Category: Plans

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.

Plan G Is the Most Complete Medicare Supplement You Can Buy Today

If you want a Medicare supplement plan that covers the most, the answer is Plan G. Full stop. It pays almost everything Original Medicare doesn’t, and for most people turning 65 right now, it’s the single best option available. I’ve watched hundreds of people agonize over this decision, and when they lay out the math, Plan G wins more often than not.

Here’s a quick bit of history that matters: Plan F used to hold the title of “most coverage.” It covered literally everything, including the Part B deductible. But Congress eliminated Plan F for anyone who became Medicare-eligible after January 1, 2020. So if you turned 65 after that date, Plan F isn’t available to you. Plan G is now the most complete plan you can actually get.

The only thing Plan G doesn’t cover is the 2026 Medicare Part B deductible, which is $257 per year. That’s it. One small gap. Everything else, including the Part A hospital deductible ($1,676 per benefit period in 2026), Part B coinsurance, skilled nursing facility coinsurance, foreign travel emergency care, and even excess charges from doctors who don’t accept Medicare assignment, is covered. You pay your monthly premium, you pay that $257 once a year, and then you’re done. No surprise bills, no percentages, no guessing.

For someone like a 67-year-old in Ohio managing a chronic condition and seeing multiple specialists, that kind of predictability is worth a lot. You know your worst-case annual out-of-pocket number before January even ends.

How Plan G Stacks Up Against the Other Major Plans

It helps to actually see what each plan covers side by side, because the marketing around Medigap can make everything sound the same. It isn’t.

What’s Covered	Plan G	Plan N	Plan K	Plan A
Part A coinsurance and hospital costs	Yes	Yes	50%	Yes
Part B coinsurance or copayment	Yes	Yes (with copays)	50%	Yes
Part A deductible ($1,676 in 2026)	Yes	Yes	50%	No
Part B deductible ($257 in 2026)	No	No	No	No
Part B excess charges	Yes	No	No	No
Skilled nursing facility coinsurance	Yes	Yes	50%	No
Foreign travel emergency (80%)	Yes	Yes	No	No

Plan N is the main competitor to Plan G, and it’s genuinely worth considering if you’re in good health and don’t mind a little more unpredictability. With Plan N, you pay up to $20 for office visits and up to $50 for emergency room visits, and you’re not covered for excess charges. In exchange, premiums are usually $20 to $40 per month lower than Plan G. If you rarely go to the doctor, that math can work in your favor. But if you’re someone who sees specialists regularly or you live in an area with a lot of non-participating Medicare providers, Plan G gives you a cleaner deal.

Plans K and L are the “cost-sharing” plans, where you pay a percentage of costs rather than a flat amount. I’ll be honest with you, I rarely see these work out well for people. They come with out-of-pocket maximums, but the uncertainty of paying 50% of various costs until you hit that limit is exactly the kind of financial stress most people are trying to avoid when they buy Medigap in the first place.

What Plan G Premiums Actually Look Like in 2026

Plan G isn’t free, and the cost matters. Premiums for a 65-year-old enrolling in Plan G typically run between $100 and $200 per month, depending on where you live, which insurer you choose, and whether you’re male or female. That’s a wide range, and the state you’re in makes a significant difference. Someone in Florida or New York is going to pay more than someone in Iowa or Indiana, sometimes by $60 or $70 a month for identical coverage.

Here’s something a lot of people don’t realize: the coverage under Plan G is standardized by federal law. Every Plan G in your state covers exactly the same things. The only difference between a $120/month Plan G and a $175/month Plan G from a different company is the price and the insurer’s financial reputation. That means you should shop hard on price, because you’re not sacrificing anything by choosing the lower-cost option from a stable insurer.

The High-Deductible Plan G is worth mentioning too. It offers the same coverage as regular Plan G, but you pay out of pocket until you hit a $2,870 deductible in 2026, and then the plan kicks in. Premiums are often $40 to $70 per month as a result. If you’re healthy and want catastrophic protection at a lower monthly cost, this version deserves a serious look.

