What Does Medicare Supplement Insurance (Medigap) Cover and Not Cover?
Learn what Medigap covers and does not cover, including deductibles, copayments, Plan G, Plan N, prescription drugs, and other Medicare out-of-pocket costs.
Key Takeaways
Medigap, also called Medicare Supplement Insurance, helps cover many of the out-of-pocket costs not covered by Original Medicare, including deductibles, copayments, and coinsurance. Private insurance companies sell Medigap plans, but the federal government standardizes coverage by plan letter.
What Medigap covers depends on the plan you choose, but most plans help pay for:
- Medicare Part A hospital coinsurance and hospital costs
- Medicare Part B coinsurance for doctor visits and outpatient care
- Skilled nursing facility coinsurance
- Hospice care copayments and coinsurance
- The first three pints of blood for transfusions
- Emergency foreign travel coverage on select plans
Popular options like Plan G and Plan N offer broader protection for retirees seeking more predictable healthcare costs.
Medigap does not cover everything. These plans generally do not pay for:
- Prescription drugs
- Dental, vision, or hearing care
- Long-term or custodial care
- Private-duty nursing
Because Medigap only works with Original Medicare, beneficiaries cannot use it alongside a Medicare Advantage plan. Choosing the right Medigap policy often comes down to balancing monthly premiums, provider flexibility, and long-term healthcare costs in retirement.
What Does Medicare Supplement Insurance (Medigap) Cover and Not Cover?
Many retirees assume Original Medicare will cover most healthcare expenses once enrollment begins. Then the bills start arriving. Hospital deductibles, copayments, coinsurance, and other out-of-pocket costs can add up quickly, especially for people who need ongoing care or frequent medical visits.
That financial uncertainty is one reason many Medicare beneficiaries choose Medigap coverage. In 2023, 43% of people enrolled in Original Medicare, about 12.2 million beneficiaries, had a Medigap policy to help manage costs Medicare does not fully pay.
Medigap plans can provide valuable financial protection, but coverage varies by plan. Some plans cover nearly all out-of-pocket costs tied to Original Medicare, while others leave beneficiaries responsible for certain deductibles, copayments, or excess charges.
By understanding what Medigap covers and what it does not, you can avoid unexpected healthcare expenses and benefit your retirement budget.
What Is Medigap?
Medigap, also called Medicare Supplement Insurance, is additional insurance sold by private companies to help cover out-of-pocket costs in Original Medicare. These policies help cover expenses such as copayments, coinsurance, and deductibles that Medicare Parts A and B do not fully cover. Many retirees choose Medigap coverage to reduce unexpected medical bills and create more predictable healthcare costs in retirement.
Although private insurance companies sell Medigap policies, federal and state governments regulate how they work. Medigap plans are standardized, which means a Plan G policy must provide the same basic benefits regardless of which company sells it or where you live.
There are 10 standardized Medigap plans available in most states: Plans A, B, C, D, G, K, L, M, and N, along with high-deductible versions of certain plans. Historically, Plans C and F offered some of the most comprehensive coverage available. However, Congress stopped allowing newly eligible Medicare beneficiaries to purchase Plans C and F after January 1, 2020, because those plans covered the Medicare Part B deductible.
Another important feature of Medigap is guaranteed renewability. In most cases, your policy renews automatically. According to Medicare.gov, the only reasons your Medigap insurance company could drop you are if you stop paying your premium, if you lied on your Medigap policy application, or if the insurance company goes bankrupt or out of business.
Medigap Plan Benefits at a Glance
Compare what each standardized Medicare Supplement plan covers. Benefits are identical across insurers for any given plan letter.
| Benefit | A | B | CPre-2020 | D | FPre-2020 | GPopular | K | L | M | NPopular |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital costs (365 extra days) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Part B coinsurance or copayment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓* |
| Blood (first 3 pints) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A hospice care coinsurance/copay | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Skilled nursing facility coinsurance | — | — | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A deductible | — | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ |
| Part B deductible | — | — | ✓ | — | ✓ | — | — | — | — | — |
| Part B excess charges | — | — | — | — | ✓ | ✓ | — | — | — | — |
| Foreign travel emergency (up to plan limits) | — | — | 80% | 80% | 80% | 80% | — | — | 80% | 80% |
| Out-of-pocket annual limit | N/A | N/A | N/A | N/A | N/A | N/A | ✓ | ✓ | N/A | N/A |
Pre-2020: Plans C and F are only available to people who became eligible for Medicare before January 1, 2020.
