How Medigap works with Medicare
Original Medicare pays its share first. Your Medigap policy then pays the benefits specified by its plan. You generally need both Part A and Part B, and you pay a Medigap premium in addition to Part B.
Medigap does not work with Medicare Advantage and does not replace Medicare. New policies do not include Part D prescription drug coverage. Medicaid, employer coverage, VA benefits and TRICARE have separate coordination rules.
What do Medigap plans cover?
Standardized plan letters describe benefits, not provider networks. Policies with the same letter generally offer the same standardized benefits, but premiums differ. Massachusetts, Minnesota and Wisconsin standardize plans differently. Not every plan pays every item in full.
| Benefit | How it can work |
|---|---|
| Part A hospital coinsurance | Includes up to 365 additional hospital days after Medicare benefits are used, subject to the policy. |
| Part B coinsurance or copayments | Coverage differs by plan; some pay a percentage and Plan N has certain copayments. |
| Blood and hospice cost sharing | Covered at the level specified for the plan letter. |
| Skilled nursing facility coinsurance | Included in some plans. |
| Part A deductible and Part B excess charges | Included in certain plans; compare the benefit chart. |
| Foreign travel emergencies | Certain plans offer limited coverage with a deductible and lifetime limit. |
| Routine dental, vision, hearing and long-term care | Generally not covered by Medigap. Ask about separate options. |
2026 figures to understand
These federal amounts are not Medigap premiums. Your policy price depends on the insurer, plan, location and other permitted rating factors.
| Item | 2026 amount |
|---|---|
| Standard monthly Part B premium | $202.90; higher-income beneficiaries may pay more. |
| Annual Part B deductible | $283. |
| Part A inpatient hospital deductible | $1,736 per benefit period, not per year. |
| High-deductible Plan F or G deductible | $2,950 before the high-deductible policy pays covered costs. |
| Plan K / Plan L out-of-pocket limits | $8,000 / $4,000; the annual Part B deductible must also be met. |
Verify 2027 Part A/B and Medigap figures when Medicare publishes them. Do not carry 2026 amounts into a 2027 quote. Separate Part D covered-drug spending limits are $2,100 for 2026 and $2,400 for 2027.
Important plan-letter differences
- Plans C and F cannot be sold to people newly eligible for Medicare on or after January 1, 2020. Earlier eligibility can change your options.
- Plan G generally does not pay the Part B deductible. A high-deductible version is available in some states.
- Plan N can require up to $20 for certain office visits and up to $50 for emergency visits that do not lead to inpatient admission. It does not cover Part B excess charges.
- Plans K and L pay a share of certain costs until applicable limits and the Part B deductible are met. Compare the official benefit chart.
Your Medigap enrollment protections
Under federal law, your six-month Medigap Open Enrollment Period begins the first month you are age 65 or older and enrolled in Part B. During this period, an insurer cannot deny a policy it sells or charge more because of your health.
Outside this period, medical underwriting may apply unless you have a guaranteed issue right or other state protection. Under-65 access differs by state. New York and other states may provide rights beyond the federal minimum; check your state insurance department.
Medicare’s annual October–December enrollment period is not a general Medigap guaranteed-issue period. Do not drop an existing policy before confirming whether a replacement will be issued and when it takes effect.
Pre-existing conditions and waiting periods
A Medigap insurer may apply a waiting period of up to six months for certain pre-existing conditions where allowed. Prior creditable coverage and protected rights can reduce or eliminate that wait. Original Medicare still pays its covered share during the waiting period.
Outside protected enrollment rights, an insurer may ask health questions, charge more or decline an application where permitted. Ask for the rules in writing before replacing coverage.
How insurers set Medigap premiums
| Pricing method | What it means |
|---|---|
| Community-rated | Age is not used to set the premium; other permitted factors and increases may apply. |
| Issue-age-rated | Based on your age when you buy. Premiums may still rise for inflation and other reasons. |
| Attained-age-rated | Based on your current age, so premiums can rise as you get older, as well as for other reasons. |
Compare the same plan letter, insurer service, available discounts and rate history. Ask about dental and vision separately; do not assume they are included.
Compare Medigap and Medicare Advantage
| Feature | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
| How coverage works | A private plan provides your Part A and Part B benefits. | Original Medicare pays first; a Medigap policy helps with specified remaining costs. |
| Doctors and hospitals | Network, referral and prior-authorization rules depend on the plan. Check each doctor and facility. | Usually any provider in the U.S. that accepts Medicare. Medicare SELECT policies can have network requirements. |
| Prescription drugs | Most plans include Part D; verify each medication and pharmacy. | New Medigap policies do not include Part D. A separate drug plan may be needed. |
| Monthly premiums | Part B still applies; the plan may charge another premium. A $0 plan premium does not mean $0 total cost. | Part B, Medigap and any separate Part D premiums apply. |
| Medical out-of-pocket costs | A yearly limit applies to covered Part A/B services; network and other rules affect the limit. | Original Medicare alone has no annual limit. Medigap pays the benefits specified by its plan letter. |
| Dental, vision and hearing | Some plans include extra benefits with limits, networks and eligibility conditions. | Medigap generally does not cover routine dental, vision or hearing services. |
| Travel and moving | Emergency and urgent care rules differ from routine care. Foreign emergency benefits are plan-specific. | Medicare works nationwide with participating providers; certain Medigap plans include limited foreign travel emergency benefits. |
| Changing coverage later | You need an applicable enrollment period. | Outside protected enrollment rights, medical underwriting may apply. State rules differ. |
Medigap does not automatically end when you join Medicare Advantage. Coordinate any cancellation and confirm your rights to return. A Licensed Insurance Agent can help explain your choices.