Key Takeaways

• Medigap plans help cover costs that Original Medicare doesn’t, but you must enroll during the right time to avoid higher costs.

• Comparing different Medigap options based on coverage needs, budget, and future healthcare expenses is essential for making the right decision.

Understanding Medigap: What It Covers and Why You Might Need It

If you’re enrolled in Original Medicare, you probably know that it doesn’t cover everything. That’s where Medigap plans come in. These supplemental plans help cover costs like copayments, coinsurance, and deductibles. Without Medigap, you might face higher out-of-pocket expenses that could add up quickly.

But choosing a Medigap plan isn’t as simple as just signing up. You need to understand what’s covered, when to enroll, and how these plans fit into your overall Medicare strategy. Let’s break down six critical facts about Medigap to help you make a well-informed decision.

1. Medigap Plans Are Standardized, but Costs Can Vary

One of the biggest benefits of Medigap is that plans are standardized across most states. This means that Plan G in one state offers the same benefits as Plan G in another. However, what varies is the cost.

In 2025, Medigap plans remain standardized in 47 states, while Massachusetts, Minnesota, and Wisconsin have their own versions. Because different insurance companies set their own pricing structures, it’s important to compare costs before making a choice.

Pricing Structures You Should Know

Medigap plans follow three main pricing models:

• Community-rated: Everyone pays the same monthly premium regardless of age.

• Issue-age-rated: Premiums are based on your age when you first buy the policy. The younger you are at enrollment, the lower your premium.

• Attained-age-rated: Premiums start low but increase as you age.

2. The Best Time to Enroll Is During Your Open Enrollment Period

Timing matters when it comes to Medigap enrollment. Your Medigap Open Enrollment Period (OEP) is a one-time, six-month window that starts the month you turn 65 and enroll in Medicare Part B.

Why This Enrollment Period Is Important

During this period, you can buy any Medigap plan available in your state without medical underwriting. That means insurers cannot deny coverage or charge you more based on pre-existing conditions. If you miss this window, you may have to go through medical underwriting, which could lead to higher costs or even denial of coverage.

3. Medigap Doesn’t Cover Everything—Know Its Limits

While Medigap can save you from significant out-of-pocket expenses, it doesn’t cover every type of healthcare cost.

What Medigap Doesn’t Cover

• Prescription Drugs: You’ll need a separate Medicare Part D plan for that.

• Long-Term Care: Nursing home stays and custodial care are not included.

• Dental, Vision, and Hearing Services: You’ll need to purchase separate coverage.

• Private-Duty Nursing: Not covered by Medigap.

Understanding these limitations helps you plan for additional healthcare needs beyond what Medigap offers.

4. Medigap Works Best If You Travel Frequently

If you love to travel, especially internationally, Medigap may be a great option. Some plans cover emergency medical care outside the U.S., which Original Medicare does not.

Foreign Travel Emergency Coverage

Most Medigap plans that offer foreign travel coverage pay 80% of emergency medical expenses after you meet a small deductible. This can be extremely helpful if you spend part of the year abroad or take frequent trips.

5. Medigap and Medicare Advantage Plans Don’t Work Together

A common mistake is assuming you can have both Medigap and a Medicare Advantage plan at the same time—you can’t. You must choose one or the other.

Key Differences

• Medigap works with Original Medicare to help cover out-of-pocket costs.

• Medicare Advantage replaces Original Medicare and typically includes additional benefits like dental, vision, and prescription drug coverage.

If you enroll in a Medicare Advantage plan, it’s illegal for an insurance company to sell you a Medigap policy unless you switch back to Original Medicare.

6. Medigap Plans Are Guaranteed Renewable—But Your Premiums Can Increase

Once you enroll in a Medigap plan, you can keep it as long as you pay your premiums. This is called guaranteed renewability.

However, while the benefits of your plan remain the same, your premiums can increase over time. These increases can happen due to inflation, changes in healthcare costs, or if your plan follows an attained-age pricing model.

What Can Cause Rate Increases?

• Annual adjustments due to rising medical expenses.

• Attained-age policies increasing as you get older.

• State regulations impacting pricing adjustments.

Making the Right Medigap Decision for Your Needs

Choosing a Medigap plan is a significant decision that affects your healthcare costs and coverage. To ensure you pick the right plan:

• Compare different pricing models to see which works best for your budget.

• Enroll during your Open Enrollment Period to avoid medical underwriting.

• Consider additional coverage for services Medigap doesn’t cover, like dental and vision.

• If you travel, look for plans with foreign emergency coverage.

• Remember that Medigap and Medicare Advantage are separate options—choose wisely.

Before making a final decision, speak with a licensed agent listed on this website. They can help you compare your options and find a Medigap plan that aligns with your needs and budget.