Guaranteed-issue rights
Certain events — an employer plan ending, a Medicare Advantage plan leaving your area, a plan misleading you — grant a limited right to buy specific plans without underwriting.
State rules differ
Some states are far more generous. Nevada, California, Illinois and several others have a “birthday rule” letting you switch to an equal-or-lesser plan each year; New York and a few others are guaranteed-issue year-round.
Switching later
Outside those protections, changing carriers usually means answering health questions and possibly being declined. Never cancel an existing policy until a new one is approved in writing.
Important limitations
- Premiums generally rise over time — with age, with medical inflation, or both, depending on the rating method.
- Medigap covers one person. Spouses buy separate policies and are priced separately.
- No drug coverage, no dental, no vision, no hearing aids, and no extras. Those are separate purchases.
- Plans sold to people who became Medicare-eligible on or after January 1, 2020 cannot cover the Part B deductible.
- Massachusetts, Minnesota and Wisconsin standardize Medigap differently from the letter system used elsewhere.
Frequently asked questions
Plan G or Plan N?
Plan G leaves you only the Part B deductible each year. Plan N costs less per month but adds small copays for some office and emergency-room visits and doesn’t cover Part B excess charges. Which one wins depends on the premium gap where you live and how often you see doctors — that’s arithmetic we can do with you.
Is a cheaper carrier riskier?
The benefits are identical by law, so a lower premium doesn’t buy you less coverage. What it can signal is a carrier’s rate-increase history. We look at that history, not just the first-year price.
Do doctors have to accept it?
If a provider accepts Medicare, they accept your Medigap policy. There’s no network and no directory to check.
I’m 65 and still working. Should I buy one now?
Often no — if your employer coverage is good, delaying Part B also delays your six-month Medigap window, which is usually the right move. The mistake to avoid is delaying without confirming your employer plan qualifies. Call before you turn 65, not after.
Talk with James directly
James O’Neal
Licensed agent & broker · O'Neal Insurance Group
- No cost for our help — ever
- Independent — many carriers, not one
- You keep the same agent next year
- Plain answers, no pressure to switch
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