The Biggest Mistake People Make When Choosing a Medigap Plan

I’ve seen this mistake more times than I can count: people choose a cheaper plan when they’re healthy, thinking they’ll upgrade later if their health declines. They pick Plan N or Plan K to save money in their mid-60s, and then at 70 they develop a serious health issue and want to switch to Plan G. By then, in most states, they’ve lost their guaranteed issue rights, and the insurer can medically underwrite them. They can be charged more or even denied coverage based on their health history.

Guaranteed issue rights, which is the period when you can enroll in any Medigap plan without health questions, only last for six months after you first enroll in Medicare Part B. After that window closes, the protections largely disappear in most states. A few states, like New York, Connecticut, and Massachusetts, have continuous open enrollment protections, but most of the country doesn’t.

This is why getting the most coverage upfront, when you’re healthy and premiums are at their lowest, often makes more long-term sense than trying to optimize your monthly bill at age 65. You’re locking in your insurability. That’s worth something real. A 65-year-old in excellent health paying $140 a month for Plan G has a very different set of future options than someone who chose a cheaper plan and is now uninsurable at 72 with a recent cancer diagnosis.

The math on saving $30 a month for five years versus being permanently locked out of better coverage doesn’t usually favor the short-term savings strategy.

Who Should Actually Consider Something Other Than Plan G

Plan G is the right answer for most people. But not everyone. I want to be straight with you about the exceptions.

If you’re in excellent health, you see a doctor once or twice a year, you’re comfortable with a small amount of cost-sharing, and you’re willing to actively track whether your doctors accept Medicare assignment, Plan N can save you real money over time. The $20 to $40 monthly savings adds up to $240 to $480 per year. Over five years, that’s potentially more than the $257 Part B deductible you’d pay with either plan.

High-Deductible Plan G is a legitimate option if you want a true safety net without high monthly premiums and you have savings to cover the deductible gap if something happens. Think of it as catastrophic protection. It’s not ideal for someone who already has frequent medical needs, but for a healthy 65-year-old who rarely uses healthcare, it can work.

If you have very limited income and even $120 a month feels like a stretch, I understand that a lower-premium plan or even looking at Medicare Advantage might be a more realistic fit. Medigap assumes you can afford a consistent monthly premium, and if that’s genuinely not possible, the planning conversation looks different.

Bottom Line

Plan G covers the most of any Medicare supplement plan available to new enrollees in 2026, and for most people, it’s the right choice. The only thing you’re paying yourself is the $257 annual Part B deductible, and in exchange you get complete protection against hospital bills, specialist visits, excess charges, and even overseas medical emergencies. Shop multiple insurers for the best price on identical coverage, enroll during your initial guaranteed issue window, and don’t let short-term premium savings talk you into a plan you might regret at 72.

Frequently Asked Questions

Is Plan G better than Plan F?

For anyone who became Medicare-eligible after January 1, 2020, Plan F isn’t available, so the comparison is moot. For those who do have access to Plan F, the difference is that Plan F covers the Part B deductible ($257 in 2026) and Plan G doesn’t. Plan F premiums are typically higher than Plan G by more than $257 per year, which means Plan G usually wins on total cost even when you account for paying the deductible yourself.

Can I switch from Plan G to a different Medigap plan later?

In most states, switching Medigap plans after your initial enrollment window closes means going through medical underwriting. Insurers can ask health questions and decline to cover you based on pre-existing conditions. New York, Connecticut, and Massachusetts are exceptions with year-round protections, but if you’re in most other states, assume that the plan you choose now is the plan you’re likely keeping long-term unless your health is still excellent when you want to change.

Does Plan G cover dental, vision, or hearing?

