Category: Plans

The Short Answer: Medigap Follows Medicare’s Lead

Medicare supplement insurance doesn’t cover preventive care screenings on its own. It covers your cost-sharing after Medicare Part B pays its share. That distinction sounds small, but it changes everything about how you plan for your healthcare costs.

Here’s the thing. Medicare Part B already covers a genuinely impressive list of preventive screenings at no cost to you, provided certain conditions are met. When those screenings are billed correctly and you’ve met your deductible requirements, Medigap steps in to handle whatever cost-sharing remains. The result is that many people on a strong Medigap plan like Plan G end up paying nothing out of pocket for covered preventive services.

But “many people” is not “all people,” and the exceptions matter a lot. I’ve seen retirees get blindsided by bills they assumed Medigap would handle, and in almost every case, the confusion came down to one of three things: a service that wasn’t technically “preventive,” a provider who didn’t accept Medicare assignment, or a screening that crossed into diagnostic territory. We’ll cover all of it.

What Medicare Part B Actually Covers for Prevention

Before you can understand what Medigap does, you need to know what Medicare does. Part B covers a wide range of preventive screenings, and for most of them, your cost-sharing is zero as long as the visit is coded and billed correctly.

Here are some of the key preventive services Part B covers at 100% with no cost to you:

• Annual Wellness Visit (AWV)
• Mammograms (screening, once every 12 months)
• Colorectal cancer screenings (colonoscopies for average-risk patients, once every 10 years)
• Pap smears and pelvic exams (once every 24 months for average-risk women)
• Prostate cancer screening (PSA test, once every 12 months)
• Lung cancer screening CT scans (for high-risk patients, once per year)
• Bone density tests (for qualifying patients, once every 24 months)
• Diabetes screenings (up to two per year for at-risk patients)
• Cardiovascular disease screenings (cholesterol, once every 5 years)
• Depression screening (once per year)
• HIV, hepatitis B, and hepatitis C screenings for qualifying patients
• Abdominal aortic aneurysm screening (once, for qualifying smokers)

For all of these, when billed as preventive, Medicare pays 100% and there’s no Part B deductible applied. That’s the law. And because there’s no cost-sharing left over, Medigap has nothing to pay. Which is actually fine, because you owe nothing.

The 2026 Part B deductible is $257. It does not apply to these preventive screenings when they’re billed correctly. Keep that number in mind, because it becomes relevant the moment a service stops being “purely preventive.”

The Diagnostic Trap: The Mistake That Costs People Real Money

This is the section I wish someone had written for my readers years ago, because I’ve seen this mistake happen over and over.

You go in for your free screening colonoscopy. Your doctor finds a polyp and removes it. You get the bill. Now you owe money. How did that happen?

When a preventive screening produces a finding that requires treatment during the same visit, the billing often changes. The procedure gets reclassified, partially or fully, as diagnostic or therapeutic. At that point, Medicare’s 100% preventive coverage no longer applies to the whole bill. You may be on the hook for 20% of the Medicare-approved amount for part of the service.

This is not a billing error. It’s just how the rules work. Medicare treats screenings and treatment as different things, even when they happen in the same room on the same day.

Here’s where Medigap earns its keep. If you have Plan G, your plan would typically cover that 20% coinsurance after you’ve met the 2026 Part B deductible of $257. If you haven’t met your deductible yet that year, you’d owe the deductible first, then Medigap covers the rest. Plan F (for those grandfathered in before January 1, 2020) would cover the deductible too.

So while Medigap doesn’t technically “cover preventive screenings,” it does protect you from the financial fallout when a screening turns into something more. That’s actually one of the best arguments for having a strong Medigap plan if you’re at the age where screenings regularly turn up findings worth investigating.

How the Main Medigap Plans Stack Up on Preventive-Related Costs

Not all Medigap plans handle cost-sharing the same way. Here’s a practical breakdown of how the most popular plans handle the costs you might face when a screening produces cost-sharing:

Medigap Plan	Covers Part B Deductible ($257 in 2026)?	Covers Part B 20% Coinsurance?	Best For
Plan G	No	Yes	Most new enrollees (available post-2020)
Plan F	Yes	Yes	Grandfathered enrollees only (pre-2020)
Plan N	No	Yes (with some copays)	Healthier people who rarely see specialists
Plan K	No	50% (not full coverage)	Lower-premium seekers willing to share more risk
Plan L	No	75% (not full coverage)	Middle-ground option with lower premiums

My honest take: for most people I work with, Plan G is the right call. At age 65 in 2026, you’re typically looking at $100 to $200 per month depending on your state and which insurer you use. Ohio, for example, tends to run toward the lower end of that range. You pay the $257 deductible once a year and then you’re fully covered for Medicare-approved costs. That’s a simple, predictable structure that most people find worth the premium.

Plan N is worth considering if you’re healthy and want a lower premium, but you’ll face copays of up to $20 for office visits and $50 for emergency room visits that don’t result in inpatient admission. For screenings that turn diagnostic, those copays can add up.

What Medigap Won’t Help With, Even on a Premium Plan

There are real gaps in preventive care coverage that no Medigap plan fixes, and I’d rather tell you about them now than have you find out the hard way.

Services Medicare doesn’t cover at all. Medigap can only cover your share of Medicare-approved costs. If Medicare denies a claim entirely, Medigap won’t pay either. Routine dental, vision, and hearing are the big three. A hearing screening at your annual wellness visit might be included, but hearing aids and most dental work are completely outside the Medicare and Medigap system. You’d need a separate plan for those.

Out-of-network providers who don’t accept Medicare assignment. If a provider doesn’t accept Medicare assignment, they can charge up to 15% more than the Medicare-approved amount. Medigap plans generally don’t cover this “excess charge” unless you have Plan F or Plan G, which do cover excess charges. This is another reason Plan G is worth the premium in my opinion.

Prescription drugs. Preventive medications, like statins recommended after a cardiovascular screening or medications prescribed based on a diabetes screening result, aren’t covered by Medigap. You need Part D for that. Don’t forget to enroll in a Part D plan even if you’re not currently taking prescriptions. The late enrollment penalty is unforgiving.

Screenings not yet approved by the USPSTF. Medicare largely follows the U.S. Preventive Services Task Force recommendations. If a screening isn’t on that list, Medicare probably won’t cover it. Your doctor might recommend it, but that doesn’t mean Medicare will pay for it.

Bottom Line

For the vast majority of Medicare beneficiaries, a plan like Medigap Plan G combined with Medicare Part B gives you strong protection on preventive care. Most screenings are free under Part B, and when a screening leads to a finding that creates cost-sharing, Plan G handles that 20% coinsurance after your $257 annual deductible. The one mistake to avoid is assuming that “free preventive screening” means “free no matter what happens during that appointment.” It doesn’t, and that’s exactly the kind of gap Medigap is built to catch.

---

Frequently Asked Questions

Does Medigap cover the Annual Wellness Visit?

The Annual Wellness Visit is covered at 100% by Medicare Part B with no cost-sharing, so there’s nothing left for Medigap to cover. You won’t get a bill for it. The catch is that if your doctor addresses other health concerns during the same visit and bills them separately, that additional portion may trigger cost-sharing that Medigap would then cover.

Will my colonoscopy be free if I have Medigap?

A routine screening colonoscopy with no findings is free under Medicare Part B. If a polyp is found and removed during the same procedure, the billing often shifts and you may owe cost-sharing. If you have Plan G, Medigap would cover that coinsurance after your annual deductible. Without Medigap, that 20% coinsurance can easily be several hundred dollars.

Does Medigap cover preventive care differently than regular medical care?

No. Medigap doesn’t distinguish between preventive and non-preventive care. It covers your cost-sharing on Medicare-approved services regardless of the type of care. The reason preventive care feels “free” is that Medicare waives the cost-sharing on those services, leaving nothing for Medigap to pay. When cost-sharing exists, Medigap covers it based on your plan’s benefits.

I just turned 65. Should I get Medigap before I have any screenings scheduled?

Yes, and the timing matters more than people realize. Your Medigap Open Enrollment Period starts the month you’re both 65 and enrolled in Part B. During that window, no insurer can deny you coverage or charge you more based on health history. If you wait until after a screening turns up a significant finding, you could face medical underwriting and potentially be denied or charged much higher premiums. Enroll during that window even if you feel perfectly healthy.

Here’s the Brutal Truth About Medigap and Hearing

No Medicare supplement plan covers hearing aids or hearing exams. Not Plan G. Not Plan F. Not any of them. And I want you to hear that clearly before you spend months comparing Medigap premiums thinking your hearing costs will be handled once you pick the right letter.

This is one of the most common gaps people discover after they’ve already enrolled, usually when they’re sitting in an audiologist’s office being handed a bill for $4,000 or $5,000 for a pair of hearing aids. By then, there’s nothing you can do except pay it.

What Medigap actually does is fill the gaps in original Medicare, meaning it covers things like your Part A hospital deductible (which is $1,676 per benefit period in 2026), your Part B coinsurance after you’ve met the annual deductible ($257 in 2026), and a handful of other costs that traditional Medicare leaves you holding. It doesn’t create new benefits. It only pays what Medicare would have paid if you had less cost-sharing. Since Medicare doesn’t cover hearing aids or routine hearing exams at all, Medigap has nothing to fill in.

That’s not a flaw in your specific plan. It’s how the entire system is structured.

What Original Medicare Actually Covers for Hearing

Original Medicare is stingy when it comes to hearing, and it has been for decades. Here’s where the line sits.

Medicare Part B will pay for a diagnostic hearing exam if your doctor orders it to diagnose a medical condition, not to fit you for a hearing aid. So if you’re having balance problems and your physician refers you to an audiologist to rule out inner ear damage, that exam is covered under Part B (after your deductible, at 80/20 cost-sharing). Medigap then kicks in to cover the 20% you’d owe.

But a routine hearing exam, the kind where you go in to see how your hearing has changed and whether you might benefit from hearing aids, is not covered. Medicare considers that preventive or elective. Same goes for the hearing aids themselves. Medicare explicitly excludes hearing aids and the exams for fitting them from Part B coverage. This exclusion has been in place since Medicare was created in 1965, and despite repeated efforts in Congress to change it, it’s still the rule today.

So when someone tells you that Medigap “covers everything Medicare covers,” that’s technically true. The problem is what Medicare doesn’t cover.

The Common Mistake That Costs People Thousands

I’ve seen this play out more times than I can count: someone in their late 60s, maybe a 68-year-old in North Carolina, picks up a Plan G because they want solid coverage. They pay around $140 to $170 per month in premiums, feel good about their coverage, and assume they’re protected. A year later, they get their first real hearing test as a senior, learn they need aids, and walk out with a $3,500 to $6,000 expense they had no idea was coming.

The mistake isn’t buying Plan G. Plan G is a genuinely good plan for most people. The mistake is assuming that “comprehensive” coverage means all healthcare costs. Medigap covers hospital and medical costs under Parts A and B. It doesn’t touch vision, dental, or hearing, which Medicare calls “routine” and excludes entirely.

Some people make a second, related mistake: they hear that Medicare Advantage plans often include some hearing benefits, and they think switching to a Medigap plan means giving that up permanently. That’s worth thinking about before you enroll. Once you’ve been on Medigap for a while, getting back into a Medicare Advantage plan is possible, but getting back onto a different Medigap plan may require medical underwriting in most states. You could be locked out of certain plans if your health has changed.

Your Real Options for Hearing Aid Coverage

Since Medigap won’t help you here, let’s talk about what actually will.

Medicare Advantage plans: Many Medicare Advantage plans include hearing benefits. The quality and generosity of those benefits varies wildly, from $500 per year toward hearing aids to full coverage of certain models. The tradeoff is that you give up the predictability of Medigap. Advantage plans use networks, prior authorizations, and variable cost-sharing. For people with significant ongoing medical needs, that tradeoff is often not worth it just to get hearing coverage. But if you’re generally healthy and primarily worried about hearing costs, it’s a real option to consider.

Standalone hearing benefit plans: Companies like TruHearing, Hearing Care Solutions, and a few others offer standalone discount programs or supplemental insurance specifically for hearing. These aren’t insurance in the traditional sense, but they negotiate discounted rates with audiologists and hearing aid providers. You pay a modest monthly fee or annual membership and get access to reduced pricing. A pair of hearing aids that retails for $5,000 might cost you $2,000 through one of these programs.

Direct-to-consumer hearing aids: Since 2022, the FDA has allowed over-the-counter (OTC) hearing aids for adults with mild to moderate hearing loss. Brands like Jabra Enhance, Lexie, and Sony sell devices for $300 to $1,600 without a prescription or audiologist visit. These won’t work for everyone, particularly those with severe hearing loss or complex fitting needs. But for the right person, they’re a legitimate and dramatically cheaper option.

Veterans benefits: If you’re a veteran, the VA may cover hearing aids and audiology services at no cost. This is one of the most underused benefits I see among veterans in their 60s and 70s. If you qualify for VA healthcare, check what your specific eligibility level covers before you pay a dime out of pocket.

Coverage Option	Covers Hearing Aids?	Covers Hearing Exams?	Typical Cost to You
Original Medicare (Part B)	No	Only if medically necessary	Full cost out of pocket
Medicare Supplement (Medigap)	No	Only if Part B covers the exam	No additional help for hearing
Medicare Advantage	Often yes, with limits	Often yes	Varies; may have network restrictions
Standalone hearing plans	Discounted, not full coverage	Discounted	$20-$50/month or annual fee
OTC hearing aids	Self-purchase only	No exam required	$300-$1,600 one-time
VA benefits	Yes (if eligible)	Yes (if eligible)	Little to no cost

How to Factor Hearing Costs Into Your Medicare Decision

If you’re still deciding between original Medicare with a Medigap plan versus Medicare Advantage, hearing is one legitimate factor to weigh. But only one. Don’t let it be the deciding factor if your overall health situation points clearly in one direction.

Here’s how I think about it. If you already know you have significant hearing loss, or you’ve been told you’ll need hearing aids soon, that changes your math. A Medicare Advantage plan with $1,500 per year in hearing benefits might save you real money. Add up what you’d spend on Medigap premiums versus what you’d spend on Advantage premiums and out-of-pocket medical costs, then factor in the hearing benefit. For a 65-year-old in Ohio who’s relatively healthy, the numbers can actually favor Advantage in this scenario.

That said, if you have a serious chronic condition, see multiple specialists regularly, or want the freedom to see any doctor in the country without referrals or networks, Medigap is still probably the better choice overall. You can always add a standalone hearing discount program for a modest monthly fee and still come out ahead on total healthcare costs.

The key is to build your coverage decision around your whole health picture, not just one line item. Hearing is important. So is not getting stuck with a $15,000 hospital bill because your Advantage plan denied a prior authorization.

Bottom Line

Medicare supplement plans don’t cover hearing aids or routine hearing exams, period, and no amount of comparing plan letters will change that. If hearing coverage matters to you, your best path is either a Medicare Advantage plan with a meaningful hearing benefit, or a Medigap plan paired with a standalone hearing discount program. For most people who are otherwise well-served by Medigap, I’d go with the latter: keep Plan G for the predictability it gives you on medical costs, and handle hearing separately with an OTC device or a discount program rather than overhauling your entire Medicare setup.

Frequently Asked Questions

Does Plan G cover hearing aids?

No. Plan G is one of the best Medigap plans available, but it doesn’t cover hearing aids or routine hearing exams. No Medigap plan does. Plan G covers costs that original Medicare covers, and Medicare doesn’t cover hearing aids at all.

Will Medicare pay for a hearing exam if my doctor orders it?

Only if it’s medically necessary, meaning your doctor is ordering the exam to diagnose or treat a medical condition, not to evaluate you for a hearing aid. If your doctor orders a diagnostic audiology exam to investigate dizziness, tinnitus, or suspected nerve damage, Medicare Part B will cover 80% after your deductible. Your Medigap plan then covers the remaining 20%. A routine hearing test to check how your hearing is doing does not qualify.

Can I add hearing coverage to my Medigap plan?

Not directly. Medigap plans are standardized by federal law, and hearing coverage isn’t one of the benefits included in any plan letter. What you can do is add a separate, standalone hearing benefit plan or discount program alongside your Medigap plan. These aren’t part of Medicare, but they can significantly reduce what you pay for hearing aids and exams.

Are over-the-counter hearing aids worth it?

For mild to moderate hearing loss, yes, they can be worth it. Since the FDA opened up the OTC market in 2022, quality has improved and prices have dropped considerably. Brands like Jabra Enhance and Lexie offer real technology at a fraction of what prescription aids cost. The caveat is that they work best when your hearing loss is not severe and you’re comfortable self-adjusting the device through an app. If you’ve been told you have significant or complex hearing loss, you’ll likely still want to work with an audiologist.

The Short Answer: Medigap Follows Medicare’s Lead on Chiropractic

Medicare supplement plans cover chiropractic care the same way they cover everything else: they pick up costs that Original Medicare leaves behind. The catch is that Medicare itself covers almost nothing when it comes to chiropractic. So before you assume your Medigap plan is going to handle your chiropractor bills, you need to understand what Medicare Part B actually pays for first.

Here’s the thing. A lot of people buy a Plan G or Plan N, feel confident they’re covered, and then get hit with a $100+ bill after a few chiropractic visits. They’re confused and frustrated. I’ve seen this happen repeatedly, and it’s almost always because nobody explained the underlying Medicare rules clearly before they enrolled.

Let me fix that right now.

What Medicare Part B Actually Covers for Chiropractic

Medicare Part B covers exactly one chiropractic service: manual manipulation of the spine to correct a subluxation. That’s it. If your chiropractor is physically adjusting your spine to correct a vertebral subluxation that’s documented in your medical record, Medicare Part B will generally cover 80% of the Medicare-approved amount after you’ve met your 2026 Part B deductible of $257.

That sounds reasonable until you read the fine print. Medicare will not cover:

• X-rays taken by your chiropractor
• Massage therapy performed at a chiropractic office
• Acupuncture (even if offered at the same clinic)
• Therapeutic exercises or stretching instruction
• Ultrasound therapy or electrical stimulation
• Maintenance care once you’ve plateaued in improvement

That last point deserves its own sentence: maintenance care. This is where most people get blindsided. If your chiropractor determines that you’ve reached your maximum therapeutic benefit but you want to keep coming in regularly to maintain that level of function, Medicare considers those visits maintenance care and will not pay for them. Not one cent.

