Deciding if and when to add a Medicare supplement plan, also known as Medigap, to original Medicare (Part A and Part B) can feel daunting when you’re already facing complex insurance plan choices. However, there’s no need to despair, says Ari Parker, co-founder and head Medicare advisor at Chapter, a nationwide service that helps people nationwide shop for Medicare plans.
“Figuring out whether or not to get supplemental insurance for Medicare — and if so, what kind — can be complicated for someone who is dealing with these decisions for the first time,” says Parker, who is the author of the book, “It’s Not That Complicated: The Three Medicare Decisions to Protect Your Health and Money.” “Once consumers break down what’s most important to them, the choices aren’t as overwhelming.”
[Read: What’s the Difference Between Medicare and Medigap?]
What Is Medigap?
Medigap is a supplemental insurance plan that pays for many costs that original Medicare doesn’t cover, such as coinsurance, copays for doctor’s visits and — in some cases — deductibles. These plans are sold by private insurers for those enrolled in original Medicare.
There are 10 different types of standardized Medigap plans offered in most states that are named by letters: A to D, F, G and K to N.
Policies designated with the same letter provide the same fundamental benefits, regardless of your location or the insurance company you purchase the policy from. The only difference between plans with the same letter — sold by different insurance companies — is the price.
Should you get a Medigap plan?
If you have original Medicare, it’s a good idea to consider getting a Medigap plan. Original Medicare typically covers 80%, not 100%, of all medical costs after the deductible is met, so it may be beneficial for you to have the extra insurance to cover the gaps in Medicare coverage.
“There is no out-of-pocket cap when you have original Medicare,” says Susan Stewart, a licensed insurance broker based in Muskegon, Michigan. “Most people cannot afford the 20% cost to have outpatient surgery, go to the emergency room or have expensive tests like CT scans and MRIs. If a beneficiary chooses original Medicare, they are wise to choose a Medigap plan where out-of-pocket expenses are limited and clearly defined.”
Since original Medicare has no yearly out-of-pocket limit as to what you pay, something like an extended hospital stay could end up costing you thousands. Having a Medigap policy not only helps with the day-to-day out-of-pocket expenses that come with medical care, but also the peace of mind of knowing that you are covered from any major medical bills and the financial implications that can come with it.
“If being able to choose your health care provider is a top priority, a Medigap plan might be the right choice for you,” Parker says. “Suppose you’re being treated for cancer, and you don’t live in Texas, but you want an appointment with a doctor at the University of Texas MD Anderson Cancer Center, which is consistently rated as one of the top hospitals for cancer treatment. With a Medigap plan, you would be covered. You wouldn’t have to worry about limitations of a network or geographical region.”
You should note, as well, that Medicare Advantage plans do have a maximum out-of-pocket limit ($9,250 in 2026), so you cannot pair a Medigap plan with a Medicare Advantage plan.
What does Medigap not cover?
Medigap plans do not cover:
— Prescription drugs
— Private duty nursing
[READ: Your Guide to Medigap Plan A]
How Much Does Medigap Cost?
The average monthly Medigap premium cost around $217 in 2023 (the most recent information available), according to KFF analysis of National Association of Insurance Commissioners 2023 data.
However, the cost of a Medigap plan can depend on an array of factors, including:
— When you purchase a Medigap plan
— Your gender
— Location
— Age
— Health status
— Whether you use tobacco
Policies that provide more coverage will have higher premiums than policies that provide less coverage. Medigap policies are also sold individually, so if both you and your partner want one, you will have to sign up separately.
The type of policy can dictate costs as well.
| Policy Type | How It’s Priced | Do Costs Increase As You Age? |
| Community-rated | The premium is the same for everyone (regardless of age) in the area. | Generally, no (though prices may increase due to inflation) |
| Issue-age-rated | The premium is based on the age you were when you bought the plan. | No |
| Attained-age-rated | The premium is based on your current age. | Yes |
Be sure to compare a few Medigap plans with the same letter but administered by different insurance companies, as there can be a big difference between what the insurance companies charge for the same coverage.
[READ: What Is Medigap Plan G?]
When Can You Get a Medigap Plan?
The best time to buy a Medigap plan is when you’re first eligible. You have a six-month Medigap open enrollment period that begins the first month you turn 65 and have Medicare Part B.
You can enroll in any Medigap policy, and the insurance company cannot deny you coverage due to preexisting health conditions during this time. After that time, you may still apply, but depending on your health, you might be denied coverage or charged higher premiums.
Once you purchase a Medigap policy, the policy is automatically renewed every year, even if you have health problems, as long as you pay your premiums.
According to Medicare.gov, the Medigap insurance company can only drop you if:
— You stop paying the monthly premium.
— You weren’t truthful on the application for the plan.
— The insurance company goes bankrupt or goes out of business.
Prescription Drug Coverage
Medigap policies currently on the market don’t include prescription drug coverage.
“If you have original Medicare, you need to have creditable drug coverage, even if you take no or just one inexpensive medication,” Stewart says. “They require that you purchase a drug plan or face a penalty when you finally get one.”
Some Medigap plans sold to consumers before 2006 included outpatient drug benefits, according to the CMS. Consumers who still have such a policy can keep this coverage and choose not to sign up for a Medicare prescription drug plan.
Otherwise, individuals with a Medigap plan can choose to enroll in Medicare Part D for prescription coverage, which is available to consumers who are enrolled in original Medicare. A provision of the Inflation Reduction Act also limits the out-of-pocket maximum Medicare Part D beneficiaries can pay. In 2026, the maximum out-of-pocket limit is $2,100.
Bottom Line
For those enrolled in original Medicare, an important choice is deciding whether to add a Medigap plan and which one. Original Medicare covers 80% of medical costs after the deductible is met, leaving no out-of-pocket cap, which can be financially risky. Medigap plans help cover the day-to-day costs, such as coinsurance or copays, but they also cover the expenses of large medical bills, such as hospital stays and surgeries.
The best time to buy a Medigap plan is during the six-month open enrollment period when you turn 65 and have Medicare Part B. During this time, coverage cannot be denied based on preexisting conditions.
After this period, obtaining coverage may be more challenging or expensive.
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Medigap Coverage: When Do You Need It? originally appeared on usnews.com
Update 01/26/26: This story was published at an earlier date and has been updated with new information.