No. Medigap plans, including Plan G, only fill the gaps in Original Medicare. Since Original Medicare doesn’t cover routine dental, vision, or hearing, Plan G doesn’t either. You’d need separate standalone coverage for those benefits. This is one area where Medicare Advantage plans often look attractive, though they come with tradeoffs like networks and prior authorization requirements that Plan G users never deal with.

What happens if I need a lot of hospital care? Does Plan G cover it all?

Yes, and this is where Plan G really earns its keep. Without any Medigap coverage, a long hospital stay could cost you thousands, because Medicare’s Part A deductible of $1,676 in 2026 applies per benefit period, not per year, and coinsurance costs kick in after 60 days. Plan G covers all of that, plus it extends your hospital coverage for up to 365 additional days after Medicare benefits are exhausted. If you’re facing a serious illness or surgery, Plan G is genuinely the most protection you can have short of carrying Medicaid alongside Medicare.

What Guaranteed Issue Rights Actually Mean (and Why They Exist)

If you’re over 65 and applying for a Medigap policy outside of your initial enrollment window, an insurance company can legally turn you down based on your health history. Guaranteed issue rights are the exception to that rule. They’re federal protections that force insurers to sell you a Medigap plan at standard rates, no medical questions asked, during specific life events.

The reason these rights exist comes down to how Medigap underwriting works. Unlike employer group health insurance, Medigap carriers in most states are allowed to look at your medical history and charge you more, or flat-out refuse to cover you, if you apply outside of protected windows. Congress recognized that certain situations leave people stuck through no fault of their own, and guaranteed issue rights are the safety valve.

Here’s the thing. A lot of people assume that because Medicare itself doesn’t require underwriting, Medigap works the same way. It doesn’t. They’re two completely different systems, and confusing them is one of the most expensive mistakes I see people make.

The Specific Situations That Trigger Your Rights

Guaranteed issue rights don’t kick in just because you want to switch plans. Something specific has to happen. The federal government lays out these trigger events clearly, and I’d encourage you to read this list carefully because missing one by even a few weeks can cost you real money.

• Your Medigap insurer goes bankrupt or leaves your state. If your current plan collapses or stops being offered in your area, you’re entitled to buy a new Medigap plan without underwriting.
• You leave an employer-sponsored plan. If you had retiree health coverage or a group health plan through work that was supplementing Medicare, and that coverage ends, you have a guaranteed issue right to buy a Medigap plan.
• You drop Medigap to join a Medicare Advantage plan for the first time. If you were new to Medicare Advantage and it turns out not to work for you, you have a 12-month trial period. Leave within that first year, and you can return to your original Medigap plan or enroll in a new one with full guaranteed issue protection.
• Your Medicare Advantage plan leaves your area or stops accepting Medicare. You can’t be penalized for your insurer’s decision to stop serving your area.
• You were covered by someone else’s Medicare Advantage or Medigap plan and that person died. Losing coverage due to a spouse’s death triggers your rights.
• You enrolled in Medigap during your Medigap open enrollment and the plan’s claims were paid based on incorrect information. This is a narrow one, but it’s there.

In most of these situations, you have 63 days from the date your old coverage ends to exercise your rights. That clock starts ticking the moment your coverage lapses. I’ve talked to people who thought they had six months, or that the window was “whenever you get around to it.” It isn’t. 63 days, and then you’re back in the general underwriting pool.

Which Medigap Plans You Can Actually Buy Under These Rights

This is where people get a surprise. Guaranteed issue rights don’t let you choose any plan on the market. The federal rules specify which plans insurers must offer you, and that list depends on your situation.

For most guaranteed issue situations, you’re entitled to Plans A, B, C, F, K, or L. But C and F are only available if you turned 65 before January 1, 2020, because those plans cover the Part B deductible, which is no longer allowed for newly eligible Medicare beneficiaries under MACRA. If you became eligible for Medicare after January 1, 2020, your realistic options under guaranteed issue are typically Plan A, B, K, or L.