The reason Medicare draws this line is baked into how the program defines covered services. Medicare Part B is designed to pay for treatment that improves or restores function. Once you’re at your best and the visits are just keeping you there, Medicare says that’s not medically necessary under their definition. You can disagree with that logic, and plenty of people do, but that’s the rule you’re working with.

So when your chiropractor hands you an Advance Beneficiary Notice (ABN) before a visit, pay attention. That form means they think Medicare probably won’t cover that service, which also means your Medigap plan won’t be covering it either.

How Medigap Fills In the Gaps (And Where It Can’t Help)

Once you understand what Medicare covers, how Medigap works for chiropractic becomes simple to explain. Medigap covers your share of Medicare-approved costs. For covered chiropractic adjustments, that means:

Plan Type	Part B Deductible	Part B Coinsurance (20%)	Excess Charges
Plan G	You pay ($257 in 2026)	Covered	Covered
Plan N	You pay ($257 in 2026)	Covered (up to $20 copay per visit)	Not covered
Plan F (pre-2020 enrollees only)	Covered	Covered	Covered

Take a practical example. Say you’re a 67-year-old in Ohio with Plan G. Your chiropractor performs a covered spinal manipulation, and Medicare approves the claim. After you’ve met your $257 Part B deductible for 2026, your Plan G covers the 20% coinsurance. Your out-of-pocket cost for that approved visit? Zero, assuming you’ve already met the deductible.

But here’s where it breaks down. If your chiropractor bills Medicare for a visit that Medicare determines is maintenance care and denies, your Medigap plan has nothing to work with. Medicare denied it. There’s no approved cost for Medigap to cover. You’re paying the full bill out of pocket, and your Medigap plan is completely irrelevant to that transaction.

That’s not a bug in the system. That’s exactly how it’s designed to work.

The Mistake I See People Make All the Time

The most common and expensive misconception I see is people assuming that because they have a “good” Medigap plan, their chiropractic bills are basically handled. They buy Plan G, they feel protected, and they stop reading the details. Then they start going to their chiropractor two or three times a week for an ongoing back condition and assume the bills are going to be minimal.

They’re not.

If those visits are covered by Medicare as active treatment, you’re probably fine after hitting your deductible. But if your condition is chronic and your chiropractor is really providing ongoing maintenance, those visits will be denied by Medicare and your Medigap plan won’t touch them. I’ve talked to people who racked up thousands of dollars in chiropractic bills they never anticipated because nobody told them this before they started treatment.

The fix is simple but requires a conversation most people skip. Before you start a course of chiropractic treatment, ask your chiropractor directly: “Will you be billing Medicare for these visits? Do you expect Medicare to approve them, or are they likely to be considered maintenance care?” A good chiropractor’s office will tell you upfront. If they hand you an ABN on your first visit, that’s your signal to ask hard questions before the treatment starts, not after you’ve already had six sessions.

Another mistake worth flagging: some people think a Medicare Advantage plan will handle chiropractic better than Medigap. Sometimes that’s true. Some Medicare Advantage plans include extra chiropractic benefits beyond what Original Medicare covers. But if you’re on Medigap, you’re on Original Medicare, and Original Medicare’s limits apply to you without exception.

When Chiropractic Coverage Actually Works Well With Medigap

There are real situations where Medigap handles chiropractic costs well, and I don’t want to leave you thinking it’s all bad news.

If you have an acute back injury, a new disc problem, or you’re recovering from something that caused genuine functional limitation, Medicare will typically cover chiropractic adjustments as active treatment. In those cases, having a Plan G or Plan N can genuinely protect you from meaningful out-of-pocket costs. Medicare approves the claim, pays 80%, and your Medigap plan covers the 20% coinsurance you’d otherwise owe.

For someone who only needs occasional chiropractic care for acute issues, say a 70-year-old who throws out their back every year or two, the combination of Original Medicare plus a Medigap plan works fine. The care is likely to be covered, and the Medigap plan does exactly what it’s supposed to do.

The people who run into trouble are those with chronic conditions who need regular ongoing adjustments. If that’s you, be honest with yourself about it before you assume your Medigap plan is your safety net for chiropractic.

Bottom Line

Your Medigap plan covers chiropractic care only when Medicare Part B approves it first, and Medicare has strict limits on what it approves. For most people who use chiropractic regularly, a significant portion of their visits won’t be covered by either Medicare or Medigap. Before you start treatment, have a direct conversation with your chiropractor about how they plan to bill Medicare. Don’t assume your Plan G or Plan N makes you bulletproof on chiropractic costs, because it doesn’t.

Frequently Asked Questions

Does Medicare pay for all chiropractic adjustments, or just some?

Medicare Part B pays for spinal manipulation to correct a documented subluxation, but only when the treatment is active and designed to improve function. Once you’ve reached your maximum improvement and visits become maintenance, Medicare stops covering them entirely. There’s no partial coverage for maintenance visits.

If my Medigap plan covers my Part B coinsurance, does that mean chiropractic is fully covered?

Only for visits that Medicare approves. If Medicare denies a chiropractic visit because it’s considered maintenance care or medically unnecessary, there’s no coinsurance for your Medigap plan to pay. You’d owe the full cost of that visit out of pocket.

What is an Advance Beneficiary Notice, and why does it matter for chiropractic?

An ABN is a form your provider gives you when they believe Medicare is likely to deny a service. If you sign it and agree to receive care anyway, you’re agreeing to pay out of pocket if Medicare denies it. For chiropractic, an ABN often means the visit is being coded as maintenance care. Don’t just sign it and move on without understanding what it means for your costs.

Are there Medicare plans that cover chiropractic better than Medigap?

Some Medicare Advantage plans offer additional chiropractic benefits beyond what Original Medicare covers, including a set number of maintenance visits per year. If ongoing chiropractic care is something you rely on, it’s worth comparing Medicare Advantage options in your area against Medigap before you enroll. That said, Advantage plans come with their own tradeoffs, so it’s not a simple switch to recommend across the board.

Plan G Is the Best Medigap Plan for Most 65-Year-Olds

If you’re turning 65 and you want the cleanest, most predictable Medicare coverage you can buy, Plan G is your answer. I’ve watched hundreds of people tie themselves in knots comparing every Medigap option on the market, and the vast majority of them end up in the same place: Plan G covers almost everything, leaves you with exactly one known out-of-pocket cost per year, and lets you see any doctor who accepts Medicare. That’s it. Done.

Now, Plan G isn’t perfect for everyone. If you’re genuinely healthy, rarely see a doctor, and have a solid emergency fund, there’s a legitimate argument for High-Deductible Plan G. And if money is very tight each month, Plan N might make sense. I’ll walk you through all of that. But if someone put a gun to my head and said “just tell me what to pick,” I’d say Plan G, standard version, without hesitation.

Here’s what Plan G actually covers: your Part A hospital coinsurance, your Part B coinsurance (that 20% Medicare leaves you on the hook for), your Part A deductible, skilled nursing facility coinsurance, foreign travel emergency coverage, and your Part B excess charges. The only thing it does not cover is the 2026 Part B deductible, which is $257. That’s the one bill you’ll pay out of pocket all year if nothing catastrophic happens. Every other Medicare-approved cost is handled.

That predictability is worth real money to people. Not just financially, but psychologically. You’re not going to open a bill in February and panic.

How the Main Plans Compare at Age 65

Let me give you a side-by-side look at the plans most 65-year-olds are actually choosing between. I’m leaving out the older plans like Plan C and Plan F, which aren’t available to people who became eligible for Medicare on or after January 1, 2020. If you turned 65 in 2020 or later, those aren’t options for you anyway.

Plan	Monthly Premium (Age 65, Est.)	Part B Deductible Covered?	Part A Deductible Covered?	Part B Coinsurance Covered?	Excess Charges Covered?	Best For
Plan G	$110-$185/month	No (you pay $257 in 2026)	Yes	Yes	Yes	Most people
High-Deductible Plan G	$35-$75/month	No	Yes (after deductible)	Yes (after deductible)	Yes (after deductible)	Healthy, financially prepared
Plan N	$80-$140/month	No	Yes	Yes, with copays	No	Infrequent doctor visits
Plan K	$50-$90/month	No	50%	50%	No	Healthy, want low premium

Premium ranges above are estimates for a 65-year-old non-smoker in 2026. Your actual premium will vary depending on your state, the insurer, and whether they use attained-age, issue-age, or community rating. That rating method matters a lot for what you’ll pay at 75 or 80, so it’s worth asking about it when you shop.

Why Age 65 Is the Best Time to Buy Medigap (and Why You Shouldn’t Wait)

Your 65th birthday doesn’t just trigger Medicare eligibility. It starts a six-month window called the Medigap Open Enrollment Period. During that window, insurers cannot deny you coverage or charge you more because of your health. Pre-existing conditions don’t matter. Your medical history doesn’t matter. Every carrier has to sell you any plan they offer at the standard rate.

Once that window closes, most states allow insurers to use medical underwriting. That means they can reject you outright or charge significantly higher premiums based on your health history. I’ve talked to people in their early 70s who developed a chronic condition in their late 60s and then tried to switch Medigap plans. Some of them were flat-out denied. Others got quoted premiums that were double what they’d have paid at 65.

This is why the advice “just see how things go first” is dangerous. There’s no guaranteed way to get back in later. A few states, including Connecticut, Massachusetts, New York, and Maine, have their own guaranteed issue protections that go beyond federal rules, so if you live there you have a little more flexibility. But in most of the country, missing your Open Enrollment Period is a mistake you can’t easily undo.

The math is also in your favor at 65. You’re younger and healthier, so your premiums are lower. Plan G for a 65-year-old might run $130 a month in Ohio. That same plan for a 72-year-old in Ohio, even if they’re healthy, can be $190 or more. Locking in at 65 with an issue-age rated plan means your premiums start lower and increase more slowly over time.

The Mistake I See People Make Constantly

Here it is: people pick the cheapest monthly premium without understanding what they’re giving up. I see this over and over. Someone decides to go with Plan N instead of Plan G to save $40 a month, without realizing that Plan N doesn’t cover Part B excess charges.

Here’s why that matters. Part B excess charges happen when a doctor doesn’t accept Medicare assignment. They can legally charge up to 15% more than the Medicare-approved amount. If you’re seeing a specialist for a serious condition, and that specialist doesn’t participate in Medicare, those charges can add up fast. Plan G covers them. Plan N doesn’t.

Now, in many states, excess charges are rare or even prohibited. In California, New York, and a handful of others, doctors aren’t allowed to charge them. But if you live in a state where they’re common, say parts of the Northeast or certain metro areas with lots of private-practice specialists, this gap in Plan N can cost you more than the premium savings.

The other mistake is buying Medigap from the first insurer who calls you. Every insurer offering Plan G has to cover the same exact benefits. The only differences are price and service. So shopping around isn’t optional. A 65-year-old woman in Florida might see Plan G quotes ranging from $115 to $175 a month for the same coverage. That’s $720 a year in savings for doing 30 minutes of comparison shopping. Use your state’s SHIP counselor, or a broker who represents multiple carriers, to do this right.

Who Should Consider High-Deductible Plan G Instead

I want to be honest here because High-Deductible Plan G is genuinely a good choice for the right person. It just isn’t right for most people, and I’ve seen it sold to people who really shouldn’t have it.

The 2026 deductible for High-Deductible Plan G is $2,870. Until you hit that number in covered expenses each year, you’re paying out of pocket. After that, the plan kicks in and covers everything standard Plan G covers. Your monthly premium might be $45 to $60 a month instead of $130 to $165.

The break-even math is straightforward. If you’re paying $100 less per month, that’s $1,200 a year in savings. But if you end up with a hospital stay or significant medical expenses, you might owe $2,870 before coverage kicks in. You need to have that money sitting somewhere accessible. Not in the market. Not tied up. Available.

High-Deductible Plan G makes sense if you’re in genuinely good health, you see a doctor a handful of times a year, you have at least $3,000 in liquid savings you can treat as your personal health buffer, and you’re comfortable with the possibility of a bad year where you pay that full deductible. If all of those are true, go for it. You’ll likely come out ahead financially over a 10-year period.

If you have a chronic condition, take multiple medications, or the idea of a $2,870 bill makes you anxious, standard Plan G is worth every extra dollar of premium.

Bottom Line

Plan G is the best Medigap plan for most people turning 65. Buy it during your Open Enrollment Period, shop at least three to five carriers, and ask about the rating method so you understand what your premium trajectory looks like over time. If you’re unusually healthy and financially cushioned, High-Deductible Plan G is worth a serious look. Everyone else: standard Plan G, full stop.

Frequently Asked Questions

Is Plan G better than Plan N for a healthy 65-year-old?

Usually yes, and here’s why. The premium difference between Plan G and Plan N is typically $30 to $50 a month. Plan N exposes you to Part B excess charges and $20 copays for office visits. If you live in a state where excess charges are common and you see specialists, that gap can easily exceed what you’d save in premiums. Plan G gives you cleaner coverage with no copay surprises. Plan N is reasonable if you live in a state that bans excess charges and you rarely need medical care.

Can I switch Medigap plans after age 65 if I change my mind?

You can try, but outside of your Open Enrollment Period, most states allow insurers to decline your application based on health history. If you’ve developed any significant health condition since you first enrolled, you may find you can’t qualify for a different plan. A few states (Connecticut, New York, Massachusetts, Maine) have stronger protections. In most states, though, your best protection is choosing the right plan at 65 in the first place.

Do Medigap premiums go up as you age?

Yes, in most cases. How much depends on whether your plan uses attained-age rating (premiums increase as you get older), issue-age rating (premiums are set at the age you bought, with only inflation-based increases), or community rating (everyone pays the same regardless of age). Attained-age plans look cheap at 65 but can get expensive by 75. Issue-age plans cost a bit more upfront but tend to stay more affordable long-term. Ask your insurer directly which method they use before you buy.

What does Plan G not cover?

Plan G doesn’t cover the 2026 Part B deductible ($257), prescription drugs, dental, vision, or hearing. For prescriptions, you’ll need a separate Part D plan. For dental and vision, you’re looking at standalone coverage or going without. Medigap is designed to cover what Original Medicare covers but doesn’t fully pay. Anything outside Medicare’s scope, Plan G won’t touch either.

The Plans With No Out-of-Pocket Maximum Are the Ones Most People Buy

Here’s something that surprises a lot of people when they first start looking at Medigap: the most popular Medicare supplement plans — Plan G and Plan N — don’t technically have an out-of-pocket maximum at all. Not in the traditional sense. What they have is something arguably better: they cap your exposure so tightly that in most years, your costs are predictable and low. But they’re not zero, and they’re not formally capped with a single number the way employer insurance or Medicare Advantage plans are.

Understanding how each Medigap plan handles your potential out-of-pocket costs is one of the most useful things you can do before picking one. So let me walk you through the real picture, ranked from most protective to least, with actual 2026 numbers and honest opinions about who each plan makes sense for.

How Medigap Plans Actually Limit What You Pay

Original Medicare by itself has no out-of-pocket maximum. None. If you’re hospitalized repeatedly, your Part A deductible resets every 60 days (the 2026 Part A deductible is $1,676 per benefit period). Part B covers 80% of approved outpatient costs, leaving you with 20% of whatever the bill is — with no ceiling. That’s the exposure Medigap exists to address.

Medigap plans limit your costs in one of two ways. Most plans do it by paying specific cost-sharing buckets — deductibles, coinsurance, copays — so you never face those bills in the first place. A smaller set of plans uses a defined out-of-pocket maximum, after which they cover everything. Knowing which approach each plan takes changes how you think about the value you’re getting.

Plan	Part A Deductible Covered?	Part B Deductible Covered?	Part B Coinsurance Covered?	Formal OOP Maximum	Estimated Annual Exposure (Typical Use)
Plan G	Yes	No	Yes (100%)	None (but exposure is just the Part B deductible)	$257 (2026 Part B deductible)
Plan F	Yes	Yes	Yes (100%)	None needed — pays everything	$0
Plan N	Yes	No	Yes (with copays)	None	$257 + up to $20/visit copays + possible excess charges
High-Deductible Plan G	After deductible	After deductible	After deductible	$2,870 (2026)	Up to $2,870
Plan K	50%	No	50%	$7,220 (2026)	Up to $7,220
Plan L	75%	No	75%	$3,610 (2026)	Up to $3,610

A quick note on Plan F: it’s only available to people who turned 65 before January 1, 2020. If you’re newly eligible for Medicare in 2026, it’s off the table. I won’t spend much time on it here for that reason, but if you do qualify, it’s worth a look.

The Plans With Formal Out-of-Pocket Maximums (And Why I’m Not Wild About Them)

Plans K, L, and High-Deductible Plan G are the three Medigap plans that use a defined out-of-pocket maximum. Once you hit that number in a calendar year, the plan pays 100% for the rest of the year. That sounds appealing on paper. In practice, I think these plans are frequently misunderstood and sometimes sold to people who’d be better served elsewhere.

Plan K has a 2026 out-of-pocket maximum of $7,220. Before you hit that ceiling, it only covers 50% of most cost-sharing. That means you’re absorbing half of your Part A hospital coinsurance, half of skilled nursing facility costs, half of hospice coinsurance. For someone who’s in and out of the hospital regularly, that 50% share can pile up fast before you hit the cap.

Plan L is better. Its 2026 maximum is $3,610, and it covers 75% of cost-sharing before the cap kicks in. For a 68-year-old in decent health who wants some protection without paying full Plan G premiums, Plan L can make sense. But it’s still a plan where you’re taking on meaningful exposure in a bad year.

High-Deductible Plan G is the one I actually think deserves more attention. The 2026 deductible is $2,870 — you pay all costs up to that amount, and after that, it works exactly like standard Plan G. The monthly premiums are dramatically lower, often $40-$70/month compared to $120-$180 for standard Plan G depending on your state and age. If you’re 65, healthy, and can absorb up to $2,870 in a rough year, this plan often wins mathematically over a 5-10 year horizon.