*Plan N copays: Up to $20 for some office visits and up to $50 for emergency room visits that do not result in inpatient admission.
Source: Coverage benefits are standardized by federal law. Benefits shown reflect Medicare.gov's standardized plan chart.
*In some states, Medigap Plans F and G come with a high-deductible version as well. The benefits are identical to the standard F and G plans—the difference is that premiums are lower, and you must pay a set amount out-of-pocket before coverage begins.
What Does Medigap Cover?
While Original Medicare covers a large portion of approved healthcare expenses, beneficiaries remain responsible for deductibles, copayments, and insurance. That is where Medigap comes in. Medigap coverage helps reduce those gaps, making healthcare costs more predictable.
Coverage varies depending on the plan you choose, but most Medigap policies help pay for costs tied to Medicare Part A and Part B services.
Common expenses Medigap plans may help cover include:
- Medicare Part A coinsurance and hospital costs after Original
- Medicare benefits are exhausted.
- Medicare Part B coinsurance, including the 20% beneficiaries typically pay for covered outpatient services.
- Blood transfusions, including the first 3 pints of blood.
- Skilled nursing facility coinsurance for most plans.
- Medicare Part A deductibles.
- Hospice care coinsurance or copayments under medicare Part A.
Some Medigap plans also include limited coverage for emergency healthcare services during international travel, which can provide additional peace of mind.
Even though Medigap can significantly reduce out-of-pocket expenses, it doesn’t eliminate every healthcare cost. Coverage varies by plan type, making it especially important to understand the differences between options. For newly eligible beneficiaries, Plan G and Plan N are the most popular choices because they offer broad coverage while balancing affordability and out-of-pocket responsibility.
What Does Medigap Plan G Cover?
Medigap Plan G is often considered the most comprehensive Medigap option available to people who became eligible for Medicare after January 1, 2020. It covers nearly all out-of-pocket costs tied to Original Medicare, which is one reason Plan G has become one of the most popular Medicare Supplement plans available today.
Plan G helps pay for many expenses beneficiaries would otherwise pay themselves, including Medicare Part A deductibles, hospital coinsurance, skilled nursing facility coinsurance, hospice care copayments, blood transfusions, and Medicare Part B excess charges. Excess charges can occur when a provider who accepts Medicare charges more than the Medicare-approved amount for certain services.
Plan G also includes emergency foreign travel coverage for qualifying medical emergencies outside the United States. Most plans cover 80% of approved emergency care costs after a deductible, up to plan limits.
The main expense Plan G doesn’t cover is the Medicare Part B deductible. In 2026, the Part B deductible is projected to be $283, meaning beneficiaries must pay that amount before Part B coverage fully begins.
If you have quite a few office or emergency visits, Plan G could be the best option for you due to its comprehensive coverage, though it does come with a higher premium.
What Does Medigap Plan N Cover?
Medigap Plan N offers many of the same core benefits as Plan G, but with lower monthly premiums in exchange for slightly higher out-of-pocket costs. If you are looking to balance coverage with affordability and have relatively few medical or emergency visits, Plan N could be the best option.
Like Plan G, Plan N helps cover Medicare Part A hospital costs, skilled nursing facility coinsurance, hospice care copayments, and emergency healthcare services while traveling internationally. It also covers most Medicare Part B coinsurance expenses, which can significantly reduce routine out-of-pocket medical costs.
However, Plan N doesn’t cover Medicare Part B excess charges. If a provider charges more than the Medicare-approved amount and does not accept Medicare assignment, you would be responsible for paying the additional costs. Plan N also requires some cost-sharing for certain medical visits, including copayments of up to $20 for office visits and up to $50 for emergency room visits that don’t result in hospital admission.
If you don’t expect frequent medical visits and want lower monthly premiums, Plan N may provide a strong middle ground between coverage and cost. The right choice often depends on healthcare usage, provider preferences, and long-term budgeting goals.
What Does Medigap Not Cover?
