Medigap Plans

*Plans C and F are open only to people who qualified for Medicare before January 1, 2020. Every plan pays Part A coinsurance and hospital costs. Coverage for travel abroad is subject to plan limits. Plan N includes some copays. Rules differ in Massachusetts, Minnesota and Wisconsin.

Plan letter determines Medigap benefits, which are standardized. Prices differ by insurer, age, ZIP code and tobacco use.

When your income and savings are limited, two programs can greatly lower your Medicare costs:

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

Original Medicare leaves gaps, and a Medicare Supplement plan is designed to fill them. It can pay these costs:

What each plan letter covers is set precisely by federal law, so a given letter carries identical benefits from every insurer in your state.

*Only people who became eligible for Medicare before January 1, 2020, can buy Plans C and F. **Plans K and L come with a yearly out-of-pocket limit that Medicare updates each year; once you hit it, the plan covers 100% of covered services for the remainder of the year. ***Plan N covers all Part B coinsurance apart from copays of up to $20 for certain office visits and up to $50 for ER visits that do not result in an inpatient admission. Massachusetts, Minnesota and Wisconsin use their own way of standardizing plans.

Most people new to Medicare choose one of these three. Plan G covers every gap except the Part B deductible. Plan N trades a lower premium for copays of up to $20 for some office visits and up to $50 for ER visits that do not lead to admission, and it does not cover Part B excess charges. High-Deductible Plan G has a $3,050 deductible for 2027, up from $2,950, then covers like Plan G. See Plan G vs Plan N.

Which method applies depends on the insurer and the state. Before buying, find out how a policy is priced, not only what it costs now.

In 2027, a standalone Part D plan can have a deductible of no more than $700 and an out-of-pocket cap of $2,400. Buy it with Medigap to avoid a late enrollment penalty that lasts for life.

Rather than paying all of most costs, Plans K and L pay a portion: Plan K covers 50% and Plan L covers 75% of most cost sharing, leaving the remainder to you. In return for their lower premiums, both carry an annual out-of-pocket limit set by Medicare each year. After you hit that limit, the plan covers 100% of covered services for the remainder of the year.

These plans may fit people who want catastrophic protection for a lower premium and can manage some costs along the way. Check whether your insurer sells Plan K or L in your state.

Only Plans C and F cover the Part B deductible. Since January 1, 2020, they have not been sold to people newly eligible for Medicare. If you became eligible for Medicare before that date, even without enrolling, you may still be able to purchase Plan C or F, including a High-Deductible Plan F that has the same $3,050 deductible for 2027.

For most people eligible to buy either, set the yearly premium gap between Plan F and Plan G against the Part B deductible. If the extra cost of Plan F exceeds what it saves you on the deductible, Plan G is the better value.

If disability or end-stage renal disease gives you Medicare before 65, federal law does not make insurers sell you a Medigap policy, though many states require it. Prices for those under 65 can run much higher, and plan options may be limited. At 65, you get a fresh six-month Medigap Open Enrollment Period, during which you can buy any plan sold in your state at the same prices others your age pay.

Within the U.S., a Medigap plan goes wherever you go, since it works with any provider that accepts Medicare. Abroad, Original Medicare generally pays nothing, but Plans C, D, F, G, M and N pay 80% of emergency care outside the U.S. after a $250 annual deductible, up to a $50,000 lifetime limit.

Once you buy Medigap, its benefits never change, but its premiums can. Insurers submit rate increases to state regulators, frequently once a year. Since the same plan letter has the same benefits everywhere, moving to a cheaper insurer can cut costs while your coverage stays the same.

The drawback is underwriting. Outside your Medigap Open Enrollment Period or a guaranteed issue situation, most states allow the new insurer to ask health questions and turn you down. Do not cancel your current policy until the new one has been approved and is in force.

Usually you won’t ever file a Medigap claim. Your doctor sends the bill to Medicare, Medicare pays its portion, and the claim passes automatically to your Medigap insurer, which then pays its portion. A Medicare Summary Notice and an explanation of benefits show you what each one paid.

Medigap plans sold now don’t include prescription coverage, so you should add a Part D plan as well. It doesn’t need to come from your Medigap insurer. Pick it based on your drugs and pharmacy in Medicare Plan Finder and look it over each fall. If you put off drug coverage with no other creditable coverage, the late penalty adds 1% of the national base beneficiary premium, $41.33 for 2027, for each month you were without it.

When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.

When a doctor “accepts assignment,” they agree to accept Medicare’s approved amount as payment in full. Doctors who don’t accept assignment may charge as much as 15% more, known as a Part B excess charge. Excess charges are covered by Plans F and G; Plan N and most other plans do not cover them.

Because most doctors accept assignment and some states restrict or ban excess charges, the risk is small for many people. Before deciding whether to pay for excess charge coverage, ask your doctors if they accept assignment.

You get a six-month Medigap Open Enrollment Period beginning in the first month you are both 65 or older and enrolled in Part B. It occurs only once and can’t be restarted. During this period, insurers have to sell you any Medigap plan they offer in your state at the same price healthy people pay.

If you work past 65, keep employer coverage and postpone Part B, your Medigap Open Enrollment Period does not begin until you sign up for Part B. Signing up for Part B early when you do not need it starts the clock and can waste this protection.

With coverage through a current employer, you may not need Medigap yet, and postponing Part B can save your Medigap Open Enrollment Period for later. Retiree coverage works differently: it can act like a supplement, so weigh it against Medigap before you give it up, since you may not be able to regain retiree coverage.

You generally have a guaranteed issue right to buy certain Medigap plans when employer or union coverage that pays after Medicare comes to an end.

You do not need to compare plans by yourself, and help should not cost you anything. Here are the free options:

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.