The Common Mistake: Confusing “Low Premium” With “Low Risk”

I’ve seen a lot of people make this mistake, and it’s an expensive one. They look at Plan K’s low monthly premium, see “out-of-pocket maximum” on the marketing materials, and assume it’s a budget-friendly safety net. It’s not, at least not in the way they think.

Here’s the thing. A $7,220 out-of-pocket maximum means your downside in a catastrophic year is $7,220 plus your premiums. For someone on a fixed income, that’s a significant financial hit. If you’re paying $60/month for Plan K instead of $150/month for Plan G, you’re saving $1,080 a year in premiums. But it only takes one bad hospitalization with complications to wipe out years of premium savings and then some.

The better framing for any Medigap plan isn’t just the out-of-pocket maximum in isolation. It’s the total worst-case annual cost: your premiums plus your maximum possible cost-sharing. Here’s what that looks like for a 65-year-old in a mid-cost state like Ohio in 2026:

Plan	Est. Monthly Premium (Age 65, Ohio)	Annual Premium	Max Annual OOP	Worst-Case Annual Total
Plan G	$130	$1,560	$257	$1,817
High-Deductible Plan G	$55	$660	$2,870	$3,530
Plan N	$105	$1,260	$257 + copays + excess	~$1,800-$2,200
Plan L	$75	$900	$3,610	$4,510
Plan K	$55	$660	$7,220	$7,880

When you look at it that way, Plan K stops looking like a deal. Plan G’s worst-case total in 2026 is under $1,900. Plan K’s worst case is nearly $8,000. The premium savings don’t come close to justifying that gap for most people.

Who Should Actually Consider Each Plan

I’d give different advice depending on your situation, so let me be specific.

Plan G is the right call for most people turning 65 in 2026. You pay the $257 Part B deductible once a year, and after that you owe nothing for Medicare-approved services. Your monthly costs are predictable. You can see any doctor who accepts Medicare, anywhere in the country. It’s not the cheapest plan, but the total cost picture is usually better than people expect.

High-Deductible Plan G makes a lot of sense if you’re 65, healthy, and have enough in savings to handle a $2,870 hit in a rough year. The math usually favors this plan over standard Plan G if you stay healthy for several years, and the protection is identical once you clear the deductible. A lot of financial-minded retirees I talk to choose this and keep the premium savings in a small reserve fund.

Plan N is worth considering if you want lower premiums than standard Plan G and you’re willing to pay up to $20 for office visits and up to $50 for ER visits. The catch is excess charges — some doctors charge more than Medicare’s approved amount, and Plan N doesn’t cover that gap. If you live somewhere with a lot of Medicare assignment (most urban areas are fine), Plan N is a solid choice. If you’re in a rural area with limited providers, check the excess charge situation first.

Plan L could work for someone who’s genuinely healthy, comfortable self-insuring up to $3,610, and focused on keeping premiums low. I’d rather see most people in Plan G, but I understand the appeal for people in their early 60s on Medicare due to disability who are managing a tight budget.

Plan K is hard for me to recommend to most people. The premium savings relative to the risk exposure rarely pencil out, and the $7,220 ceiling is genuinely scary if you’re on Social Security income.

Bottom Line

For most people turning 65 in 2026, Plan G is the right Medicare supplement plan. It keeps your annual exposure at just the $257 Part B deductible, offers complete predictability, and the worst-case total cost beats every other plan except Plan F (which you probably can’t get). If you’re healthy and cost-conscious, High-Deductible Plan G is the one plan worth genuinely comparing to standard Plan G. The others have their place, but Plan K especially should make you nervous when you run the actual numbers.

Frequently Asked Questions

Does Plan G have an out-of-pocket maximum?

Not in the formal sense, but your real-world exposure is capped at the 2026 Part B deductible of $257 per year. After you pay that once, Plan G covers 100% of Medicare-approved costs for the rest of the year. That’s functionally as good as a $257 out-of-pocket maximum for most people.

Which Medigap plan has the lowest out-of-pocket maximum?

Among plans with a formal defined maximum, High-Deductible Plan G has the lowest at $2,870 in 2026. But standard Plan G limits your real exposure to $257 (the Part B deductible) with no deductible to meet first, which makes it more protective for most people despite having no stated maximum.

Is Plan K worth it if I’m healthy?

Rarely. The low premium looks attractive, but the $7,220 out-of-pocket maximum means one serious illness could cost you far more than you saved on premiums. Unless you’re in genuinely excellent health with significant liquid savings and a clear preference for self-insuring, Plan G or High-Deductible Plan G almost always beats Plan K on total expected cost.

Can my out-of-pocket costs really be zero with a Medigap plan?

With Plan F, yes — but only if you were eligible for Medicare before January 1, 2020. With Plan G, your only guaranteed cost is the $257 Part B deductible in 2026. After that, your costs for Medicare-approved services are zero for the rest of the calendar year. That’s about as close to zero ongoing exposure as you can get in the American healthcare system.

Yes, Medigap Covers Physical Therapy — But Medicare Leads the Way

Medicare supplement plans do cover physical therapy, but they’re not doing the heavy lifting on their own. They’re picking up what Original Medicare leaves behind. That distinction matters more than most people realize when they’re shopping for a plan.

Here’s how it actually works: Medicare Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology as long as your doctor certifies the treatment is medically necessary. Part B pays 80% of the Medicare-approved amount after you’ve met the 2026 Part B deductible of $257. Your Medigap plan then pays the remaining 20% coinsurance — which is where your real protection comes from.

For inpatient rehab (like a skilled nursing facility after a hospital stay), you’re dealing with Part A rules instead. The 2026 Part A deductible is $1,676 per benefit period. A good Medigap plan covers that deductible and the daily coinsurance that kicks in for longer stays.

I’ve spent years watching people assume their Medigap plan covers therapy independently, like a standalone benefit. It doesn’t work that way. If Medicare won’t pay for a therapy session, your Medigap plan won’t either. They move together. Understanding that relationship upfront will save you from some genuinely unpleasant surprises.

What Part B Covers for Outpatient Therapy (And the Limits That Catch People Off Guard)

Congress eliminated the old therapy caps back in 2018, which was a huge deal for people with chronic conditions or serious injuries. Before that, there was a hard dollar limit on how much Medicare would pay for outpatient therapy in a year. Now there’s no cap, but there is a threshold called the KX modifier amount that changes annually.

In 2026, once your outpatient therapy costs exceed $2,330 for physical therapy and speech-language pathology combined (or $2,330 separately for occupational therapy), your provider has to add a KX modifier to your claim. This modifier certifies that continued therapy is medically necessary. Medicare can also conduct a medical review to verify that. It’s not automatic denial — it’s a checkpoint. But if your provider doesn’t document things properly, claims can get kicked back.

For most people going through routine post-surgery rehab or recovering from a fall, the $2,330 threshold is more than enough. But if you’re managing something like a stroke, a serious spinal injury, or a progressive neurological condition, you could blow past that number fast. I’ve talked to people who needed six months of intensive speech therapy after a stroke and racked up far more than that. Medicare kept paying, but only because the therapy was well-documented as medically necessary at every step.

Your Medigap plan follows along for the ride. If Medicare approves the claim, your plan pays its share. That 20% coinsurance adds up quickly when you’re doing three sessions a week over several months.

How Different Medigap Plans Handle Therapy Costs

Not all Medigap plans are created equal here, and the differences are worth knowing before you lock yourself into a plan.

Medigap Plan	Part B Coinsurance (Outpatient Therapy)	Part A Deductible	Skilled Nursing Coinsurance (Days 21-100)	Part B Deductible
Plan G	100% covered	100% covered	100% covered	You pay $257 (2026)
Plan N	Covered (copays may apply)	100% covered	100% covered	You pay $257 (2026)
Plan K	50% covered	50% covered	50% covered	You pay $257 (2026)
Plan L	75% covered	75% covered	75% covered	You pay $257 (2026)
Plan A	100% covered	Not covered	Not covered	You pay $257 (2026)

Plan G is the one I recommend to most people who are asking me about therapy and rehab coverage. You pay the Part B deductible once a year, and after that, you’re essentially fully covered for anything Medicare approves. Plan G premiums typically run between $100 and $200 a month at age 65 depending on where you live and which insurer you go with. That’s a predictable cost you can budget around.

Plan N is a reasonable middle ground if you’re generally healthy, but watch out for the potential copays of up to $20 per outpatient visit and up to $50 for emergency room visits. If you’re doing physical therapy three times a week, those $20 copays can eat into your savings fast. Do the math for your specific situation before assuming Plan N is the cheaper option.

Plans K and L were designed to lower premiums by sharing more costs with you. For someone who rarely uses medical care, that might be fine. For someone who needs ongoing rehab, they’re often the wrong choice. I’ve seen people on Plan K get blindsided by their out-of-pocket costs during extended therapy. The out-of-pocket maximums for these plans exist, but they’re higher than most people expect.

The Big Misconception: Skilled Nursing Facility Coverage After a Hospital Stay

This is where I see people get genuinely hurt financially. Not because the rules are hidden, but because they’re confusing and the hospital doesn’t always explain them clearly.

Here’s the mistake: people assume that any stay in a skilled nursing facility (SNF) for rehab is automatically covered by Medicare. It’s not. You have to meet a very specific requirement first. You must have had a qualifying inpatient hospital stay of at least three days (not counting the day you’re discharged). That’s three full days as a formal inpatient admission, not under “observation status.”

Observation status is the landmine here. If your hospital classifies you as under observation, even if you’re sleeping in a hospital bed for four nights, you don’t have a qualifying stay. You cannot then get Medicare to pay for skilled nursing rehab. I’ve seen this happen to people after hip replacements, after falls, after cardiac events. They thought they were covered. They weren’t, and the bills were devastating.

If Medicare does cover your SNF stay, here’s what the 2026 numbers look like: Medicare pays 100% for days 1-20. For days 21-100, there’s a daily coinsurance of $209.50. After day 100, Medicare pays nothing. Plan G and Plan N both cover that daily coinsurance fully for days 21-100, which is where Medigap really earns its premium for people who need extended rehab.

Ask about your admission status at the hospital. Actually ask. Don’t assume inpatient status. It’s one of the few things I tell everyone regardless of their situation.

Home Health Therapy: A Different Animal

If you’re homebound and a doctor orders physical therapy at your home, Medicare Part A or Part B can cover home health services, including physical and occupational therapy. Interestingly, this is one area where Medigap has limited direct impact, because Medicare typically pays 100% for covered home health visits with no coinsurance required from you.

The catch is the definition of “homebound.” Medicare defines this strictly. You have to have a condition that makes leaving home require considerable effort. If you’re walking around the neighborhood or driving to appointments regularly, you likely don’t qualify for home health benefits. Medicare audits home health claims aggressively.

There is a 20% coinsurance for durable medical equipment sometimes associated with home therapy, and your Medigap plan does cover that. But for the therapy visits themselves, you’re often not paying out of pocket anyway, which is genuinely good news if you qualify.

Bottom Line

For most people who want solid protection against the costs of physical therapy and rehab, Plan G is the right call. It eliminates almost all out-of-pocket exposure once you’ve paid the annual Part B deductible, and it covers both the outpatient therapy coinsurance and the skilled nursing facility daily charges that can otherwise run into the tens of thousands. If you’re choosing between plans and you have any reason to expect significant therapy needs, don’t let a slightly lower Plan N premium talk you into absorbing per-visit copays that add up faster than you’d think.

Frequently Asked Questions

Does Medicare cover physical therapy with no limit on sessions?

There’s no annual session limit anymore. Medicare covers medically necessary outpatient therapy without a cap on the number of visits. Once costs exceed $2,330 (2026 threshold) for PT and speech therapy combined, providers have to document medical necessity more explicitly, but coverage doesn’t stop.

Will my Medigap plan cover therapy if Medicare denies the claim?

No. If Medicare denies a therapy claim, your Medigap plan won’t cover it either. Medigap only pays for costs that Medicare has already approved. That’s why the medical necessity documentation from your provider matters so much. If a claim is denied, you can appeal, and it’s often worth doing.

What happens if I need rehab in a skilled nursing facility for more than 100 days?

Medicare stops paying entirely after day 100 in a benefit period. No Medigap plan covers SNF costs beyond day 100. For extended care, you’d be looking at Medicaid (if you qualify) or paying out of pocket. This is one of the legitimate gaps in standard Medigap coverage that people should plan around separately.

Does Medigap cover gym-based or wellness physical therapy?

Generally not. If a physical therapist is providing medically necessary treatment that Medicare approves, your Medigap plan covers its share. But general fitness programs, maintenance exercise classes, or gym memberships aren’t covered by Medicare or Medigap, even if a doctor recommended exercise for your health. The line is medical necessity, and maintenance exercise usually doesn’t meet that bar under Medicare’s definitions.

What Plan M Actually Covers (And Where It Cuts Corners)

Plan M is one of the lesser-known standardized Medigap plans, and that’s partly because it occupies a strange middle ground that doesn’t work for everyone. It covers most of what Plan G covers, but with two significant gaps: it only pays half of the Medicare Part A hospital deductible, and it doesn’t cover the Part B deductible at all.

Here’s the full picture of what Plan M does and doesn’t cover:

Benefit	Plan M	Plan G (for comparison)
Medicare Part A coinsurance and hospital costs	Yes	Yes
Medicare Part B coinsurance or copayment	Yes	Yes
Blood (first 3 pints)	Yes	Yes
Part A hospice care coinsurance or copayment	Yes	Yes
Skilled nursing facility coinsurance	Yes	Yes
Part A deductible (2026: $1,676 per benefit period)	50% only	100%
Part B deductible (2026: $257)	No	No
Part B excess charges	No	Yes
Foreign travel emergency (up to plan limits)	80%	80%

That Part A deductible is the big one to pay attention to. In 2026, it’s $1,676 per benefit period, not per year. If you get hospitalized twice in a year under separate benefit periods, you’d owe $838 each time with Plan M, while a Plan G holder pays nothing. That adds up faster than most people expect.

The Part B deductible not being covered isn’t a dealbreaker for most people. At $257 in 2026, you pay it once per year before Medicare starts covering your outpatient care. That’s annoying but manageable. The Part A cost-sharing is the real exposure here.

What Plan M Costs and How the Math Works

Plan M premiums run meaningfully lower than Plan G premiums, typically 15 to 25 percent less depending on your insurer, state, and age. For a 65-year-old woman in a mid-size market, you might see Plan G at around $130 to $160 per month and Plan M in the $100 to $130 range. The gap varies a lot by location.

Let’s run the numbers honestly. Say you’re paying $130/month for Plan G versus $108/month for Plan M. That’s a $264 annual savings on premiums. In exchange, you’re taking on up to $838 in potential out-of-pocket costs from your half of the Part A deductible, plus the $257 Part B deductible.

If you don’t get hospitalized, Plan M wins. If you have one hospitalization, you’re roughly breaking even or slightly behind. Two hospitalizations in a year and Plan M has cost you more than Plan G would have.

The question isn’t just math, though. It’s also about your risk tolerance. Some people sleep better knowing their hospital bills are covered completely. Others genuinely prefer lower monthly premiums and are willing to absorb the occasional out-of-pocket cost. Neither preference is wrong, but you need to go in with clear eyes about what you’re trading.

One more thing: Plan M premiums are set by each insurer individually, even though the benefits are standardized by federal law. Two different companies can charge very different prices for identical Plan M coverage. Always compare multiple quotes in your area before you buy.

The Biggest Misconception About Plan M

I’ve seen a lot of people assume Plan M works like a high-deductible plan where you’re gambling that you’ll stay healthy. That’s not quite right, and the confusion leads people to either dismiss Plan M unfairly or choose it for the wrong reasons.

Plan M is not a high-deductible plan. There’s a separate product called Plan G High Deductible that has a $2,870 deductible in 2026 before your coverage kicks in. Plan M has no annual deductible of its own. You only pay cost-sharing on the specific items that Plan M leaves partially or fully uncovered, which is primarily that 50% of the Part A hospital deductible.

The other misconception I run into constantly is that people think the Part B deductible not being covered is a bigger deal than it is. I understand why: anything labeled a “gap” sounds alarming when you’re trying to fill gaps. But $257 once a year is genuinely not a significant financial exposure. You’d pay that from your wallet without it stressing your budget. The Part A deductible is a different story because it can hit multiple times in a year.

Also, Plan M does cover Part B excess charges on some policies depending on the insurer’s offering, but in the standardized federal definition, Plan M does not include excess charge protection. Don’t assume you’re covered for that. Always read the policy summary, not just the plan name.

Who Plan M Is Actually Right For

Here’s where I’ll be direct with you, because too many articles dodge this question.

Plan M makes the most sense for people who are genuinely healthy, have a solid emergency fund to cover a surprise hospital bill, and are primarily motivated by keeping their monthly premium down without dropping to a less protective plan entirely. A 67-year-old in Ohio who’s never been hospitalized, sees her doctor three or four times a year for routine visits, and has $10,000 sitting in savings she could tap if needed? Plan M could be a smart choice for her.

It’s also worth considering if you live in a state where Plan G premiums are especially high. In some markets, the premium difference between Plan G and Plan M is large enough that the savings are hard to ignore even with the added risk.

Plan M is probably not right for you if:

• You have a chronic condition that leads to frequent hospitalizations
• You’re on a fixed income where a surprise $800 bill would genuinely cause hardship
• You hate the idea of having any cost-sharing exposure after paying monthly premiums
• The premium difference in your area between Plan M and Plan G is less than $15 to $20 per month

That last point matters more than people realize. If the savings are only $10 or $12 a month, you’re not saving enough to justify taking on any additional risk. The math just doesn’t work in your favor.

How Plan M Compares to Plan N (The Other “Middle Ground” Option)

If you’re looking at Plan M, you should almost certainly also look at Plan N before you decide. They’re both positioned as lower-premium alternatives to Plan G, and they attract a similar type of buyer.

