Medigap Is Good. It’s Not Perfect.
Most people buying a Medicare supplement plan assume they’re buying near-total coverage. And honestly, for major medical events, they’re right. But there are real holes in Medigap coverage that catch people off guard every year, and some of them are expensive enough to matter. I’m not going to scare you unnecessarily. Most of these gaps won’t affect the average retiree in a given year. But if you don’t know about them going in, you’ll be blindsided when one does.
Here’s what I actually want you to walk away with: an honest picture of what Medicare supplement plans cover, what they don’t, and where you might need to plan around the edges. Because the worst time to discover a coverage gap is when you’re already in the middle of a medical situation.
The Gaps That Are Built Into Every Medigap Plan
No matter which standardized Medigap plan you pick, there are categories of care that fall completely outside what any of them cover. These aren’t fine print quirks. They’re structural. Medicare itself doesn’t cover these things, and since Medigap supplements Medicare, if Medicare won’t pay, Medigap won’t either.
The biggest one is prescription drugs. Not a single Medigap plan sold today covers outpatient prescription medications. That coverage lives entirely in Part D, which is a separate plan you buy separately. I’ve talked to people who assumed their Plan G handled their prescriptions. It doesn’t. Never did. You need Part D running alongside your Medigap plan, or you’re paying for medications entirely out of pocket.
Beyond drugs, here’s what Medigap flat-out won’t cover regardless of which plan you buy:
- Routine dental care – cleanings, fillings, extractions, dentures
- Routine vision care – eye exams for glasses or contacts, frames, lenses
- Hearing aids and routine hearing exams
- Long-term custodial care – help with daily activities in a nursing home or at home
- Cosmetic surgery
- Acupuncture (with very limited Medicare exceptions)
- Most care received outside the United States
Dental is the one that hurts people the most. A 68-year-old in Michigan with a Plan G can have a $900 crown, and Medigap won’t touch it. You’d need a standalone dental plan or to pay out of pocket. This isn’t a flaw in your specific plan. It’s just the line where Medicare ends.
Plan-Specific Gaps That Surprise People
Beyond the universal exclusions, some gaps depend on which Medigap plan you chose. And this is where picking the wrong plan at enrollment creates real financial exposure down the road.
The biggest example right now involves the Part B deductible. In 2026, the Part B deductible is $257. That doesn’t sound like much, but here’s the thing: if you’re on Plan G (the most popular plan for new Medicare enrollees), you pay that deductible yourself every year before Medigap kicks in for Part B services. Plan F, the older plan that covered it, is no longer available to people who became eligible for Medicare after January 1, 2020.
Plan N has a different exposure: you pay copays of up to $20 for office visits and up to $50 for emergency room visits that don’t result in inpatient admission. For someone with three or four doctor visits a year, that’s maybe $60-$80. Not the end of the world. But if you’re managing a chronic condition and seeing specialists frequently, Plan N’s cost-sharing can add up faster than the premium savings justify.
Here’s a comparison of what the common plans actually leave you paying:
| What You’re Paying | Plan F | Plan G | Plan N |
|---|---|---|---|
| 2026 Part A deductible ($1,676/benefit period) | Covered | Covered | Covered |
| 2026 Part B deductible ($257/year) | Covered | You pay | You pay |
| Part B excess charges | Covered | Covered | You pay |
| Office visit copays (up to $20) | Covered | Covered | You pay |
| ER copay if not admitted (up to $50) | Covered | Covered | You pay |
| Prescription drugs | Not covered | Not covered | Not covered |
Plan G is still the right choice for most people turning 65 right now. The $257 Part B deductible is predictable, modest, and worth the tradeoff for having no copays or excess charge exposure the rest of the year.
The Misconception That Costs People the Most Money
I’ve seen this one more times than I can count: people assume that because they have a Medigap plan, they’re protected anywhere in the country with any doctor. That’s mostly true for in-network doctors, but Part B excess charges are a real gap that catches people off guard, especially if they’re on Plan N.
Here’s how excess charges work. Medicare sets an approved amount for every service. Most doctors accept that amount as payment in full. These are called Medicare-participating providers. But some doctors are non-participating, meaning they can charge up to 15% above the Medicare-approved rate. That extra 15% is an excess charge, and Medicare won’t pay it.