While Medigap helps reduce many of the out-of-pocket costs tied to Original Medicare, it doesn’t cover every expense you may face. You might be surprised to learn that some common healthcare services still require separate insurance, standalone plans, or additional savings.
Medigap policies generally don’t cover:
- Long-term care, including extended nursing home or custodial care.
- Routine dental care, dentures, or most dental procedures.
- Vision care, including routine eye exams and glasses.
- Hearing aids and hearing-related services.
- Private-duty nursing.
- Prescription drugs.
It’s critical to note that Medigap’s coverage for prescription drugs varies. Modern Medigap plans sold to new Medicare beneficiaries don’t include prescription drug coverage, which means you typically need a separate Medicare Part D plan for medications. However, older Medigap policies issued before 2005 sometimes include limited drug benefits; those plans are available to new enrollees.
These coverage gaps play a major role in retirement healthcare and financial planning. Even with a comprehensive Medigap policy, you may still need to budget for additional services Medicare and Medigap don’t pay for, especially dental, vision, hearing, and long-term care expenses.
Is Medigap Right for You?
Medigap can bring you financial peace of mind, but the right choice depends on your personal healthcare needs and financial comfort level. Some people prefer the predictability of paying higher monthly premiums in exchange for fewer unexpected medical bills. In contrast, others are comfortable taking on more out-of-pocket costs to keep premiums lower.
Many people choose Medigap because it offers both flexibility and stability. Since Medigap works alongside Original Medicare, you can generally see any provider nationwide who accepts Medicare without worrying about network restrictions. This can be especially important for people who travel frequently, split their time between states, or want broader access to providers.
Timing also matters when enrolling in Medigap. The best time to buy a policy is usually during your six-month Medigap open enrollment period, which begins when you are both 65 or older and enrolled in Medicare Part B. During this period, insurance companies generally can’t deny coverage or charge higher premiums based on your health history.
Costs can vary significantly between insurers, even for identical plan letters. Comparing premiums, pricing structures, and long-term affordability can help you choose coverage that fits your medical and financial needs.
Medigap vs Medicare Advantage
Many people eventually choose between Medigap and Medicare Advantage, two options for managing healthcare costs beyond Original Medicare. In 2024, 54% of eligible Medicare beneficiaries had Medicare Advantage plans, while millions of others chose Original Medicare with supplemental coverage, such as Medigap.
Medigap supplements Original Medicare by helping pay deductibles, copayments, and coinsurance. Medicare Advantage, also called Medicare Part C, replaces Original Medicare with Medicare-approved private plans that often bundle medical, hospital, and prescription drug coverage together.
One major difference between the two is provider flexibility. While Medigap typically allows you to see any provider nationwide that accepts Medicare, Medicare Advantage plans rely on provider networks. Many Medicare Advantage plans also include benefits Medigap doesn’t cover, such as dental, vision, hearing, and prescription drug coverage. Although there are advantages to both Medigap and Medicare Advantage, you can’t bundle the two together.
Medigap vs. Medicare Advantage at a Glance
Both work alongside Medicare, but they're structured differently and can't be combined. Here's how they compare.
Medigap (Supplement)
Works with Original Medicare
Medicare Advantage (Part C)
Replaces Original Medicare
| Feature | Medigap | Medicare Advantage |
|---|---|---|
| How it works | Supplements Original Medicare by paying deductibles, copays, and coinsurance | Private plan that replaces Original Medicare and bundles benefits |
| Provider access | ✓Any provider nationwide that accepts Medicare | ✕Limited to plan's network (HMO/PPO) |
| Referrals for specialists | ✓Not required | ✕Often required (especially HMO) |
| Prescription drug coverage | ✕Not included — need separate Part D | ✓Usually bundled in |
| Dental, vision, hearing | ✕Not covered | ✓Often included as extra benefits |
| Monthly premium | Higher premium, lower out-of-pocket costs | Lower premium (sometimes $0), variable out-of-pocket |
| Annual out-of-pocket maximum | None on most plans (K and L include limits) | ✓Federally capped each year |
| Travel coverage | Some plans include foreign travel emergency care | Limited outside the plan's service area |
| Can be combined | ⚠ You cannot have both Medigap and Medicare Advantage at the same time | |
How To Choose the Right Medigap Plan
When choosing the right plan, don’t look at what provides the most coverage. Instead, choose the plan that matches your lifestyle and your healthcare needs over the long term.