Feature	Plan M	Plan N
Part A deductible coverage	50% (you pay ~$838 in 2026)	100% covered
Part B deductible	Not covered	Not covered
Part B excess charges	Not covered	Not covered
Office visit copays	None	Up to $20 copay
Emergency room copay	None	Up to $50 (waived if admitted)
Typical premium vs. Plan G	15-25% lower	15-20% lower

In my experience, Plan N tends to be the better deal for most people who want lower premiums. Here’s why: Plan N covers 100% of the Part A deductible, which is your biggest financial exposure. Yes, you’ll pay up to $20 for some office visits and up to $50 for emergency room trips, but if you’re only seeing your doctor four or five times a year, those copays add up to maybe $80 to $100 annually. That’s usually less exposure than carrying half the Part A deductible.

That said, if you’re a frequent outpatient visitor who rarely ends up in the hospital, Plan M’s structure might actually work better. This is one situation where your personal health history genuinely matters. Think about how you actually use healthcare, not how you hope you’ll use it.

Bottom Line

Plan M is a legitimate option, but it’s not the first plan I’d recommend to most people. For healthy, financially stable Medicare beneficiaries who want meaningful savings on their monthly premium and can absorb occasional cost-sharing, it’s worth a serious look. For most people, though, Plan N offers a cleaner trade-off because it eliminates your biggest out-of-pocket risk (the hospital deductible) while still delivering lower premiums than Plan G. Compare both side by side with real quotes from your state before you decide anything.

Frequently Asked Questions

Is Plan M available in all states?

Plan M is a federally standardized plan, which means insurers are allowed to offer it, but they’re not required to. In practice, Plan M isn’t available from many carriers in most states, which is part of why it flies under the radar. You may find only one or two insurers in your area offering it. Always use a quote tool that checks multiple carriers, because availability varies significantly by ZIP code.

Can I switch from Plan M to Plan G later if I want more coverage?

Possibly, but it’s not guaranteed. After your initial Medigap open enrollment period ends, insurers in most states can use medical underwriting to decide whether to cover you. If you’ve developed a health condition since you first enrolled, you might be denied or charged more. Minnesota, Connecticut, and Massachusetts have different rules, but in most states, switching plans later carries real risk. Don’t count on being able to upgrade later just because you can afford to then.

Does Plan M cover emergency care when I travel outside the U.S.?

Yes. Plan M includes foreign travel emergency coverage at 80% after a $250 deductible, up to a lifetime limit of $50,000. That matches what Plan G offers for foreign travel. It’s not unlimited, and it only applies to emergencies, not routine care abroad. If you’re a frequent international traveler, look closely at those limits and consider whether supplemental travel insurance might fill any remaining gaps.

What happens if I see a doctor who doesn’t accept Medicare assignment with Plan M?

If a provider charges more than Medicare’s approved amount (called excess charges), Plan M does not cover those extra costs. You’d owe the difference out of pocket, which can be up to 15% above Medicare’s approved rate. This is the same situation as Plan N buyers. If you see specialists who don’t accept Medicare assignment, this is a real exposure. The fix is simple: ask whether your doctors accept Medicare assignment before you enroll in any plan that doesn’t cover excess charges.

The Short Answer: Yes, But Don’t Count On It Being Easy

You can try to switch Medicare supplement plans any time of year. The problem is that most insurers don’t have to accept you, and most of the time, they won’t if you have health issues. That’s the part nobody tells you upfront, and it trips up a lot of people who assume Medicare’s open enrollment rules work the same way for Medigap as they do for other types of insurance.

Here’s the thing. Medigap is private insurance sold by private companies. Outside of a few protected windows, those companies can run you through medical underwriting, ask about your health history, and flat-out deny your application or charge you significantly more. In most states, this applies whether you’re switching plans in January, July, or any other month.

So yes, mid-year switches are possible. But whether you’ll actually get approved, and at what price, depends almost entirely on your health status and which state you live in.

How Medical Underwriting Works Against You When You Switch

When you first signed up for Medicare Part B, you had a six-month window called the Open Enrollment Period. During that window, insurers had to sell you any Medigap plan at standard rates, no questions about your health. That window is gone now. It doesn’t come back just because you want a different plan.

Outside of that initial window, insurers in most states can ask you questions like: Have you been hospitalized in the past two years? Do you have diabetes, heart disease, COPD, or cancer? Are you currently taking blood thinners? If the answers raise flags, they can decline your application entirely.

I’ve seen people get rejected for conditions they considered minor. A history of atrial fibrillation, a knee replacement from three years ago, even some mental health diagnoses have caused denials. The underwriting standards vary by insurer, but they’re real, and they bite people who weren’t expecting them.

This is why the timing of a switch matters so much. If you’re in good health right now and your current plan’s premiums are climbing, switching mid-year might make perfect financial sense. If you’ve had health events recently, you may be stuck where you are until a protected window opens up for you.

Situations Where You Have the Right to Switch Without Underwriting

There are specific situations where you’re legally protected and insurers must accept you, no health questions. These are called Guaranteed Issue rights, and they’re worth knowing because they’re the only reliable path to switching if your health isn’t perfect.

• Your insurer leaves your area or goes bankrupt. If your current Medigap insurer stops doing business in your state, you have 63 days to switch to another plan without underwriting.
• You have employer coverage that’s ending. If you delayed Medigap and had employer group health coverage that’s now ending, you may have a guaranteed issue window.
• You enrolled in a Medicare Advantage plan and want to switch back. If you moved from Original Medicare plus Medigap to a Medicare Advantage plan, and within the first year you decide Advantage isn’t for you, you can switch back to a Medigap plan with guaranteed issue rights.
• Your Medicare Advantage plan leaves your area or ends. Same principle: you get a protected window to pick up Medigap coverage without health screening.

Outside of these situations, you’re in underwriting territory. Which means your health, not the calendar, controls whether a mid-year switch is realistic for you.

The Misconception That Kills People’s Plans: Assuming Lower Premiums Means a Better Deal

This is the mistake I see most often, and it’s an expensive one. Someone calls around, finds a Plan G with a premium that’s $40 a month cheaper than what they’re currently paying, and starts celebrating. They apply, get approved (or assume they will), and cancel their existing coverage. Then something goes wrong in the process, and suddenly they’re either uninsured for a period or stuck paying both premiums.

A few things people get wrong here:

1. They cancel their current plan before the new one is confirmed. Never do this. Keep your existing Medigap coverage active until you have written confirmation that your new plan is in force. Insurers can rescind applications. Processing delays happen.
2. They don’t account for the timing of premium billing. If you switch mid-month, you may owe partial premiums to both insurers. That’s fine, but factor it into your math.
3. They compare premiums without comparing rate increase histories. A plan that’s $30 cheaper today might have raised rates 12% last year, while your current plan raised rates 4%. Chasing the current lowest premium without looking at the trajectory is short-sighted.

Here’s a comparison of what matters when evaluating a mid-year switch:

Factor	What Most People Focus On	What You Should Actually Compare
Premium	Current monthly cost	3-5 year rate increase history
Benefits	Plan letter (G, N, etc.)	Identical across all insurers for same plan letter
Pricing method	Often ignored	Community-rated vs. issue-age vs. attained-age
Insurer stability	Often ignored	A.M. Best rating, years in Medicare market
Underwriting requirements	Often ignored	Whether you’ll actually get approved

The benefits for a given plan letter are standardized by federal law. A Plan G from Aetna pays exactly the same claims as a Plan G from Mutual of Omaha. So the only things you’re really comparing are price, price stability, and whether the insurer will accept you. Don’t overcomplicate it.

State Exceptions That Actually Give You More Freedom

A handful of states have passed their own rules that give residents more switching flexibility than federal law requires. If you live in one of these states, your options are genuinely better.

California has a Birthday Rule: during the 60 days following your birthday each year, you can switch to a plan with equal or lesser benefits from any insurer without underwriting. So if you’re a 69-year-old in California with health issues, you have a real annual window to shop.

Oregon has a similar Birthday Rule with the same 60-day window.

Idaho and Nevada also have Birthday Rule provisions, though the specific rules differ slightly, so verify the current details for your situation.

Missouri, Illinois, and a few others have anniversary rules or other consumer protections worth looking into.

Connecticut, Maine, Massachusetts, and New York have guaranteed issue year-round, meaning insurers in those states can’t deny you based on health at any point. If you live in one of these states, mid-year switching is as easy as finding a lower premium and filling out an application. It’s genuinely that simple there.

If you’re not in one of these states and you’re in decent health, the best time to switch is when you find a better deal and can pass underwriting. Don’t wait for an imaginary “right time” that doesn’t exist in most states.

The Real Financial Math on Switching Mid-Year

Let’s make this concrete. Say you’re a 67-year-old in Ohio on Plan G, currently paying $178 a month. You find another Plan G from a highly-rated insurer at $139 a month. That’s a $39 monthly difference, or $468 a year.

If you pass underwriting, switching is almost certainly worth it. The 2026 Plan G benefits are identical either way: you’re covered for everything Medicare Part A and Part B cover, except the Part B deductible (which is $257 in 2026). Same hospital coverage, same Part A deductible ($1,676 per benefit period in 2026), same coinsurance. The check you get when you need care looks exactly the same. The only variable is what you pay monthly.

Now factor in whether the new insurer uses attained-age pricing (rates go up as you age) vs. community-rated (everyone pays the same regardless of age). If the cheaper plan uses attained-age pricing, that $39 gap might disappear in two or three years and reverse after that. This is worth a direct conversation with the insurer or an independent broker before you switch.

That said, for a healthy person in a state without special protections, I’d still recommend switching when the savings are meaningful and the insurer is financially stable. Waiting costs you real money while you deliberate.

Bottom Line

If you’re in good health and you’ve found a lower-priced Plan G or Plan N from a reputable insurer, switch. Don’t wait for a specific time of year, because there’s no special mid-year window that helps you in most states. Apply, get approved in writing, then cancel your old coverage. If your health has changed significantly since you first enrolled, or you’ve had recent hospitalizations or diagnoses, talk to an independent broker who can tell you which underwriters in your state are most likely to approve you before you apply anywhere.

---

Frequently Asked Questions

Is there a Medigap open enrollment period each year like there is for Medicare Advantage?

No. This is one of the most common points of confusion. The annual October 15 through December 7 enrollment period applies to Medicare Advantage and Part D drug plans, not Medigap. Your one guaranteed Medigap open enrollment window is the six months after you first enroll in Part B. After that, you’re subject to underwriting in most states.

Can I have two Medigap plans at once during a switch?

Technically you can overlap briefly, but you won’t get benefits from both. You can only have one active Medigap policy covering you at a time. It’s fine to keep the old plan active until the new one confirms, but cancel promptly once you have written confirmation of the new coverage to avoid unnecessary double premiums.

What happens to my Medigap coverage if I’m hospitalized while I’m switching plans?

This is exactly why you should never cancel your current plan before the new one is confirmed in writing. If you’re between plans when a hospitalization happens, you could face significant out-of-pocket costs. The 2026 Part A deductible is $1,676 per benefit period, and that’s just the starting exposure. Keep coverage active through the transition.

My premiums went up 15% this year. Should I switch even though I have some health issues?

It depends on the nature of those health issues. Mild, well-controlled conditions sometimes pass underwriting. Serious or recent conditions often don’t. Before you apply anywhere and create a record of a denial, talk to an independent Medigap broker who knows which carriers in your state are more lenient. Some insurers are stricter than others, and applying to the wrong one first can make your situation harder. If you’re in California, Oregon, or one of the guaranteed-issue states, none of this applies: shop freely.

Yes, Medigap Covers Ambulance — But It Works in Layers

Medicare supplement plans do cover ambulance services, but not in the way most people expect. You don’t just hand over your Medigap card and walk away with no bill. It’s a two-step process, and if you don’t understand both steps, you’re going to be confused when you get the explanation of benefits.

Here’s how it actually works. Original Medicare (Part B) covers medically necessary ambulance transport at 80% after you meet your deductible. That leaves you with the remaining 20% coinsurance, which is where your Medicare supplement kicks in. Depending on which plan you have, Medigap pays some or all of that 20%.

For 2026, the Part B deductible is $257. Once you’ve met that for the year, Medicare pays its 80% share on an approved ambulance claim. Your Plan G, Plan N, or whatever plan you carry then steps in behind Medicare to cover what’s left.

That leftover 20% isn’t small. An average ground ambulance transport runs $1,200 to $2,000 before Medicare discounts. After Medicare’s 80%, you could still be looking at $240 to $400 out of pocket on a single ride — and that’s assuming the ambulance company accepts Medicare assignment. If they don’t, costs can be significantly higher.

What “Medically Necessary” Actually Means for Ambulance Coverage

This is where a lot of people get blindsided. Medicare doesn’t cover ambulance transport just because you called 911 or because your doctor said you needed it. Medicare covers ambulance transport when it’s medically necessary AND when other transportation would be contraindicated for your condition.

In plain terms: if you could have safely ridden in a car or wheelchair van, Medicare can deny the ambulance claim entirely. That means your Medigap plan has nothing to pay, because Medigap only pays what Medicare approves first.

Examples that typically qualify as medically necessary:

• You’re unconscious or in active cardiac arrest
• You need to be immobilized due to a fracture or spinal injury
• You require oxygen or IV medications during transport
• Your condition requires monitoring that only trained EMTs can provide

Examples that often don’t qualify:

• Routine transport to dialysis (there are specific rules here — see below)
• Non-emergency transport to a doctor’s office when you could sit in a car
• Convenience-based ambulance use, even if you feel unwell

Dialysis is a special case worth knowing about. Medicare does cover ambulance transport to and from dialysis for patients who are bed-confined, but not just because someone needs dialysis. The patient has to meet the medical necessity standard on top of needing dialysis. I’ve seen people assume dialysis automatically means covered ambulance rides, and that’s not accurate.

How Each Major Medigap Plan Handles Ambulance Costs

Not all Medicare supplement plans work the same way here. The differences come down to how much of that Part B coinsurance (the 20%) and the Part B deductible they cover.

Medigap Plan	Part B Deductible (2026: $257)	Part B Coinsurance (20%)	Your Out-of-Pocket on Ambulance
Plan G	You pay it once per year	Medigap pays 100%	$257 first use of year, then $0
Plan N	You pay it once per year	Medigap pays 100%	$257 first use of year, then $0
Plan F (pre-2020 enrollees only)	Medigap pays it	Medigap pays 100%	$0
Plan K	You pay it once per year	Medigap pays 50%	$257 deductible + 10% of approved charge
Plan L	You pay it once per year	Medigap pays 75%	$257 deductible + 5% of approved charge
High-Deductible Plan G	Applied to your deductible	Applied to your deductible	Up to $2,870 (2026 deductible) before coverage kicks in

If ambulance use is a realistic concern for you — you have a heart condition, you’re recovering from a stroke, you live alone in a rural area where an emergency is more likely to require transport — Plan G or standard Plan N gives you the cleanest coverage once that annual deductible is met.

The Mistake That Costs People Real Money

I’ve seen this happen more times than I can count: someone gets taken by ambulance, the ambulance company is out-of-network, and the person assumes their Medigap plan will cover the gap the same way it does for in-network care. It doesn’t always work that way, and here’s why.

Original Medicare has an “approved amount” for ambulance services. If the ambulance company accepts Medicare assignment, they agree to take that approved amount as payment in full (minus your cost-sharing). But if the company doesn’t accept assignment, they can charge you up to 15% more than Medicare’s approved amount on top of your 20% coinsurance. That extra 15% is called the Part B excess charge.

Here’s the catch: Plan N does not cover Part B excess charges. Plan G does cover them. So if you have Plan N and you’re transported by a non-participating ambulance provider, you could owe that 20% coinsurance plus the 15% excess charge, all at once.

In a rural area, this is particularly relevant. Rural ambulance providers are more likely to be independent companies that haven’t signed Medicare assignment agreements. If you’re 68 years old, living 40 minutes from the nearest hospital, and your area has one ambulance service that doesn’t take assignment, you want Plan G. Not Plan N, not a high-deductible plan. Plan G.

There’s another misconception I want to address head-on: some people think that because their Medicare Advantage plan “covers ambulance,” they don’t need to think carefully about this. Medicare Advantage handles ambulance differently than Original Medicare plus Medigap. With MA plans, you’re subject to whatever copays and network rules that specific plan has. Some MA plans charge $250-$300 per ambulance trip regardless of the situation. If you’re comparing Medigap to Medicare Advantage, ambulance coverage is one of the areas where traditional Medicare plus a solid Medigap plan often wins.

Air Ambulance: The Coverage Gap Nobody Talks About

Ground ambulance is relatively straightforward once you understand the rules. Air ambulance is a different beast, and I’d be doing you a disservice if I didn’t flag this separately.

Medicare Part B does cover medically necessary air ambulance transport under the same 80/20 structure as ground transport. Your Medigap plan covers that 20% the same way. The problem is that air ambulance providers have historically been among the most aggressive non-participating providers in the country.

Before the No Surprises Act (which took effect in 2022), air ambulance companies could bill you astronomically above Medicare rates, and Medigap only covered the Medicare-approved portion. The No Surprises Act improved protections for people with private insurance, but Medicare beneficiaries operate under different rules. You’re protected from the worst abuses, but air ambulance billing disputes do still happen.

If you live somewhere that air transport is realistically possible in an emergency (mountainous areas, rural regions, areas with major trauma centers far away), ask your Medigap insurer specifically how they handle air ambulance claims and whether your plan covers Part B excess charges. Get it in writing.

Bottom Line

For most people, Plan G is the right call when ambulance coverage matters to you. It covers the 20% coinsurance, it covers Part B excess charges from non-participating providers, and after you pay the 2026 deductible of $257 once in January, you’re protected for the rest of the year. If you’re in a rural area, have a cardiac history, or live alone, don’t let a $20-40/month premium difference between Plan G and Plan N push you toward a plan that leaves you exposed to excess charges when it matters most.

Frequently Asked Questions

Does Medicare supplement cover non-emergency ambulance transport?

Only if Original Medicare covers it first. Medigap doesn’t override Medicare’s medical necessity rules. If Medicare denies the ambulance claim because the transport wasn’t medically necessary, your Medigap plan pays nothing. The determination of medical necessity is made by Medicare based on the documentation from the ambulance provider and your medical records.