If you have Plan G, excess charges are covered. If you have Plan N, they’re not. So a Plan N enrollee who sees a non-participating specialist could get hit with an unexpected bill. In practice, the majority of U.S. doctors do accept Medicare assignment, so this risk varies a lot by location. If you’re in a state that prohibits excess charges (like Ohio or Massachusetts), it’s essentially a non-issue. But if you’re in New York, Florida, or another state where balance billing is common, Plan N’s excess charge gap is a real thing to think about before you choose it.
The broader misconception I want to address: Medigap is not a blank check. People sometimes delay needed care because they assume Medigap will cover it, then discover the service Medicare deemed “not medically necessary” isn’t covered at all. Medigap follows Medicare’s coverage decisions. If Medicare denies a claim, Medigap won’t override it. Period.
The Foreign Travel Gap and Long-Term Care Exposure
These two deserve their own conversation because they’re underappreciated risks that could actually hurt you financially if you’re not planning around them.
On foreign travel: some Medigap plans (C, D, F, G, M, and N) do include a foreign travel emergency benefit, but it’s limited. Plans typically cover 80% of emergency care costs abroad after a $250 deductible, and there’s a $50,000 lifetime maximum. That sounds like a lot until you price what an emergency medical evacuation actually costs. If you spend significant time outside the U.S., a standalone travel health insurance policy is worth the $200-$400 a year. Don’t assume Medigap’s travel benefit will fully protect you.
Long-term care is the scarier one. If you need help with bathing, dressing, or eating because of a chronic illness or dementia, Medigap won’t pay for it. Medicare itself only covers skilled nursing facility care under specific conditions, and only for up to 100 days per benefit period. Custodial care, which is what most people in nursing homes actually need, isn’t covered by Medicare or Medigap at all. The 2026 Part A deductible of $1,676 per benefit period applies to inpatient hospital stays, and after day 20 in a skilled nursing facility, you’re paying a daily coinsurance. Plan G covers that coinsurance, but it won’t cover the custodial care that follows.
If long-term care is a concern for you, and it should be for anyone without significant assets to self-insure, that’s a separate planning conversation involving long-term care insurance or hybrid life insurance policies. Medigap simply wasn’t designed for it.
Bottom Line
For most people turning 65 today, Plan G is the right Medigap choice. The coverage gaps it leaves you with, primarily the 2026 Part B deductible of $257 and prescription drugs, are manageable and predictable. Add a solid Part D plan alongside it, and you’re in good shape for routine and major medical care. What you can’t expect Medigap to do is cover dental, vision, hearing, long-term care, or foreign travel beyond its limited benefit, so plan separately for those if they matter to your situation.
Frequently Asked Questions
Does Medigap cover dental work?
No. No Medigap plan covers routine dental care, including cleanings, fillings, crowns, or dentures. Medicare itself doesn’t cover routine dental, and since Medigap supplements Medicare, dental falls entirely outside its scope. You’ll need a standalone dental plan or to budget for dental costs separately.
Will Medigap cover me if I get sick while traveling internationally?
Most of the common Medigap plans include a foreign travel emergency benefit, but it’s capped at a $50,000 lifetime maximum after a $250 deductible. Plans typically cover 80% of emergency costs abroad. That’s helpful but not unlimited, and it doesn’t cover non-emergency care or medical evacuations in full. If you’re traveling abroad regularly, a separate travel health insurance policy is a smart addition.
Why doesn’t Medigap cover prescriptions?
Congress separated prescription drug coverage into its own program, Part D, when it was created in 2006 under the Medicare Modernization Act. The logic was to create a distinct, competitive market for drug coverage. As a result, Medigap and Part D have always been separate, and no Medigap plan sold today can include outpatient drug coverage. You need to enroll in a standalone Part D plan alongside your Medigap policy.
If Medicare denies a claim, does Medigap still pay?
No. Medigap only picks up costs that Medicare recognizes and approves. If Medicare determines a service isn’t medically necessary or isn’t a covered benefit, Medigap won’t step in to cover it. This is one of the most important things to understand about how Medigap works. It’s a supplement to Medicare’s coverage decisions, not an override of them.