Start by reviewing your current medical habits and anticipated healthcare needs. Next, you will need to compare how insurers price their plans, keeping in mind that costs can vary not just by plan letter but also by insurer. Some insurers raise premiums as you age, while others base your rate on your age when you first enroll, or charge the same community rate to everyone regardless of age.
Healthcare coverage should also fit within your broader retirement strategy. Medical costs often increase as you age, and inflation can place additional pressure on fixed income sources over time. Even relatively manageable healthcare expenses today may become more difficult to absorb in retirement, especially if long-term care needs, prescription costs, or ongoing specialist visits increase.
That is why many retirees evaluate Medigap coverage, not just as a monthly expense, but as part of a larger financial planning decision. Balancing premiums, out-of-pocket costs, retirement savings, and everyday living expenses can help create more predictable long-term budgeting and reduce the likelihood that unexpected healthcare bills will disrupt your financial goals later in retirement.
Making the Most of Your Medigap Coverage
Healthcare decisions can feel overwhelming, especially once you start comparing premiums, coverage limits, and out-of-pocket costs. The good news is that the right Medigap plan can reduce much of that uncertainty and make healthcare expenses easier to manage throughout retirement.
As your healthcare needs change over time, it is worth periodically reviewing your coverage to ensure your plan still fits your budget and health needs. Even though Medigap benefits are standardized, premiums vary among insurers, and these differences, coupled with additional prescription drug costs, provider charges, and other medical expenses, can still affect your overall retirement spending.
The goal is not just finding coverage. It is building a healthcare strategy that helps you feel more financially prepared and confident moving forward.
If you would like to learn more about Medicare, compare coverage options, or better understand long-term healthcare planning in retirement, My Guide to Retirement offers additional tools and educational resources to help you navigate those decisions more confidently.
FAQs About Medigap Coverage
Medigap rules, costs, and coverage details can quickly become confusing, especially when comparing plans or enrolling for the first time. Below are answers to some of the most common questions retirees ask when evaluating Medigap coverage and how it works alongside Medicare.
Medigap helps cover out-of-pocket costs left by Original Medicare, including Medicare Part A and Part B coinsurance, copayments, and deductibles. Most plans also cover hospital stays for up to 365 additional days after Medicare benefits are exhausted, and the first three pints of blood each year. Some plans additionally cover foreign travel emergency care and offer skilled nursing facility coinsurance.
Medigap does not cover prescription drugs, dental care, vision care, hearing aids, eyeglasses, long-term care, or private-duty nursing. It also cannot be used to cover costs associated with a Medicare Advantage plan. Retirees who need prescription drug coverage must enroll in a separate Medicare Part D plan.
No. Medigap plans sold after 2005 do not include prescription drug coverage. If you need drug coverage, you will need to enroll in a standalone Medicare Part D plan in addition to your Medigap policy.
Plan G is the most comprehensive Medigap plan available to new Medicare enrollees. It covers Medicare Part A and Part B coinsurance, the Part A deductible, skilled nursing facility coinsurance, Part B excess charges, and 80% of foreign travel emergency care. The only cost Plan G does not cover is the annual Medicare Part B deductible, which is $283 in 2026.
Plan N covers most of the same benefits as Plan G, including Part A coinsurance, Part B coinsurance, skilled nursing facility coinsurance, and 80% of foreign travel emergency care. However, Plan N does not cover Part B excess charges and requires copayments of up to $20 for some office visits and up to $50 for emergency room visits that do not result in a hospital admission.
No. Medigap policies work only alongside Original Medicare (Parts A and B). If you are enrolled in a Medicare Advantage plan, you cannot use a Medigap policy to cover your out-of-pocket costs.
The best time to enroll in a Medigap plan is during your six-month open enrollment period, which begins the month you turn 65 and have Medicare Part B. During this window, insurers are required to offer you coverage regardless of your health history. They cannot charge higher premiums based on pre-existing conditions. Enrolling outside this period may subject you to medical underwriting.
Start Planning Today for a Secure and Healthy Retirement
Use the free tools and resources at My Guide To Retirement to plan a comfortable and fulfilling retirement, according to your specific financial and health goals.