What if the ambulance takes me out of state?

Medicare Part B covers medically necessary ambulance transport regardless of state lines, as long as it meets the medical necessity criteria. Your Medigap plan follows the same rules. Unlike Medicare Advantage, Medigap plans work anywhere in the country that accepts Medicare, so crossing a state line doesn’t change your coverage.

Will Medigap cover ambulance if I’m taken to an out-of-network hospital?

Yes. This is actually one of the big advantages of Original Medicare plus Medigap over Medicare Advantage. There’s no network restriction for Medigap. If the ambulance takes you to a hospital that accepts Medicare (which is virtually all hospitals), your Medigap plan covers the applicable cost-sharing regardless of which hospital it is.

I have Plan N. Am I really exposed to extra costs for ambulance?

Potentially, yes. Plan N doesn’t cover Part B excess charges. If your ambulance provider doesn’t accept Medicare assignment and bills the 15% excess charge, you’ll owe that out of pocket on top of your 20% coinsurance. In most urban and suburban areas, this is rare because most ambulance companies do accept assignment. But if you’re in a rural area or somewhere with limited provider options, it’s a real risk worth knowing about before you need a ride.

What Medicare Actually Pays for Skilled Nursing Facility Care

Most people are shocked when they see the bill after a skilled nursing facility stay. They assumed Medicare covered it. And in a sense it does — but only partially, and only under conditions that are stricter than most people realize.

Here’s how the benefit period breaks down under Original Medicare in 2026. For days 1 through 20, Medicare covers 100% of the cost. That sounds great until you hit day 21. Starting on day 21, you’re on the hook for a coinsurance amount of $209.50 per day in 2026. That’s not a typo. Every single day from day 21 through day 100, you owe $209.50 out of pocket. After day 100, Medicare pays nothing at all.

That means a 60-day skilled nursing stay — which is not unusual after a hip replacement or stroke — could cost you over $8,000 in coinsurance alone. A 90-day stay pushes that figure past $14,600. And this is on top of your Part A deductible of $1,676 per benefit period in 2026, which you likely already paid when you were hospitalized.

This is exactly the gap that Medigap was designed to fill. But here’s what a lot of people don’t fully understand: not every Medicare supplement plan covers the skilled nursing facility coinsurance. The coverage depends entirely on which plan you buy.

Which Medigap Plans Actually Cover the SNF Coinsurance

Let me be direct about this. If skilled nursing facility coverage matters to you — and it should — then you need to pick a Medigap plan that explicitly covers the SNF coinsurance. Several plans do. A few don’t. And one popular plan is more limited than people expect.

Here’s a quick breakdown of how the major standardized Medigap plans handle SNF coinsurance coverage:

Medigap Plan	SNF Coinsurance (Days 21-100)	Part A Deductible	Part B Deductible
Plan G	100% covered	100% covered	Not covered
Plan N	100% covered	100% covered	Not covered
Plan F (grandfathered)	100% covered	100% covered	100% covered
Plan K	50% covered	50% covered	Not covered
Plan L	75% covered	75% covered	Not covered
Plan A	Not covered	Not covered	Not covered
Plan B	Not covered	100% covered	Not covered

For most people newly enrolling in Medicare in 2026, Plan G is the gold standard. It covers the SNF coinsurance in full, covers the Part A deductible, and the only thing it doesn’t cover is the Part B deductible (which is $257 in 2026 — a small price to pay for that level of protection). Plan G premiums typically run $100 to $200 per month at age 65, depending on your state and which insurer you use. A 65-year-old woman in Ohio might pay $115 to $140 a month with a reputable carrier. That’s a reasonable trade-off for coverage that can save you tens of thousands of dollars in a bad year.

Plan N is worth a look if you’re in good health and want lower premiums. It also covers the SNF coinsurance fully, but you’ll pay up to $20 per doctor visit and up to $50 for emergency room visits. It’s a better fit for someone who rarely sees specialists and wants to save $20-$40 a month on premiums.

The Qualification Rules Most People Miss

Here’s where it gets frustrating. Even if you have the best Medigap plan in the world, your insurance can only pay what Medicare approves. And Medicare’s rules for qualifying for skilled nursing facility coverage are strict enough that a lot of people don’t actually qualify — even when they think they will.

To qualify for Medicare’s SNF benefit, three conditions must be met. First, you must have had a qualifying hospital stay of at least three consecutive days as an inpatient (not under observation status). Second, the SNF admission must be for a condition that was treated during that qualifying hospital stay. Third, you must need skilled care — meaning daily skilled nursing or therapy services — not just custodial care like help with bathing and eating.

The observation status issue is the one that catches people off guard most often. Hospitals sometimes keep patients under “observation” rather than admitting them as inpatients. From the patient’s perspective, everything looks the same: you’re in a hospital bed, wearing a gown, getting IV fluids. But under Medicare’s rules, observation days don’t count toward the three-day qualifying stay. That means if you were in the hospital for four days under observation and then transferred to a skilled nursing facility, Medicare won’t cover your SNF stay at all — and neither will your Medigap plan, because Medigap only fills gaps in Medicare-approved costs.

I’ve seen this happen to people who were genuinely blindsided. If you’re ever admitted to a hospital and you’re not sure of your status, ask directly: “Am I admitted as an inpatient, or am I under observation status?” It’s a question you have every right to ask.

The Common Misconception That Costs People Real Money

The single biggest mistake I see is people confusing skilled nursing facility care with long-term care. They are not the same thing, and Medigap does not cover long-term care. Not even close.

Medicare’s SNF benefit covers short-term, medically necessary skilled care after a qualifying hospital stay. We’re talking about post-surgical rehabilitation, wound care, IV antibiotics, physical therapy after a stroke — things that require licensed nurses or therapists on a daily basis. Once you plateau in your recovery and no longer need skilled services, Medicare stops paying. That’s true even if you still need help walking, dressing, or eating. That kind of ongoing personal assistance is classified as custodial care, and it’s excluded from Medicare and Medigap entirely.

Long-term custodial care is expensive. A private room in a nursing home in many states runs $8,000 to $10,000 per month or more. Medigap will never cover that. If long-term care is a concern — and statistically it should be, because about 70% of people turning 65 will need some form of it — you need to be looking at long-term care insurance or hybrid life/LTC policies, not Medigap. Those are separate products entirely.

I bring this up because I’ve talked to people who thought their Plan G was a safety net for nursing home care. It isn’t. And finding that out at age 80 when you need placement is a terrible time to discover the gap.

How SNF Coverage Works in Practice: A Real Example

Let me walk through a realistic scenario so this stops being abstract. Take a 72-year-old man in Florida who falls and breaks his hip. He’s admitted to the hospital as an inpatient (not observation) and has surgery. He stays in the hospital for four days, then gets transferred to a skilled nursing facility for rehabilitation.

Here’s what the cost picture looks like with and without Plan G:

Expense	Without Medigap	With Plan G
Part A deductible (2026)	$1,676	$0
SNF days 1-20	$0	$0
SNF days 21-45 (25 days at $209.50/day)	$5,237.50	$0
Total out-of-pocket	$6,913.50	$0 (after Plan G premium)

A 45-day skilled nursing stay after a hip replacement is not unusual. That’s a $6,900 exposure without Medigap, covered almost entirely by Plan G. Even at $150/month in premiums, that’s $1,800 a year — and one SNF stay wipes out years of premium costs in a single event.

Bottom Line

If you’re choosing a Medigap plan and skilled nursing facility coverage matters to you (it should), Plan G is the right choice for most people. It gives you full SNF coinsurance coverage, strong hospitalization protection, and predictable costs, all for a premium that most people find manageable. Don’t let the slightly lower premiums of Plan K or Plan L talk you into partial coverage on something this expensive — the math doesn’t work out in your favor when you actually need a SNF stay.

Frequently Asked Questions

Does Medigap cover all 100 days of a skilled nursing facility stay?

No. Medicare and Medigap together cover days 1 through 100, but the structure is different for each phase. Medicare pays 100% for days 1-20. For days 21-100, plans like Plan G and Plan N cover the daily coinsurance ($209.50 in 2026) so you pay nothing. After day 100, Medicare pays nothing and neither does Medigap. A skilled nursing facility stay that extends past 100 days is your full financial responsibility unless you have a separate long-term care policy.

What if I was in the hospital under observation status — does Medigap still help?

Only if Medicare approves the SNF stay in the first place. If your hospital time was spent under observation rather than as a formal inpatient admission, you likely won’t qualify for Medicare’s SNF benefit at all. Medigap fills gaps in Medicare-covered services, so if Medicare doesn’t cover the SNF stay, Medigap won’t either. This is one reason to always confirm your admission status while you’re still in the hospital.

Will Medigap cover a nursing home stay if I just need help with daily activities?

No. This is custodial care, not skilled care, and it’s not covered by Medicare or any Medigap plan. Medicare’s SNF benefit only applies when you need daily skilled nursing or therapy services. Once your condition stabilizes and you no longer require that level of care, Medicare stops covering the stay — regardless of whether you’re still in the facility.

Is Plan G really worth the higher premium compared to Plan N for SNF coverage?

Both Plan G and Plan N cover the SNF coinsurance in full, so on that specific benefit they’re equal. The difference is that Plan N has copays for doctor and ER visits. If you’re healthy and rarely see specialists, Plan N can save you $20-$40 a month in premiums. But if you’re a frequent healthcare user or want zero surprises, Plan G’s predictability is worth the extra cost. For SNF coverage specifically, either plan will protect you equally well.

The Short Answer: Some Plans Do, But Not All of Them

Most Medicare supplement plans that include foreign travel emergency coverage will pay for emergency care abroad — but only after you’ve met a $250 annual deductible, and only up to a lifetime maximum of $50,000, with Medicare paying nothing and you covering 20% of the bill after that deductible. That’s not a typo. Original Medicare stops at the U.S. border, and the foreign travel benefit in Medigap plans isn’t nearly as generous as people assume.

I’ve talked to a lot of retirees who think their Medigap card is basically a global health card. It’s not. But it’s also not useless. If you’re taking a cruise to the Caribbean or spending a few weeks in Europe, the coverage built into certain Medigap plans can genuinely protect you from a catastrophic bill. You just need to understand what you’re actually getting before you board that plane.

Here’s the thing: whether this coverage is enough depends almost entirely on where you’re going, how long you’ll be there, and how much international travel you plan to do. Let me walk you through the specifics so you can make a real decision instead of just hoping for the best.

Which Medigap Plans Include the Foreign Travel Benefit

Not every Medigap plan includes the foreign travel emergency benefit. It’s standardized across insurers for the plans that do include it, but several popular plans don’t offer it at all.

Medigap Plan	Foreign Travel Emergency Coverage	Notes
Plan A	No	Bare-bones coverage, no travel benefit
Plan B	No	Adds Part A deductible coverage but still no travel
Plan C	Yes	No longer available to new Medicare enrollees after Jan 1, 2020
Plan D	Yes	Less commonly sold but includes travel benefit
Plan F	Yes	Closed to new enrollees after Jan 1, 2020; existing holders keep it
Plan G	Yes	The most popular plan for new enrollees; includes travel benefit
Plan K	No	Cost-sharing plan, no travel benefit
Plan L	No	Cost-sharing plan, no travel benefit
Plan M	Yes	Rarely sold but does include travel coverage
Plan N	Yes	Growing in popularity; includes the travel benefit

If you’re on Plan G, which is what most people enrolling today end up choosing, you’re covered for foreign travel emergencies. Same goes for Plan N, which is the runner-up for cost-conscious buyers. But if someone sold you Plan K or Plan L because the premiums were low, you’ve got zero foreign travel coverage from Medigap. That’s worth knowing now rather than when you’re in a hospital in Costa Rica.

How the Coverage Actually Works (And What That $50,000 Limit Really Means)

The foreign travel emergency benefit in Medigap has three rules you need to memorize before you travel internationally.

First, there’s a $250 annual deductible you pay before the benefit kicks in. That resets every January 1st regardless of when you used it. It’s separate from the 2026 Part B deductible of $257, so yes, you could be looking at two separate deductibles in the same year depending on how your care plays out.

Second, after you hit that $250 deductible, Medigap pays 80% of the approved costs. You’re responsible for the other 20%. There’s no out-of-pocket maximum for that 20% within the foreign travel benefit itself, which is a real gap people overlook.

Third, and this is the one that catches people off guard: there’s a $50,000 lifetime maximum. Not per trip. Lifetime. If you’re a frequent international traveler and you ever have a serious medical event abroad, you could burn through a significant chunk of that limit in one hospitalization. A serious accident in Switzerland, a cardiac event in Japan, or a medical evacuation from pretty much anywhere can easily run $30,000 to $100,000 or more. That $50,000 lifetime cap can disappear fast.

The coverage also only applies during the first 60 days of any trip outside the United States. If you’re a snowbird spending four months in Mexico, you’re only covered for the first 60 days of that trip. Day 61 onward, you’re on your own unless you have separate travel insurance.

The Mistake I See People Make Over and Over

In my experience, the single biggest mistake people make is assuming their Medigap plan’s foreign travel benefit is enough coverage for any international trip they want to take. It’s not, and treating it that way can be a financially devastating decision.

Here’s a specific scenario. A 68-year-old woman in Arizona with Plan G goes on a river cruise through Europe for three weeks. She falls and fractures her hip in Germany. She needs surgery, a hospital stay, and a medical evacuation back to the United States. The total bill comes to $85,000. After her $250 deductible, her Medigap plan pays 80% up to $50,000, so it covers $40,000. She owes the remaining 20% of the $50,000 covered portion ($10,000) plus the full $35,000 above the cap. She’s out $45,000 out of pocket on a trip she thought her insurance had covered.

That’s not a hypothetical designed to scare you. Medical evacuations alone routinely cost $50,000 to $200,000 depending on where you are in the world. The Medigap foreign travel benefit is a safety net, not full coverage. Treat it accordingly.

The other mistake I see is people not realizing that this benefit doesn’t exist at all in some plans. I’ve had people tell me they’re not worried about international travel costs because they have Medicare supplement. Then I ask which plan they have. Plan K. No foreign travel benefit whatsoever. If this is you, please check your plan documents before your next trip.

What You Should Actually Do If You Travel Internationally

For short trips, a few weeks max, if you’re on Plan G or Plan N, the built-in Medigap foreign travel benefit combined with a basic travel insurance policy with medical coverage is probably sufficient for most people. A travel medical insurance add-on often runs $50 to $150 for a two-week trip and can layer on top of your Medigap benefit to fill in that 20% coinsurance gap and provide coverage above the $50,000 lifetime limit.

If you travel internationally several times a year or take extended trips, you need an annual travel insurance plan or a dedicated international health insurance policy. These aren’t expensive compared to the risk. A comprehensive annual travel insurance plan for a healthy 67-year-old in Ohio typically runs $400 to $900 per year depending on the coverage level. That is not a lot of money when you’re talking about protecting yourself from a six-figure medical bill in a foreign country.

If you spend significant time outside the U.S., like several months per year in another country, look at international health insurance plans designed for expatriates or long-stay travelers. These are structured differently from trip-based travel insurance and often make more sense for people who split their year between countries.

One more thing: always carry a card or document that explains your Medigap coverage when you travel. Foreign hospitals won’t know what Medigap is. You’ll typically pay out of pocket upfront and file for reimbursement when you return to the U.S. Keep every receipt and every document from your treatment abroad.

Bottom Line

If you’re on Plan G or Plan N, you do have some foreign travel emergency coverage through your Medigap plan, but it has real limits that most people underestimate. For the vast majority of international travelers, pairing your Medigap plan with an affordable travel insurance policy is the right move, and it’s not even a close call. Don’t skip that step just because you think your supplement card has you covered everywhere.

Frequently Asked Questions

Does Medicare itself cover emergency care outside the United States?

Almost never. Original Medicare (Parts A and B) only covers care received in the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. There are a few very narrow exceptions, like if you’re traveling the most direct route between Alaska and another state and pass through Canada, but for practical purposes you should assume Medicare covers nothing outside the U.S.

Is the $50,000 lifetime limit per person or per policy?

It’s per person, per lifetime. Once you’ve used $50,000 in foreign travel emergency benefits across all your international trips combined, that benefit is gone permanently. It doesn’t reset annually. This is one of the main reasons frequent international travelers need additional coverage beyond what their Medigap plan provides.

What counts as an “emergency” for the Medigap foreign travel benefit to apply?

The care must be medically necessary and must begin within the first 60 days of your trip. Your Medigap insurer will typically define an emergency as a sudden illness or injury that requires immediate treatment and where failure to treat could result in serious harm. Planned procedures you schedule while you’re abroad won’t qualify. Routine care won’t qualify. It has to be a genuine emergency.

Can I buy a Medigap plan specifically because I want the foreign travel coverage?

Yes, and that’s a legitimate reason to choose Plan G or Plan N over lower-premium plans like K or L. That said, if international travel coverage is a major priority for you, I’d encourage you to think of the Medigap foreign travel benefit as your second line of defense, not your primary one. Buy the plan that makes sense for your overall health coverage needs, then add a travel insurance policy that covers the gaps the Medigap benefit leaves open.

What Medigap Actually Covers When It Comes to Mental Health

Most people are shocked to learn that Medicare covers mental health services at essentially the same rate as physical health services — and that Medigap follows right along with that coverage. The Mental Health Parity and Addiction Equity Act changed things significantly, and the combination of Original Medicare plus a solid Medigap plan can actually leave you with very little out-of-pocket for outpatient therapy and psychiatric care.

Here’s how it works: Original Medicare Part B covers outpatient mental health services at 80% after you’ve met your deductible — the 2026 Part B deductible is $257. That means Medicare pays 80 cents of every approved dollar, and you’re responsible for the remaining 20%. A Medigap plan that covers Part B coinsurance (Plans G, N, and F, among others) then steps in and pays that 20%. So for a standard outpatient therapy session, a well-covered beneficiary can end up paying $0 out of pocket once they’ve satisfied that annual deductible.