Here’s a comparison of the main plans available under guaranteed issue rights and what they actually cover:

Plan	Part A Coinsurance	Part B Coinsurance	Part A Deductible	Part B Deductible	Out-of-Pocket Limit (2026)
Plan A	100%	100%	No	No	None
Plan B	100%	100%	Yes	No	None
Plan K	100%	50%	50%	No	~$7,220
Plan L	100%	75%	75%	No	~$3,610
Plan F (pre-2020 eligible only)	100%	100%	Yes	Yes	None
Plan C (pre-2020 eligible only)	100%	100%	Yes	Yes	None

I’ll be direct: if you became eligible for Medicare after 2020 and you’re exercising guaranteed issue rights, Plan A gives you the most basic protection and nothing more. The 2026 Part A deductible is $1,676 per benefit period, and Plan A doesn’t cover that. That’s a real exposure. Plan B covers it, and that’s why most people in this situation are better served by Plan B if they can get it under their specific trigger event.

The Mistake That Costs People the Most Money

I’ve seen this happen more than I’d like to admit. Someone turns 65, decides they want to try Medicare Advantage because the $0 premium sounds appealing, and they skip their initial Medigap open enrollment period without understanding that it only comes around once. Then, a few years later, they develop a health condition. They want to switch to original Medicare with a Medigap plan. And they find out that without a guaranteed issue trigger event, insurers can turn them down or charge them significantly more.

That’s the core misconception: people think they can switch back to Medigap whenever they feel like it. You can’t, at least not with full protections. The initial open enrollment window you get when you first turn 65 and enroll in Part B is the most powerful Medigap protection that exists. It lasts six months and never comes back.

There is one narrow exception worth knowing. If you joined Medicare Advantage for the very first time and you leave within 12 months, you get that trial period protection. But if you’ve been in Medicare Advantage for three years and now you want out? You’re relying on a specific guaranteed issue trigger event, or you’re going through underwriting. In most states, that means you could be denied entirely if you have diabetes, heart disease, COPD, or any number of common conditions.

A 67-year-old in Ohio who has been in Medicare Advantage since 65 and now has a cancer diagnosis may find that no Medigap insurer will touch her unless she qualifies for a guaranteed issue trigger. That’s not a hypothetical. I’ve heard versions of that story too many times.

State Rules Can Give You More Protection Than Federal Law

Here’s something a lot of people don’t know: several states go further than federal law and give you broader Medigap protections. This matters because federal law sets the floor, not the ceiling.

States like New York and Massachusetts require Medigap insurers to use community rating and offer guaranteed issue year-round. In other words, you can apply for Medigap in New York at any age and any time, without underwriting, regardless of your health. The trade-off is that premiums are higher for healthy people because risk is spread across everyone.

Connecticut, Maine, and a handful of other states also have expanded protections, including annual enrollment windows or continuous guaranteed issue rights for certain plans. If you live in one of these states, your situation is fundamentally different from someone in Texas or Georgia, where the standard federal rules apply and underwriting outside of protected windows is the norm.

Before you assume you’re stuck, look up your state’s specific rules. Your state insurance commissioner’s website is where you’ll find this. And if you’re working with an independent broker, make sure they know your state’s rules cold. Some don’t, and that costs people coverage they were entitled to.

Bottom Line

If you have a legitimate guaranteed issue trigger event, use it within 63 days and don’t wait. For most people who became eligible for Medicare after 2020, Plan G is off the table under guaranteed issue, so Plan B is usually your strongest realistic option to limit out-of-pocket exposure. And if you haven’t hit 65 yet? Your initial open enrollment window when you first sign up for Part B is the most valuable Medigap right you’ll ever have, and I’d strongly encourage you not to skip it just because Medicare Advantage looks cheaper today.

Frequently Asked Questions

Can I be charged more during a guaranteed issue period even if the insurer has to accept me?

No. Guaranteed issue means the insurer can’t use your health history to set your premium. They still use standard rating factors like your age, sex, and where you live, but they can’t add a surcharge or apply a waiting period because of your specific medical conditions. That said, if your state uses attained-age rating, your premiums will still increase as you get older over time.

