Medicare Supplement Plans (Medigap Plans): What You Need to Know
Thinking about a Medicare Supplement Plan to help cover what Original Medicare doesn’t? This guide breaks down how these plans work and whether they might be a good fit for your needs.
As you prepare for Medicare enrollment, the many parts and options can feel confusing. Medicare Parts A and B cover a large share of your medical costs, but you’re still responsible for deductibles, copayments, and coinsurance. That’s where Medicare Supplement plans, also called Medigap plans, step in.
These plans are designed to help pay the out-of-pocket costs that Original Medicare leaves behind, offering predictable expenses and peace of mind, especially if you expect frequent doctor visits or ongoing care.
Medicare Part A Gaps: Hospital & Skilled Nursing Costs
While Medicare Part A provides hospital coverage, it still leaves several gaps in what you’ll pay out of pocket. Here’s a breakdown of those costs:
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Gap 1: Hospital Deductible:
You must pay a $1,676 deductible upfront, which covers the first 1–60 days of a hospital stay, whether you're there for one day or all sixty. -
Gap 2: Extended Hospital Stays
From days 61–90, you’ll pay a $419 daily copay.
If your stay extends beyond 90 days, you’ll enter your “lifetime reserve days” and owe a $838 daily copay for days 91–150. -
Gap 3: Skilled Nursing Facility Care
Medicare covers the first 20 days at no cost.
But from days 21–100, you’ll face a $209.50 daily copay.
Medicare Part B Gaps: Outpatient & Doctor Services
While Part B covers outpatient care and doctor visits, it still leaves significant costs that fall on you. Here are the main gaps:
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Gap 4: Annual Deductible
You’ll need to pay the $257 annual deductible before Medicare Part B coverage begins. -
Gap 5: 20% Coinsurance
After meeting the deductible, Medicare pays 80%, and you’re responsible for the remaining 20% of approved charges.
This coinsurance has no cap, meaning there’s no maximum out-of-pocket limit, leaving you exposed to high costs in the event of ongoing or major care. -
Gap 6: Part B Excess Charges
Some doctors don’t accept Medicare’s approved payment rates in full.
If a provider charges more, you may be billed up to an additional 15%, known as an excess charge, which you must pay out of pocket unless your Medigap plan covers it.
How Do Medicare Supplement Plans Work?
Medigap plans are designed to work alongside Original Medicare, helping cover the out-of-pocket costs that Parts A and B don’t pay.
Here’s how the process works:
- When you visit a doctor or healthcare provider, present both your Medicare card and your Medigap card.
- The provider bills Medicare first.
- After Medicare pays its share, the remaining balance is automatically sent to your Medigap insurance company.
- Depending on your Medigap plan, some or all of that balance may be covered, meaning you may owe little to nothing out of pocket.
Key benefits of Medicare Supplement plans:
- No pre-authorizations required
- Guaranteed renewable for life, as long as you continue to pay premiums
- Nationwide coverage, you can use your plan anywhere in the U.S. where Medicare is accepted
- Standardized benefits across most states, making plan comparisons simple
When Can You Change Medicare Supplement Plans?
Unlike Medicare Advantage and Part D plans, you can apply to change your Medicare Supplement (Medigap) plan at any time of the year. However, there’s one important catch: most changes require you to go through medical underwriting.
That means the insurance company can review your health history and may:
- Deny your application
- Charge a higher premium based on your current health
- Impose coverage limitations
To make a smart switch, consider:
- Whether your healthcare needs have changed
- If your current plan still offers good value
- Whether better pricing or benefits are available from another carrier
Working with a licensed Medicare advisor or broker can help you compare options and guide you through the underwriting process to ensure a smooth transition, if switching makes sense for your situation.
How Much Do Medicare Supplement Plans Cost?
The cost of a Medicare Supplement (Medigap) plan can vary based on several factors, including:
- The insurance company you choose
- Your location (rates differ by state and zip code)
- Your age and gender
- Whether you're applying outside of your Initial Enrollment Period and subject to medical underwriting
- Any discounts available (such as household or non-smoker discounts)
While rates can range widely, the average monthly premium for a Medigap plan is approximately $155. Some plans may be lower or higher depending on your specific situation and the benefits included.
For the most accurate quote, it’s best to speak with a licensed advisor who can compare rates across multiple carriers in your area.
Top Medicare Supplement (Medigap) Plans
There are eight standardized Medicare Supplement plans available today, each labeled with a letter (A, B, D, G, K, L, M, and N). However, Plans C and F are only available to individuals who were eligible for Medicare before January 1, 2020.
Among these options, three plans consistently rank as the most popular among Medicare beneficiaries:
- Plan G – Offers the most comprehensive coverage available to new enrollees, covering everything except the Part B deductible.
- Plan N – A lower-cost option with strong coverage, small copays for office visits and ER visits, and no coverage for Part B excess charges.
- Plan F – Available only to those eligible before 2020, it covers all gaps in Original Medicare, including the Part B deductible.
Important to note
- Coverage is standardized by law, meaning Plan G from one company covers the same benefits as Plan G from another.