For inpatient psychiatric care, we’re talking Part A territory. The 2026 Part A deductible is $1,676 per benefit period. Medicare covers inpatient psychiatric hospital stays, though there’s a 190-day lifetime limit on care in a freestanding psychiatric hospital — a cap that doesn’t apply to psychiatric units inside general hospitals. Your Medigap plan covers the Part A deductible and inpatient coinsurance depending on which plan you have.

How the Major Medigap Plans Stack Up for Mental Health

Not every Medigap plan is built the same, and that matters when you’re thinking about mental health coverage specifically. Let me give you the real breakdown.

Medigap Plan	Part B Coinsurance (Outpatient Therapy)	Part A Deductible	Part B Deductible	Typical Monthly Premium (Age 65)
Plan G	Covered	Covered	Not covered	$100-$200/month
Plan N	Covered (with copays)	Covered	Not covered	$80-$150/month
Plan F (pre-2020 enrollees only)	Covered	Covered	Covered	$150-$250/month
Plan K	50% covered	50% covered	Not covered	$50-$100/month
Plan L	75% covered	75% covered	Not covered	$70-$120/month

If you’re seeing a therapist regularly — say, twice a month — Plan G is almost certainly the right call. You pay the $257 Part B deductible once a year, and then your 20% coinsurance is covered for every session after that. A typical Medicare-approved therapy session might be billed at $150-$200, so that 20% coinsurance adds up fast without Medigap. Plan N is worth considering if you’re cost-conscious and okay with a copay of up to $20 per office visit, but for someone in ongoing mental health treatment, the math often favors Plan G.

The Big Misconception That’s Costing People Money

I’ve seen this mistake more times than I can count, and it frustrates me every time: people assume their therapist or psychiatrist doesn’t “take Medicare,” so they just assume there’s no coverage and pay out of pocket. That’s a costly assumption that’s often wrong.

Here’s what’s actually happening in those cases. There are two different situations to understand. First, some providers do opt out of Medicare entirely — they’ve filed formal paperwork to do so. With those providers, Medicare and Medigap pay nothing, full stop. Second, and far more common, is a provider who simply hasn’t enrolled in Medicare but hasn’t formally opted out either. These are called “non-participating” or “non-enrolled” providers, and the coverage rules are more nuanced than people realize.

The more important issue is that mental health providers — therapists, psychologists, licensed clinical social workers — accept Medicare at varying rates depending on your area. In rural areas especially, provider shortages mean some people genuinely can’t find an in-network mental health provider. That’s a real access problem that no Medigap plan solves. But in most metro areas, the assumption that mental health providers don’t take Medicare is simply outdated.

One more thing people get wrong: they think Medigap covers things Medicare doesn’t. It doesn’t work that way. Medigap covers your cost-sharing on things Medicare does cover. So if Medicare approves a service, Medigap picks up what Medicare leaves behind. If Medicare doesn’t cover it, Medigap won’t cover it either. That distinction matters a lot when you’re thinking about, say, experimental treatments or certain alternative mental health services.

What Medicare and Medigap Won’t Cover for Mental Health

Let’s be honest about the gaps, because there are real ones.

Medicare does not cover custodial care — meaning long-term residential mental health facilities where you’re essentially being housed rather than actively treated. If you have a family member with severe schizophrenia or dementia-related behavioral issues who needs long-term residential placement, Medicare and Medigap aren’t going to carry that cost. Long-term care insurance or Medicaid is the conversation you need to have for that scenario.

Prescription drugs for mental health conditions aren’t covered by Part A or Part B either — you need Part D for that. Antidepressants, antipsychotics, mood stabilizers — all of that runs through Part D, not Medigap. This is a point of real confusion because people assume their Medigap plan covers everything. It doesn’t touch prescription drugs.

There’s also the 190-day lifetime limit I mentioned earlier, specifically for freestanding psychiatric hospitals. This is a Medicare rule that goes back decades and hasn’t been eliminated. It’s somewhat archaic given how psychiatric care actually works today — most serious inpatient stays happen in psychiatric units inside general hospitals, which aren’t subject to that cap. But if you or someone you’re planning for has a history of extended inpatient psychiatric treatment, it’s worth knowing that limit exists.

And then there’s the provider access issue. Medigap can only help you with cost-sharing. It can’t manufacture mental health providers in your area who accept Medicare. In some markets, particularly rural ones, this is a genuinely limiting factor that no insurance product fully solves.

Special Situations Worth Knowing About

A few scenarios come up often enough that they deserve their own attention.

If you’re newly on Medicare and have a pre-existing mental health condition, the Medigap open enrollment period is critical for you. During your six-month open enrollment window (which starts when you’re both 65 and enrolled in Part B), insurers cannot deny you coverage or charge you more because of pre-existing conditions. Someone with a history of depression, anxiety disorders, bipolar disorder, or past psychiatric hospitalizations can enroll in any Medigap plan during this window on the same terms as someone with no health history. Once that window closes, you’re subject to medical underwriting in most states, and a mental health history can absolutely affect your eligibility or pricing.

For a 67-year-old in Ohio who’s been seeing a therapist weekly for years, getting into Plan G during that open enrollment window is one of the smartest financial moves they can make. The math is straightforward: 52 therapy sessions a year at a 20% coinsurance of $30-$40 each adds up to $1,560-$2,080 in coinsurance annually, none of which you’d owe with Plan G after your deductible.

Telehealth for mental health is also worth mentioning. Medicare expanded telehealth coverage significantly post-pandemic, and many of those expansions have been extended through 2026. Telehealth mental health visits covered by Medicare are treated like any other Part B mental health service, which means your Medigap plan covers the coinsurance the same way. For people with mobility limitations or those in areas with limited provider access, this is genuinely useful coverage.

Bottom Line

If you’re using or planning to use mental health services regularly, Plan G is the right Medigap plan for most people — it’s that straightforward. Pair it with a Part D plan for your psychiatric medications, make sure your providers are enrolled in Medicare, and your out-of-pocket exposure for ongoing outpatient mental health care is essentially just the $257 annual Part B deductible. Don’t let the misconception that mental health providers don’t take Medicare stop you from getting coverage that could save you thousands of dollars a year.

Frequently Asked Questions

Does Medigap cover therapy sessions?

Yes, if your therapist accepts Medicare assignment. Medicare Part B covers outpatient mental health services at 80% after the 2026 deductible of $257, and most Medigap plans (including Plan G and Plan N) cover the remaining 20% coinsurance. The key is that your provider must accept Medicare — if they’ve formally opted out, neither Medicare nor Medigap will pay.

Does Medicare cover psychiatrists the same way it covers psychologists?

Yes. Medicare covers visits to psychiatrists, psychologists, licensed clinical social workers, and other qualified mental health providers under Part B, all at the same 80/20 split. The provider type doesn’t change how your Medigap coverage applies — what matters is that they’re enrolled in Medicare and the service is medically necessary.

I’m on antidepressants. Will my Medigap plan cover those?

No. Prescription drugs are not covered by Medigap at all. You need a standalone Part D plan for that. Most antidepressants and many psychiatric medications are widely covered on Part D formularies, often in the lower cost tiers. Make sure you’re enrolled in Part D and check that your specific medications are on your plan’s formulary each year during open enrollment.

Can a Medigap insurer reject me because of a mental health history?

During your Medigap open enrollment window (the six months starting when you’re 65 and enrolled in Part B), no — they cannot deny you or charge more based on any health history, including mental health. After that window closes, most states allow medical underwriting, and a history of mental health conditions can affect your eligibility or premiums. This is exactly why timing your Medigap enrollment correctly is so important if you have a mental health history.

Plan F Is Still Available, But You Probably Can’t Get It

Medicare Supplement Plan F didn’t disappear. It’s still being sold in 2026, premiums are still being collected, and hundreds of thousands of people still have it. But since January 1, 2020, it’s been closed to new enrollees who became eligible for Medicare after that date. So if you turned 65 in 2020 or later, Plan F is off the table for you. Full stop.

This confuses a lot of people, and I understand why. You’ll still see Plan F listed on comparison tools. Insurers still advertise it. If you call a broker who isn’t paying attention, they might even try to quote it to you. But if you aged into Medicare after December 31, 2019, no insurer is legally allowed to sell you Plan F.

The reason this rule exists comes down to the MACRA law Congress passed in 2015. Lawmakers decided that covering the Part B deductible entirely (which Plan F does) encouraged overuse of medical services. Whether you agree with that reasoning or not, the law is the law. Anyone who was already Medicare-eligible before 2020 was grandfathered in. Everyone else got Plan G as the new gold standard.

So before we go any further: check your Medicare eligibility date. If you turned 65 before January 1, 2020, keep reading. If you didn’t, skip to the section on Plan G. I won’t waste your time.

What Plan F Actually Covers (And Why It Was So Popular)

Plan F was the most popular Medigap plan in the country for a long time, and that’s not an accident. It covers everything Original Medicare doesn’t. Every gap. Nothing left for you to pay out of pocket, with one exception: your monthly premium.

Here’s exactly what Plan F covers on top of what Medicare Parts A and B pay:

• Part A deductible (2026 amount: $1,676 per benefit period)
• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted
• Part A hospice care coinsurance or copayment
• Part B deductible (2026 amount: $257)
• Part B coinsurance or copayment (the standard 20% Medicare doesn’t cover)
• Part B excess charges
• Skilled nursing facility care coinsurance
• First three pints of blood
• Foreign travel emergency (up to plan limits)

That Part B deductible coverage is the one thing Plan F has that Plan G doesn’t. That’s it. That’s the entire difference. The 2026 Part B deductible is $257. If your Plan F premium is more than $257 per year higher than a comparable Plan G premium, you’re paying more for less. And in most states I’ve looked at, that’s exactly what’s happening.

There’s also a High-Deductible Plan F option. It works differently: you pay all Medicare-covered costs until you hit a deductible ($2,870 in 2026), and then the plan kicks in. The tradeoff is a much lower monthly premium. I’ll come back to this later because it’s actually underused and sometimes the right call.

The Plan F vs. Plan G Math You Need to Do Right Now

If you’re grandfathered into Plan F eligibility and you’re comparing your options, here’s the honest breakdown. Plan G covers everything Plan F covers except the Part B deductible. That deductible is $257 in 2026. So the only question is: how much more are you paying in premiums for Plan F versus Plan G?

I’ve seen Plan F premiums run $30 to $80 per month higher than Plan G for the same age group and region. That’s $360 to $960 per year. For a benefit worth $257. The math doesn’t work in Plan F’s favor for most people who are just starting out with Medigap.

Here’s a side-by-side to make it concrete:

Feature	Plan F	Plan G
Part B Deductible Covered	Yes ($257 in 2026)	No (you pay $257/year)
Part A Deductible Covered	Yes	Yes
Part B Excess Charges Covered	Yes	Yes
Foreign Travel Emergency	Yes	Yes
Typical Monthly Premium (age 65)	$150-$250+	$100-$200
Available to New Enrollees?	No (post-2019 eligibility)	Yes

That said, there’s a scenario where staying on Plan F makes sense: if you already have it, your premiums haven’t climbed dramatically, and you’re healthy. Switching to Plan G typically requires medical underwriting outside of guaranteed issue windows, and if you have health issues, you might not qualify. In that case, staying put beats risking a denial.

The Biggest Mistake I See People Make With Plan F

Here’s the mistake that costs people real money: assuming Plan F is being phased out means their existing coverage is going away, or that they need to switch immediately to stay covered. It doesn’t, and they don’t. If you already have Plan F, your coverage is not being cancelled. You can keep it as long as you keep paying the premiums and your insurer stays in the market.

What IS happening, and what you should actually pay attention to, is the pricing trend. Because new, younger (and typically healthier) people can no longer join Plan F pools, the existing pool of Plan F members gets older every year. Older members use more healthcare. That means claims go up, and premiums follow. This is called adverse selection, and it’s a real problem for Plan F going forward.

If you’ve had Plan F since before 2020 and your premiums have been increasing faster than Plan G rates in your area, that’s a signal worth paying attention to. I’d suggest calling a few insurers for Plan G quotes and comparing the total annual cost. If you’re healthy enough to pass underwriting, switching could save you money. If you’re not, staying on Plan F might still be your best option regardless of the math.

The other mistake I see: people who aged into Medicare before 2020 but never enrolled in Medigap, and now think they missed their chance at Plan F. If you’re in a guaranteed issue situation, like you’re newly losing employer coverage, you can still enroll in Plan F if you were eligible before 2020. Don’t assume that window is closed without checking your specific situation with an insurance agent who knows the rules.

High-Deductible Plan F: The Option Nobody Talks About Enough

High-Deductible Plan F is genuinely worth knowing about if you’re eligible. You get the same coverage as regular Plan F, but you pay a $2,870 deductible in 2026 before the plan starts covering costs. In exchange, your monthly premium can drop to $30 to $70 per month in many states.

Think about who that suits. A 66-year-old in Ohio who’s relatively healthy, rarely goes to the hospital, and wants catastrophic protection without paying $180 a month for regular Plan F premiums. Over a healthy year, they might pay nothing out of pocket beyond their low premium. Over a bad year, they pay up to $2,870 plus their premiums. Either way, they have a ceiling.

Compare that to someone with ongoing health issues who needs regular specialist visits and has a history of hospitalizations. For that person, the full coverage of standard Plan F or Plan G is probably worth the higher premium because they’ll hit that deductible fast and then have nothing else to pay.

High-Deductible Plan G is also available to anyone, and works the same way for post-2020 enrollees. The deductible is identical ($2,870 in 2026). If you’re not Plan F-eligible, High-Deductible Plan G is the equivalent option and worth comparing against standard Plan G before you commit.

Bottom Line

If you became Medicare-eligible after January 1, 2020, Plan F isn’t an option and Plan G is what you want. If you’re already on Plan F and your premiums are reasonable, don’t panic, just watch the pricing trend and run the numbers annually. For most people shopping Medigap today, Plan G gives you nearly identical coverage at a lower price, and that’s the right call for the majority of new enrollees.

Frequently Asked Questions

Can I still buy Medicare Supplement Plan F in 2026?

Only if you were eligible for Medicare before January 1, 2020. That means you turned 65 before that date or qualified for Medicare due to disability before then. If you aged into Medicare in 2020 or later, no insurer can legally sell you Plan F.

Is it worth switching from Plan F to Plan G?

Often yes, but it depends on two things: how much more you’re paying for Plan F versus Plan G in your area, and whether you’re healthy enough to pass underwriting. If the premium gap is more than $257 per year (the 2026 Part B deductible), Plan G saves you money on paper. But if you have health conditions and could be denied coverage, staying on Plan F might be the smarter move.

Will Plan F be cancelled or phased out completely?

No. Existing Plan F policies won’t be cancelled because of the 2020 rule change. You can keep your Plan F as long as you pay your premiums. The issue is that premiums for Plan F tend to increase faster over time because the pool of members is getting older and no new, younger members are joining it.

What’s the difference between Plan F and High-Deductible Plan F?

Both cover the same things, but High-Deductible Plan F requires you to pay the first $2,870 of Medicare-covered costs (in 2026) before your coverage kicks in. The payoff is a much lower monthly premium, sometimes $30 to $70 per month versus $150 or more for standard Plan F. It’s a good fit for people who are healthy and want protection against a major medical event without a large monthly bill.

The Short Answer: No, Medigap Won’t Pay for Your Prescriptions

Medicare Supplement insurance does not cover prescription drug costs. Full stop. If you’re counting on your Medigap plan to help pay for medications at the pharmacy, you’re going to be in for a painful surprise when that first prescription bill arrives.

This trips up a surprising number of people, and I understand why. Medigap covers so much else: hospital stays, doctor visits, skilled nursing facility coinsurance, even emergency care when you’re traveling abroad. It feels like it should cover drugs too. But it doesn’t, and the reason comes down to how Medicare itself is structured.

Original Medicare has four parts. Part A covers hospital care. Part B covers outpatient and doctor services. Part C is Medicare Advantage. Part D covers prescription drugs. Medigap is designed to fill the gaps in Parts A and B only. Part D has always been its own separate beast, and Medigap was never built to touch it.

So if you have a Medigap plan and no Part D coverage, you’re paying for every prescription out of pocket. That’s true whether you’re on Plan G, Plan N, or anything else. The letter of your Medigap plan has nothing to do with drug coverage.

What Actually Covers Your Prescription Drug Costs

To get prescription drug coverage with Original Medicare, you need to enroll in a standalone Part D plan. These are sold by private insurance companies, and they work alongside your Original Medicare and your Medigap plan. You pay a monthly premium for the Part D plan separately from your Medigap premium.

Part D premiums vary a lot depending on which plan you choose, which state you live in, and which drugs you take. A basic Part D plan might run $15 to $25 per month in some markets. More comprehensive plans covering brand-name drugs with lower copays can be $50 to $80 per month or more. In 2026, the Medicare Part D out-of-pocket cap is $2,000 for the year, which is a significant improvement from just a few years ago.

Here’s where people often get confused: if you go with a Medicare Advantage plan instead of Original Medicare plus Medigap, your drug coverage is usually bundled in. Most Medicare Advantage plans include Part D drug coverage as part of the package. But if you’re on Original Medicare with Medigap, drug coverage is always a separate decision and a separate enrollment.

The enrollment timing matters too. When you first become eligible for Medicare, you have a window to sign up for Part D without a penalty. If you skip it and don’t have other creditable drug coverage (like from an employer), you’ll pay a late enrollment penalty that gets added to your premium permanently. I’ve talked to people who skipped Part D enrollment because they didn’t take many medications at the time and thought they’d sign up later. That decision cost them money every single month going forward.

How Medigap and Part D Work Together

Once you understand that Medigap covers the gaps in Parts A and B while Part D covers drugs, the whole system actually makes more sense. Think of them as two separate layers of protection that you stack on top of Original Medicare.

Here’s how those layers interact for someone like a 67-year-old in Ohio who has Plan G and a standalone Part D plan:

• She sees her doctor: Medicare Part B pays 80%, Plan G pays the remaining 20%
• She gets hospitalized: Part A covers the bulk of it, Plan G covers the Part A deductible (which is $1,676 per benefit period in 2026)
• She picks up a prescription: Part D handles it, with copays and coverage levels defined by her specific Part D plan

Plan G doesn’t interact with Part D at all. They don’t share deductibles. They don’t coordinate on drug claims. They’re completely separate systems administered by separate policies, often through completely different insurance companies.

That said, having strong Medigap coverage frees up money that might otherwise go to unexpected medical bills, which can make it easier to also budget for a solid Part D plan. People who have good Medigap coverage tend to have more financial predictability overall, which is the whole point.

The Mistake I See People Make All the Time

Here’s one that genuinely frustrates me because it’s so preventable. People who are healthy when they retire decide to skip Part D enrollment because they only take one or two generic medications that are cheap at Costco or Walmart. They figure they’ll add drug coverage later if they need it.

This logic sounds reasonable. It isn’t.

The late enrollment penalty for Part D is 1% of the national base premium for every month you go without creditable coverage after your initial enrollment window. That penalty never goes away. It’s added to your Part D premium for as long as you have Medicare. If you wait three years before enrolling, you’re paying a 36% penalty on top of your premium for the rest of your life.

More importantly, health changes fast after 65. The person who was on two cheap generics at 67 might be on several expensive brand-name medications by 70 after a cardiac event or a new diagnosis. By then, not only are the drugs more expensive, but the Part D penalty is making the premium higher too. It’s a double hit.

My strong advice: enroll in at least a basic, low-cost Part D plan during your initial enrollment window even if you barely use it right now. Pay $20 a month to protect yourself from the penalty. It’s worth it.

There’s a second misconception worth addressing here. Some people hear that Medigap plans used to cover drugs and assume that’s still an option. Prior to 2006, some Medigap plans did include drug coverage, specifically old Plans H, I, and J. Those plans have not been sold since 2006. If you’ve read something online suggesting certain Medigap plans cover prescriptions, that information is outdated. None of the currently available Medigap plans (A, B, D, G, K, L, M, N) include any drug coverage.

Comparing Your Coverage Options Side by Side

It helps to see all of this laid out clearly. Here’s how the main Medicare coverage approaches handle prescription drugs:

Coverage Setup	Covers Prescriptions?	How Drugs Are Covered	Best For
Original Medicare alone	No	No drug coverage at all	Nobody — this is a gap most people can’t afford
Medigap (any plan) alone	No	No drug coverage at all	Incomplete setup — you still need Part D
Medigap + standalone Part D	Yes	Separate Part D plan handles all drug costs	People who want predictable costs and free provider choice
Medicare Advantage (most plans)	Yes	Drug coverage bundled into the plan	People who want lower premiums and don’t mind network restrictions
Original Medicare + Part D only (no Medigap)	Yes	Part D covers drugs, but no help with Part A/B gaps	Very healthy people willing to take on more financial risk

The Medigap plus Part D combination is the one I’d steer most people toward, particularly if they value being able to see any doctor who accepts Medicare without referrals or prior authorizations. Yes, you’re paying two separate premiums. But you’re also getting real protection on both sides of the equation.

Bottom Line

Medicare Supplement plans don’t cover prescription drugs, and no amount of searching for the “right” Medigap plan is going to change that. If you’re on Original Medicare with Medigap, you need a standalone Part D plan, and you should enroll during your initial eligibility window even if your drug costs are low right now. For most people, the combination of Plan G and a solid Part D plan is the strongest setup available, giving you predictable costs, broad access to doctors, and real protection against both medical and drug expenses.

Frequently Asked Questions

Can I add drug coverage to my existing Medigap plan?

No. Medigap plans don’t have an option to add prescription drug coverage. They’re structured to cover gaps in Medicare Parts A and B only. To get drug coverage, you need to enroll in a separate standalone Part D plan. The two policies are entirely separate products, usually sold by different companies, and they don’t interact with each other when it comes to drug claims.

What if I don’t take any prescription drugs right now? Do I still need Part D?

Yes, you should still enroll in a low-cost Part D plan. Skipping it leaves you vulnerable to the late enrollment penalty, which is permanent. A basic plan might only cost $15 to $25 per month, which is a small price to protect yourself from a penalty that compounds for every month you wait. Health conditions can change quickly, and the penalty will make coverage more expensive precisely when you need it most.

Does any part of Medicare cover prescription drugs without a separate plan?

Medicare Part B does cover a narrow category of drugs, specifically medications that are administered in a doctor’s office or outpatient setting, like chemotherapy infusions, certain injections, and some immunosuppressive drugs. But the drugs you pick up at a pharmacy counter are covered only through Part D. Most people’s prescriptions fall into the Part D category, not Part B.

If I switch from Medicare Advantage back to Original Medicare and Medigap, what happens to my drug coverage?

When you disenroll from Medicare Advantage, you lose the drug coverage that was bundled into that plan. You’ll need to enroll in a standalone Part D plan separately. The good news is that leaving Medicare Advantage gives you a Special Enrollment Period to sign up for Part D, so you won’t face a coverage gap as long as you act promptly during that window. Don’t wait on this one.

Plan A and Plan B Are the Most Basic Medigap Options — and That’s Not a Compliment

Most people assume Plan A is the best Medigap plan because it’s first in the alphabet. It’s not. Plan A is actually the most stripped-down Medigap option available, and Plan B isn’t much better. I’m not saying they’re useless — I’m saying you need to understand exactly what you’re getting before you sign up for either one, because a lot of people don’t.

Here’s the thing: the letters in Medigap don’t rank by quality. They just label standardized benefit packages set by the federal government. Every insurance company selling Plan A has to offer the exact same benefits as every other company selling Plan A. So when you’re comparing Plan A vs Plan B, you’re really comparing two specific sets of coverage — not two tiers of quality.

Let’s get into what each one actually covers, where they differ, and whether either of them makes sense for someone buying Medigap in 2026.

What Plan A Covers (and What It Leaves Out)

Plan A is the floor. It covers the absolute minimum that any Medigap plan is required to cover by federal law. That includes:

• Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted
• Medicare Part B coinsurance or copayments (typically 20% of outpatient costs after the deductible)
• The first three pints of blood each year
• Part A hospice care coinsurance or copayments

That’s it. What’s notably not covered under Plan A: the Part A hospital deductible, the Part B deductible, skilled nursing facility coinsurance, or foreign travel emergency care. The 2026 Part A deductible is $1,676 per benefit period. That’s per benefit period, not per year — meaning if you’re hospitalized twice in one year and they’re counted as separate benefit periods, you could owe that deductible twice. Plan A doesn’t touch any of that.

So if you have Plan A and you end up in the hospital for five days, you’re paying $1,676 out of pocket before Plan A picks up anything hospital-related. That’s a real exposure most people aren’t expecting.

What Plan B Adds Over Plan A

Plan B covers everything Plan A covers, plus one thing: the Part A inpatient hospital deductible. That’s the $1,676-per-benefit-period deductible mentioned above. That single addition is the only difference between Plan A and Plan B.

Here’s a side-by-side look:

Benefit	Plan A	Plan B
Part A coinsurance and hospital costs (up to 365 additional days)	Yes	Yes
Part B coinsurance or copayments	Yes	Yes
Blood (first 3 pints)	Yes	Yes
Part A hospice care coinsurance	Yes	Yes
Part A inpatient hospital deductible ($1,676 in 2026)	No	Yes
Skilled nursing facility coinsurance	No	No
Part B deductible ($257 in 2026)	No	No
Part B excess charges	No	No
Foreign travel emergency (up to plan limits)	No	No

Plan B’s one improvement is genuinely meaningful. The Part A deductible is the most commonly triggered big-ticket exposure for Medicare beneficiaries. A short hospitalization — even just two nights — triggers that full $1,676. If you’re hospitalized more than once in a year, Plan B protects you each time.

That said, both plans leave a lot of gaps open. Skilled nursing facility coinsurance, which runs $209.50 per day for days 21 through 100 in 2026, isn’t covered by either. Neither is foreign travel emergency coverage, which matters more than people realize once they actually retire and start traveling.

The Mistake People Make When They Pick Plan A or Plan B

I’ve seen this happen too many times. Someone turns 65, gets a mailer from an insurance company showing a low premium for Plan A or Plan B, and thinks they’ve found a deal. They haven’t. They’ve bought the cheapest version of a product that already isn’t very expensive to begin with, at the cost of leaving themselves exposed to thousands of dollars in potential out-of-pocket costs.

The misconception is that a lower premium means you’re saving money. For Medigap, that’s often backwards. A plan with a lower premium but worse coverage can cost you far more in a year where you actually use healthcare. A 68-year-old in Ohio paying $85/month for Plan A looks like she’s saving money compared to someone paying $145/month for Plan G. But if she has one hospital stay, she’s immediately out $1,676 that Plan G would have covered. Her “savings” evaporate in a single billing cycle.

The other mistake: people confuse Medicare Supplement Plan A with Medicare Part A. They’re completely different things. Medicare Part A is the original hospital coverage you get through Medicare. Medicare Supplement Plan A is a private insurance product that fills gaps in your Medicare coverage. I know it sounds obvious when you lay it out like that, but the confusion is real and I’ve seen it derail entire purchasing decisions.

Who Should Actually Consider Plan A or Plan B in 2026

I want to be straight with you: most people shopping for Medigap in 2026 should not be stopping at Plan A or Plan B. Plans G and N offer dramatically better coverage, and the premium difference is often smaller than people expect. Plan G, which covers almost everything except the 2026 Part B deductible of $257, typically runs $100 to $200 per month at age 65 depending on your state, insurer, and health status during open enrollment.

That said, there are situations where Plan A or Plan B might make sense:

• You’re on a very tight fixed income and need to minimize monthly premium costs above all else
• You’re in excellent health and are willing to take on more financial risk in exchange for lower premiums
• You have other assets that could absorb a large unexpected medical bill without devastating your finances
• You live in a state like Massachusetts, Minnesota, or Wisconsin, which have their own standardized Medigap systems and these plan labels may not apply the same way

Between Plan A and Plan B specifically, I don’t see a strong argument for Plan A at all. Plan B adds the hospital deductible protection, and the premium difference between the two is usually modest. A 65-year-old in Texas might pay $10 to $20 more per month for Plan B than Plan A. Given that the Part A deductible alone is $1,676, you’d only need to trigger it once every seven to fourteen years to break even on that premium difference. Most people will exceed that easily.

Bottom Line

If you’re choosing between Plan A and Plan B, pick Plan B without much hesitation. The single benefit it adds over Plan A — covering the Part A hospital deductible — is worth more than its premium difference in almost every realistic scenario. But honestly, most people shopping for Medigap should be looking at Plan G or Plan N first, not stopping at Plan A or Plan B. These are entry-level plans, and if you can afford even slightly higher premiums, you’ll almost certainly be better protected by stepping up.

Frequently Asked Questions

Is Medicare Supplement Plan A the same as Medicare Part A?

No, and this mix-up is more common than you’d think. Medicare Part A is the hospital insurance component of original Medicare that you receive through the federal government. Medicare Supplement Plan A is a private insurance policy you buy to help cover what original Medicare doesn’t pay. They share a letter, but they’re completely different programs.

Why would anyone buy Plan A instead of Plan B?

Mainly the lower monthly premium. Plan A will generally cost a bit less per month than Plan B because it covers less. For someone with a very tight budget where every dollar matters, that can be the deciding factor. But if you have any flexibility at all, the extra coverage from Plan B is almost always worth it.

Can I switch from Plan A to Plan G later if I want better coverage?

You can try, but there’s no guarantee you’ll qualify. Outside of your initial Medigap open enrollment period (which starts when you’re 65 and enrolled in Part B), insurers in most states can require medical underwriting. That means they can deny you or charge you more based on your health history. If you have a serious diagnosis after you enroll in Plan A, switching to a better plan could be difficult or impossible.

Do Plan A and Plan B premiums vary by insurance company?

Yes, significantly. The benefits are standardized by federal law, so every Plan A has the same coverage no matter who sells it. But the premiums are set by each insurer individually. A 65-year-old woman in Florida could see Plan B premiums ranging from roughly $80 to $160 per month depending on the insurer. This is why it pays to compare quotes from multiple companies, not just go with the first mailer you receive.

What Plan K and Plan L Actually Are (And Why Most People Skip Them)

Plan K and Plan L exist because Congress wanted to give Medicare beneficiaries a lower-premium Medigap option that still provides some cost-sharing protection. Sounds good in theory. In practice, these two plans are the most misunderstood options in the entire Medigap lineup, and the people who buy them often end up wishing they hadn’t.

That’s not me being dramatic. I’ve seen people choose Plan K or Plan L because the monthly premium looked attractive, then get surprised by a $1,000+ bill after a hospital stay. So before you make that same call, let me give you the full picture.

Plan K and Plan L are what’s called “cost-sharing” Medigap plans. Unlike Plan G, which covers almost everything Medicare doesn’t pay, Plan K and Plan L only cover a portion of your cost-sharing gaps. The trade-off is a lower monthly premium. But there’s a ceiling on your annual out-of-pocket costs, which is the piece that actually makes these plans worth considering for a narrow group of people.

Here’s how the basic structure works. Plan K covers 50% of most cost-sharing gaps. Plan L covers 75%. Both plans have an annual out-of-pocket maximum, after which they pay 100% of covered costs for the rest of the calendar year. In 2026, that out-of-pocket maximum is $7,220 for Plan K and $3,610 for Plan L.

What Plan K and Plan L Cover (And What They Don’t)

Let’s get specific, because the vague descriptions you’ll find on most insurance sites don’t actually help you make a decision.

Neither Plan K nor Plan L covers the 2026 Part B deductible, which is $257. That’s already a difference from Plan G. Neither plan covers Part B excess charges, which is what happens when a doctor doesn’t accept Medicare assignment and bills above the Medicare-approved rate. And neither plan covers foreign travel emergency care.

What they do cover, partially, is most of the other standard Medicare gaps. Here’s a side-by-side breakdown:

Benefit	Plan K	Plan L	Plan G (for comparison)
Part A hospital coinsurance and costs up to 365 days after Medicare benefits are used	100%	100%	100%
Part A deductible ($1,676 in 2026)	50%	75%	100%
Part A hospice care coinsurance or copayment	50%	75%	100%
Skilled nursing facility care coinsurance	50%	75%	100%
Part B coinsurance or copayment	50%	75%	100%
Part B deductible ($257 in 2026)	Not covered	Not covered	Not covered
Part B excess charges	Not covered	Not covered	100%
Foreign travel emergency (up to plan limits)	Not covered	Not covered	80%
Annual out-of-pocket maximum (2026)	$7,220	$3,610	None (virtually unlimited protection)

One thing worth highlighting: Plan K and Plan L both cover 100% of Part A hospital coinsurance costs up to 365 days beyond Medicare’s coverage period. That one matters more than people think. A long inpatient stay is exactly the kind of catastrophic event that can wipe out someone’s savings, and both plans protect you there.

That said, the 50% and 75% coverage on the Part A deductible is real money. The 2026 Part A deductible is $1,676 per benefit period, not per year. If you’re hospitalized twice in a calendar year and it counts as two benefit periods, you owe that deductible twice. With Plan K, you’d be responsible for $838 each time. With Plan G, you’d owe nothing.

The Out-of-Pocket Maximum: The One Reason to Consider These Plans

The out-of-pocket maximum is the thing that saves Plan K and Plan L from being totally irrelevant. Once you’ve paid $7,220 (Plan K) or $3,610 (Plan L) in covered out-of-pocket costs during the calendar year, the plan pays 100% for the rest of the year.

Here’s the thing: Plan G doesn’t have an out-of-pocket maximum. It’s structured so that it covers almost everything, so you rarely need one. But if something catastrophic happens and you’re on Plan G, your only real exposure is the $257 Part B deductible and any Part B excess charges from non-participating providers.

With Plan K, your worst-case scenario in a given year is $7,220 in covered costs plus your monthly premiums. That’s not nothing. For a healthy 65-year-old who’s comparing Plan K premiums to Plan G premiums, you’d need to run the actual numbers for your state and age.

In most states, Plan G premiums for a 65-year-old run $100 to $200 per month. Plan K premiums for the same person often run $60 to $100 per month. The annual premium savings might be $700 to $1,200 depending on your situation. If you’re healthy and rarely use healthcare, that premium gap might feel worthwhile. But if you have one moderate hospital stay, you could quickly eat through those savings and more.

For a 72-year-old in Ohio who’s managing a chronic condition and expects regular specialist visits, Plan K almost certainly isn’t the right call. The math usually doesn’t favor it once you account for realistic healthcare use at that age.

The Biggest Mistake People Make With Plan K and Plan L

I’ve seen this mistake more times than I can count. Someone sees the lower monthly premium, signs up for Plan K or Plan L, and assumes the out-of-pocket maximum works the same way it does in the Affordable Care Act marketplace. It does not.

The out-of-pocket maximum in Plan K and Plan L only applies to covered benefits under those plans. It doesn’t cap your total Medicare spending. So if you see a doctor who charges excess fees above the Medicare-approved rate, those charges don’t count toward your out-of-pocket limit because Plan K and Plan L don’t cover excess charges at all. You’re just responsible for them, period.

Same thing with the Part B deductible. That $257 doesn’t count toward your out-of-pocket limit because the plan doesn’t cover it. You pay it out of pocket, and it’s not tracked against your cap.

People also get tripped up by the “per benefit period” structure of Part A. The out-of-pocket maximum resets every January 1. But the Part A deductible is per benefit period, which doesn’t follow the calendar year. If you’re hospitalized in November and then again in January, those are potentially two separate benefit periods, meaning two separate Part A deductibles. Plan K covers 50% of each one, but you’re still on the hook for the other 50% twice.

That’s not how most people are picturing it when they sign up. They think they’ve got a clean $7,220 annual limit on everything. They don’t.

Who Plan K and Plan L Actually Make Sense For

I want to be straight with you: Plan K and Plan L are right for a small group of people, and wrong for most.

They might make sense if you’re in your mid-to-late 60s, genuinely healthy with no chronic conditions, and you’re trying to minimize monthly costs right now while still having a catastrophic backstop. If your alternative is going without any Medigap coverage at all because premiums feel too high, Plan K is better than nothing. The out-of-pocket max does protect you from a truly catastrophic situation.