- Premiums, however, can vary significantly depending on the insurance company, location, and personal factors.
Working with a licensed Medicare advisor can help you compare rates across carriers to find the best value for your preferred plan.
What Is Medicare Supplement Plan F?
Plan F is widely known for offering the most comprehensive coverage of all Medicare Supplement plans. It covers all six major gaps in Original Medicare, meaning you typically pay nothing out-of-pocket for Medicare-approved services.
However, Plan F is no longer available to people who became eligible for Medicare on or after January 1, 2020. Only those with a Medicare eligibility date before that time, generally meaning you were born on or before January 1, 1955, can still enroll.
Because of its full coverage, Plan F also comes with a higher monthly premium, averaging around $175.
What Is Medicare Supplement Plan G?
Plan G is now the most popular Medigap plan for those who are not eligible for Plan F. It offers nearly identical benefits, covering everything except the Medicare Part B deductible, which is $257 in 2025.
With broad coverage and a lower price point, Plan G averages about $150 per month and is considered a strong value for beneficiaries who want robust protection without overpaying.
What Is Medicare Supplement Plan N?
Plan N is a popular and budget-friendly choice among newer Medicare enrollees. It covers four of the six major Medicare gaps, excluding:
- The Part B deductible
- Part B excess charges (additional charges from providers who don’t accept Medicare’s standard rates)
Plan N also includes small copays:
- $20 for doctor visits
- $50 for emergency room visits (if you aren’t admitted)
The average monthly premium for Plan N is about $100, making it a more affordable option. However, it’s important to remember that you’ll be responsible for excess charges, which can lead to unexpected out-of-pocket expenses depending on your providers.
What’s the Difference Between Medigap and Medicare Advantage?
When deciding how to handle the gaps in Original Medicare, most people choose between Medicare Supplement (Medigap) and Medicare Advantage plans. While both offer additional coverage, they work very differently:
1. Structure
- Medigap is supplemental insurance that works with Original Medicare (Parts A & B). You continue to use your red, white, and blue Medicare card and pay a monthly premium for Medigap to help cover costs like deductibles, copayments, and coinsurance.
- Medicare Advantage (Part C) is a replacement for Original Medicare. You get coverage through a private insurance company, and that plan becomes your primary insurance, bundling hospital, medical, and often prescription coverage into one.
2. Doctor & Hospital Access (Networks)
- Medigap offers nationwide access, you can see any doctor or hospital that accepts Medicare.
- Medicare Advantage plans usually have restricted networks (HMO or PPO), which may limit your choice of providers outside of emergencies.
3. Costs
- Medicare Advantage plans often come with lower monthly premiums, some even have a $0 premium, and may include extra benefits like dental, vision, hearing, or gym memberships. However, these plans typically have copays and out-of-pocket maximums you’ll pay as you use services.
- Medigap plans generally have higher premiums, and you’ll also need a standalone Part D plan for prescriptions. However, they offer predictable costs and minimal out-of-pocket expenses when receiving care.
Which Should You Choose?
The right plan depends on your needs and budget.
- Prefer low, predictable medical bills and freedom to see any provider? Medigap may be a better fit.
- Want a lower monthly premium and all-in-one coverage with some added benefits? A Medicare Advantage plan might work well.
Tip: Speak with a licensed Medicare advisor to compare your options based on your health needs, medications, travel habits, and financial goals.
Explore Your Medigap Options with Dalton Insurance
Choosing the right Medicare Supplement plan can feel overwhelming, but you don’t have to figure it out alone. At Dalton Insurance, we’re here to help you confidently navigate your Medigap options and find a plan that fits your healthcare needs and budget.
Take advantage of our free educational resources, or join our virtual Medicare Essentials workshop to get clear, practical information about your choices.
Don’t wait to secure the comprehensive coverage you deserve in retirement. Download our free “Complete Guide to Medicare” for an in-depth look at how Medicare works, what it covers, and how much you can expect to pay.
Need one-on-one support? Schedule a call with a local Medicare advisor or contact us today, we’re here to help you take control of your healthcare future.
Medigap FAQs
Medigap is private health insurance that helps pay for out-of-pocket costs not covered by Original Medicare—such as copayments, coinsurance, and deductibles.
To buy a Medigap policy, you must be enrolled in both Medicare Part A and Part B. Medigap is not available to those enrolled in a Medicare Advantage plan.
The ideal time is during your Medigap Open Enrollment Period, which begins the month you turn 65 and are enrolled in Part B. During this window, you can enroll without medical underwriting—meaning you can’t be denied coverage or charged more due to health conditions.
No. Medigap does not include drug coverage. You’ll need to enroll in a separate Medicare Part D plan for prescriptions.
Yes, you can apply to change your plan at any time. However, outside of certain situations, you’ll likely need to go through medical underwriting, and your acceptance isn’t guaranteed.
Yes. Medigap plans are standardized by the federal government. That means Plan G from one company covers the same benefits as Plan G from another—but premiums can vary, so it’s worth shopping around.