They might also make sense if you have significant savings and you want to self-insure the smaller costs while protecting against the big stuff. A 67-year-old in Ohio with $300,000 in savings and no ongoing health issues might rationally choose Plan K, pocket the premium difference, and accept the risk of a few hundred dollars in cost-sharing per year.

But if you’re managing heart disease, diabetes, COPD, or any condition that means regular specialist visits, labs, or potential hospitalizations? Plan K and Plan L will likely cost you more in total than Plan G would have, even accounting for the lower premiums. That’s not a guess. That’s what the math shows when you run realistic scenarios.

Plan L is the easier sell of the two because the out-of-pocket maximum is half of Plan K’s limit. If you’re going to choose one of these, Plan L gives you meaningfully more protection for what’s usually a modest premium increase over Plan K.

Bottom Line

For most people turning 65, Plan G is the better choice. It covers nearly everything, it’s widely available, and the peace of mind it provides is worth the higher premium for the vast majority of situations. Plan K and Plan L are built for a specific type of buyer: relatively healthy, cost-conscious, with savings to absorb moderate healthcare costs. If that’s not you, don’t let a lower monthly number talk you into a plan that leaves you exposed when you actually need it.

Frequently Asked Questions

Does the Plan K or Plan L out-of-pocket maximum reset every year?

Yes, both maximums reset on January 1 each calendar year. In 2026, Plan K’s limit is $7,220 and Plan L’s is $3,610. These amounts are set by the federal government and can change from year to year, so check the current figures when you’re comparing plans.

Can I switch from Plan K or Plan L to Plan G later?

Technically yes, but you may not be able to do it without medical underwriting. Outside of your initial enrollment period, most states allow insurers to ask health questions and potentially deny coverage or charge higher premiums based on your health history. A few states like New York and California have guaranteed issue protections year-round, but most don’t. Don’t assume you can upgrade easily later.

Why don’t Plan K and Plan L cover the Part B deductible?

Federal law actually prohibits any Medigap plan sold to new Medicare enrollees after January 1, 2020 from covering the Part B deductible. That’s why Plan C and Plan F are no longer available to people new to Medicare. Plan K and Plan L predate that rule, but they were never designed to cover the Part B deductible anyway. It’s a deliberate design choice to keep premiums lower and put some skin in the game on Part B costs.

Is Plan L worth the extra premium over Plan K?

In most cases, yes. The jump from 50% coverage to 75% coverage is meaningful, especially on the Part A deductible and skilled nursing facility coinsurance. And Plan L’s out-of-pocket maximum of $3,610 in 2026 is substantially less exposure than Plan K’s $7,220. The premium difference between the two is usually smaller than the protection difference, which makes Plan L the smarter pick if you’re committed to this category of plans.

The One Thing Standing Between You and Near-Zero Medical Bills

The 2025 Medicare Part B deductible is $257, and that’s essentially the only thing Plan G doesn’t cover. Pay that once at the start of the year, and you’re done. After that, Plan G picks up virtually everything Medicare approves for the rest of the year. No copays. No coinsurance. No hospital bills showing up weeks later.

That’s the short version. But there’s more to it than that, and I’ve watched people make expensive mistakes because they didn’t understand the full picture before they enrolled. So let’s go through this carefully.

What the Plan G Deductible Actually Covers (and What It Doesn’t)

When people say “the Plan G deductible,” they almost always mean the Part B deductible. In 2025, that’s $257. You pay it once per calendar year, typically on your first outpatient service or doctor visit of the year. After you’ve paid it, Plan G covers 100% of the Medicare-approved amount for Part B services for the rest of the year.

But here’s what a lot of people miss: there’s also a Part A deductible, and Plan G covers that one in full. The 2025 Part A deductible is $1,676 per benefit period. That’s what you’d owe if you were hospitalized. Plan G pays that entire amount so you pay nothing.

Think about what that means in real terms. A 70-year-old in Florida who has hip replacement surgery could be looking at a $1,676 hospital deductible just to walk in the door. Plan G wipes that out. Then after she pays her $257 Part B deductible for outpatient follow-up visits, Plan G covers the rest of that too.

Here’s a side-by-side look at what Plan G covers compared to Original Medicare alone:

Cost Type	Original Medicare Only (2025)	With Plan G (2025)
Part A hospital deductible (per benefit period)	$1,676 you owe	$0 (Plan G pays it)
Part B annual deductible	$257 you owe	$257 you owe
Part B coinsurance (20% after deductible)	You pay 20% of all approved costs	$0 (Plan G pays it)
Part A coinsurance (days 61-90 in hospital)	$419/day you owe	$0 (Plan G pays it)
Skilled nursing facility coinsurance (days 21-100)	$209.50/day you owe	$0 (Plan G pays it)
Foreign travel emergency (80% after $250 deductible)	Not covered	Covered up to plan limits

So when someone says Plan G has a deductible, they mean one $257 payment per year. Everything above? Gone.

Plan G vs. Plan N vs. High-Deductible Plan G: Which One Actually Makes Sense

There are actually three versions of Plan G floating around, and this is where I see people get confused.

Standard Plan G is what most people mean when they say “Plan G.” You pay the $257 Part B deductible, Plan G covers the rest. Premiums for a 65-year-old are typically $100 to $200 per month depending on your state and the insurer. Someone in Ohio might pay $130/month. Someone in New York could pay closer to $190.

High-Deductible Plan G is a separate version with a much higher deductible before Plan G kicks in at all. In 2025, that deductible is $2,870. The upside is that premiums are much lower, often $40 to $70 per month. The idea is that you’re self-insuring for routine costs and only need the coverage if something serious happens.

Plan N is the third option worth mentioning here. Plan N covers the Part A deductible just like Plan G, but it doesn’t cover the Part B deductible or small copays ($20 for office visits, $50 for ER visits that don’t result in admission). Premiums are usually lower than standard Plan G, sometimes by $20-$40 per month.

Which one is right for you? Here’s my honest take:

• If you’re in good health, relatively young (65-68), and comfortable holding some financial risk, High-Deductible Plan G is worth a serious look. The math can work in your favor for years before a major claim.
• If you see doctors regularly or have a chronic condition, Standard Plan G gives you the cleanest, most predictable coverage. You pay $257 once and you’re done for the year.
• If you’re cost-conscious but still want solid hospital protection and you don’t mind small copays, Plan N is a reasonable middle ground.

The Mistake I See People Make All the Time

People confuse Plan G with Plan F and assume Plan G covers the Part B deductible. It doesn’t. Plan F did cover it, which is why Plan F used to be the gold standard. But Plan F was closed to new enrollees after January 1, 2020. Anyone who turned 65 after that date can’t enroll in Plan F at all.

I’ve seen people receive marketing materials from insurers describing their new plan as covering “all Medicare-approved costs,” and they assume that means zero out-of-pocket. Then they get a bill for $257 in January after their first doctor visit and they’re furious. The coverage is accurate. The assumption was wrong.

The $257 Part B deductible is intentional. When Congress eliminated Plan F for new enrollees, the stated reasoning was that first-dollar coverage removes any incentive to think about whether a service is necessary. That’s a policy argument you can agree or disagree with, but it’s why the rule exists. Plan G is the best coverage currently available to new Medicare enrollees, but it was designed to have that one small gap.

The other mistake? People focus obsessively on the $257 and ignore the much bigger exposure it prevents. A single hospitalization with a skilled nursing facility stay could cost you $15,000 or more with Original Medicare alone. Plan G covers nearly all of it after that $257 deductible. Getting fixated on the small number while ignoring the large ones is backwards thinking.

How to Think About Plan G Premiums vs. Your Deductible

Let me give you a real example. A 67-year-old in Ohio finds a Plan G policy for $145 per month. That’s $1,740 per year in premiums. Add the $257 Part B deductible and your maximum predictable annual cost is $1,997, assuming no major hospitalization.

Now compare that to Original Medicare alone. If you have three specialist visits, a few lab tests, one imaging scan, and one short hospitalization in a year, you could easily hit $5,000 to $8,000 out of pocket depending on the services. Plan G turns that unpredictable exposure into a known, fixed number.

That predictability is what you’re buying. For people on fixed incomes, not just the coverage itself but the ability to budget for healthcare costs with confidence, that has real value that doesn’t show up in a simple premium-vs-deductible comparison.

That said, if you’re genuinely healthy, see a doctor once a year for a wellness visit, and have a solid emergency fund, High-Deductible Plan G might save you $800 to $1,200 per year in premiums. Over five healthy years, that’s real money. The risk is that year six brings a cancer diagnosis or a fall, and then you’d rather have had standard Plan G all along.

There’s no objectively correct answer, but I’ll tell you this: most people sleep better with standard Plan G, and the premium difference usually isn’t large enough to justify the anxiety of the high-deductible version unless you’re genuinely financially comfortable absorbing a $2,870 hit.

Bottom Line

For most people turning 65 today, Medicare Supplement Plan G is the best coverage available, and the 2025 Part B deductible of $257 is a small price for what you get in return. If you’re in average or below-average health, have chronic conditions, or simply want to know exactly what you’ll spend on healthcare each year, standard Plan G is the right call. High-Deductible Plan G deserves a look if you’re healthy and cost-sensitive, but don’t let the lower premium fool you into thinking it’s always the smarter move.

Frequently Asked Questions

Does Plan G cover the Part B deductible in 2025?

No. The 2025 Part B deductible is $257, and you pay that yourself. After you’ve met it, Plan G covers 100% of Medicare-approved Part B costs for the rest of the year. This is the main difference between Plan G and the now-discontinued Plan F.

What is the High-Deductible Plan G deductible for 2025?

The 2025 High-Deductible Plan G deductible is $2,870. You pay all Medicare-approved costs up to that amount before the plan pays anything. In exchange, premiums are significantly lower, typically $40 to $70 per month compared to $100 to $200 for standard Plan G.

Does Plan G cover the Part A hospital deductible?

Yes, completely. The 2025 Part A deductible is $1,676 per benefit period. With standard Plan G, you pay nothing toward it. This is one of the most underappreciated benefits of Plan G, since a single hospitalization can trigger that full deductible.

Can I still enroll in Plan G if I missed my initial enrollment window?

You can apply, but you may face medical underwriting outside of your Medigap Open Enrollment Period (the six months starting when you’re both 65 and enrolled in Part B). That means an insurer can charge you more or deny coverage based on your health history in most states. If you’re in that window, don’t delay. Guaranteed issue rights are too valuable to let expire.

Plan G Is as Close to Full Coverage as You Can Get in 2026

Medicare Supplement Plan G covers nearly every out-of-pocket cost Original Medicare leaves you with — except one. That one exception is the 2026 Part B deductible, which sits at $257. That’s it. That’s the only thing Plan G won’t pay.

Everything else? Covered. Hospital coinsurance, skilled nursing coinsurance, foreign travel emergencies, excess charges from doctors who don’t accept Medicare assignment — Plan G handles all of it. For most people turning 65 right now, this is the strongest Medigap plan available, and I’d argue it’s the right choice for the majority of people who want predictable healthcare costs.

Let me walk you through exactly what’s included, what the real costs look like, and where I’ve seen people trip up when they’re evaluating Plan G versus other options.

The Specific Benefits Plan G Covers

Here’s what Plan G actually pays for, broken down clearly:

• Part A hospital coinsurance and costs: After your Medicare benefits are exhausted, Plan G covers an additional 365 days of hospital care. The 2026 Part A deductible is $1,676 per benefit period — Plan G covers that too.
• Part A hospice care coinsurance or copayments: Small cost-sharing amounts for hospice services are fully covered.
• Skilled nursing facility coinsurance: Days 21 through 100 of a skilled nursing stay cost $209.50 per day in 2026 under Original Medicare. Plan G covers every dollar of that.
• Part B coinsurance or copayments: After you pay your Part B deductible once per year, Plan G picks up the 20% that Medicare doesn’t pay. Every doctor visit, outpatient procedure, lab test, durable medical equipment — that 20% is gone.
• Part B excess charges: Some doctors charge up to 15% above Medicare’s approved amount. Plan G covers that extra charge. This matters more than people realize if you live somewhere with lots of non-participating providers.
• Blood (first 3 pints): Medicare doesn’t cover the first three pints of blood you need. Plan G does.
• Foreign travel emergency care: Up to 80% of emergency care costs when traveling outside the U.S., after a $250 deductible, up to a $50,000 lifetime limit. This is actually a meaningful benefit if you travel internationally.

The only gap — and I want to be clear that it is genuinely just one gap — is that $257 Part B deductible. You pay that once per calendar year, and after that, Plan G handles the rest.

How Plan G Compares to the Other Popular Medigap Plans

Most people shopping for Medigap are weighing Plan G against Plan N and, if they’re older, possibly still looking at Plan F. Here’s an honest comparison:

Benefit	Plan F	Plan G	Plan N
Part A deductible ($1,676 in 2026)	Covered	Covered	Covered
Part B deductible ($257 in 2026)	Covered	Not covered	Not covered
Part B coinsurance	Covered	Covered	Copays up to $20 per visit
Part B excess charges	Covered	Covered	Not covered
Skilled nursing coinsurance	Covered	Covered	Covered
Foreign travel emergency	Covered	Covered	Covered
Who can buy it?	Pre-2020 enrollees only	Anyone eligible for Medicare	Anyone eligible for Medicare

Plan F is off the table for anyone who became Medicare-eligible on or after January 1, 2020. So if you’re newly enrolling in Medicare, the real decision is G versus N.

Plan N costs less per month, but it comes with those $20 copays per office visit, potential $50 emergency room copays, and no excess charge protection. For someone who sees multiple specialists or lives in a state where lots of providers don’t accept Medicare assignment — think New York, for example — those costs add up fast. For a healthy 65-year-old with two or three doctor visits a year, Plan N might still make sense. But Plan G is simpler, and simplicity has real value when you’re managing your health at 70 or 75.

What Plan G Actually Costs, and How to Think About the Value

Plan G premiums for a 65-year-old typically run between $100 and $200 per month in 2026, depending on where you live, which insurance company you choose, and whether you go with standard or high-deductible Plan G. A 67-year-old in Ohio might pay around $130 to $155 per month. That same person in Florida might pay $155 to $185. State regulations, competition between insurers, and how the plan is priced (attained-age, issue-age, or community-rated) all affect your long-term cost.

Here’s how I think about the value: Plan G’s worst-case annual out-of-pocket exposure in 2026 is $257 — the Part B deductible. That’s it. After that, you owe nothing more. No coinsurance on a $40,000 hospital stay. No surprise bills from a surgeon who charges above Medicare rates. For someone who ends up needing surgery, a hospitalization, or extended skilled nursing care, Plan G pays for itself many times over.

Even in a healthy year with minimal healthcare use, you’re buying certainty. And I’ll tell you from watching people deal with unexpected diagnoses in their late 60s and 70s: the certainty is worth something. A cancer diagnosis, a hip replacement, a cardiac event — these things happen, and when they do, having $0 in coinsurance is a big deal.

High-deductible Plan G is worth mentioning for people who are genuinely healthy and want lower monthly premiums in exchange for a higher deductible. In 2026, that deductible is $2,870. Once you hit that, the plan kicks in with full Plan G benefits. Some people like this structure. Personally, I think it works best for people with significant savings and low healthcare utilization, not for someone who’s managing chronic conditions.

The Mistake I See People Make Most Often with Plan G

The most common misconception I run into is people thinking that Plan G covers prescription drugs. It does not. Not even close. Medigap plans — every single one of them — do not cover prescription drugs.

If you’re enrolling in Plan G, you still need a separate Part D prescription drug plan. This trips people up constantly. They assume that paying $150 a month for a Medigap plan means their medications are handled. They’re not. You need to enroll in a standalone Part D plan during your Initial Enrollment Period, or you’ll face a late enrollment penalty when you eventually sign up — a penalty that follows you permanently.

The second mistake is thinking that Plan G covers dental, vision, or hearing. It doesn’t. Original Medicare doesn’t cover most of those services either, and Medigap doesn’t fill that gap. You need separate coverage or a dental discount plan if those things matter to you.

A third error I’ve seen, particularly with people coming off employer coverage: assuming you can switch to Plan G anytime without underwriting. You can’t, in most states. Outside of your Open Enrollment Period (the six months starting the month you turn 65 and are enrolled in Part B), insurers can ask health questions and deny you or charge more based on pre-existing conditions. If you’re in your window right now, take it seriously. I’ve talked to too many people who waited and then couldn’t get Plan G because of a health condition they developed in the meantime.

Bottom Line

For most people enrolling in Medicare in 2026, Plan G is the right Medigap choice. It leaves you with one small annual cost — the $257 Part B deductible — and covers everything else. The monthly premium is manageable, the peace of mind is real, and the long-term protection against major medical costs is hard to beat. If you’re in good health and want to save money monthly, Plan N is worth a serious look, but for anyone who values simplicity and full protection, Plan G wins.

Frequently Asked Questions

Does Plan G cover the Medicare Part B deductible?

No. The 2026 Part B deductible is $257, and Plan G does not cover it. You pay that once per calendar year, and after that, Plan G covers your Part B coinsurance in full. This is the only meaningful difference between Plan G and the now-unavailable Plan F.

Can I use Plan G with any doctor?

Yes, as long as the doctor accepts Medicare. Plan G works with any provider nationwide who takes Original Medicare. You don’t need referrals, there are no networks, and you don’t need prior authorization. That’s one of the biggest advantages Medigap has over Medicare Advantage plans.

What happens if I travel outside the U.S.?

Plan G includes foreign travel emergency coverage. It pays 80% of emergency care costs outside the United States after a $250 deductible, up to a $50,000 lifetime maximum. It’s not unlimited, but it’s genuinely useful if you travel internationally and something goes seriously wrong.

When’s the best time to buy Plan G?

During your Medigap Open Enrollment Period, which starts the month you turn 65 and are enrolled in Medicare Part B. During this six-month window, insurers cannot deny you coverage or charge you more based on your health. Miss that window, and in most states, you’ll face medical underwriting. Buy it during your window, even if you feel perfectly healthy.