What if I miss the 63-day window? Is there anything I can do?

In most states, your only real option is going through medical underwriting, which means the insurer reviews your health history and can decline you or charge a higher rate. If your state has expanded protections, you may still have options, which is why checking your state rules matters. Otherwise, you may find yourself relying on Medicare Advantage or going without supplement coverage entirely until another trigger event occurs.

Does having COBRA coverage after losing a job extend my guaranteed issue window?

This one’s tricky. If you took COBRA after leaving a job, your guaranteed issue right to buy Medigap doesn’t kick in the day you left the job. It kicks in when the COBRA coverage actually ends. Some people think they’ve lost their window because they used COBRA as a bridge. You haven’t, but your 63-day clock starts when COBRA ends, not when employment ended.

I’m enrolled in Medicare Advantage and thinking about switching. Do I automatically have guaranteed issue rights?

Not automatically. Simply wanting to switch isn’t a trigger. You need a qualifying event, like your plan leaving your service area, your plan stopping Medicare coverage, or you being within your first 12 months of your first Medicare Advantage enrollment. If none of those apply, you’re going through underwriting in most states, which is why the timing of when you make decisions about Medicare Advantage really matters.

What Is Medicare Supplement Plan G High Deductible, and Who Is It Actually For?

High Deductible Plan G is the budget version of standard Plan G, and whether it’s a smart move or a costly mistake depends almost entirely on your health situation and how you handle financial risk. These two plans cover identical services once you’ve met the threshold. The only real difference is that with High Deductible Plan G, you pay out-of-pocket until you hit the 2026 deductible of $2,870 before your Medigap coverage kicks in. After that, the plan covers your costs the same way standard Plan G does.

So why would anyone choose it? Because the premiums are dramatically lower. A 65-year-old in Ohio might pay $55 to $90 per month for High Deductible Plan G versus $130 to $175 for standard Plan G. That’s a real difference, and for someone who’s healthy, that savings adds up fast.

I want to be upfront about something before we go further. This plan gets oversold to people who shouldn’t have it, and it also gets dismissed by people who would genuinely benefit from it. Both mistakes cost real money. Let’s work through the actual tradeoffs so you can decide which side of the line you’re on.

The Real Pros of High Deductible Plan G

The premium savings are the headline benefit, but they’re not the only one. Here’s what actually works in this plan’s favor.

Lower monthly premiums. This is the big one. If you’re paying $90 less per month compared to standard Plan G, that’s $1,080 in annual savings. Over five years, you’ve kept $5,400 in your pocket. Even if you have a moderate-cost year and pay $1,500 toward your deductible, you’ve still come out ahead. The math genuinely works for healthy people.

Built-in catastrophic protection. Your exposure is capped. No matter what happens, once you’ve paid $2,870 in 2026, everything else is covered at 100%. You’re not looking at unlimited liability. That ceiling matters. It’s not the same as having no coverage at all, which is a comparison some agents make to scare people away from this plan.

It plays well with an HSA if you’re still working. If you’re under 65 and have a High Deductible Plan G through a Medicare Supplement (which is possible in some states for people who enrolled in Medicare before 65 due to disability), you may be able to use HSA funds to offset costs. Even post-65, having a dedicated savings buffer for the deductible turns this plan into a genuinely smart financial structure.

Lower rate increase exposure over time. In my experience, plans with lower base premiums tend to have a smaller absolute dollar increase each year, even when the percentage increase is similar. Starting at $75/month versus $160/month means you’re compounding from a lower base. That matters over a 10 or 15 year horizon.

The Real Cons of High Deductible Plan G

I’d be doing you a disservice if I only told you the good parts. Here’s where this plan creates real problems.

You have to actually pay the deductible. This sounds obvious, but a lot of people underestimate how disruptive $2,870 in out-of-pocket costs can be if they’re on a fixed income. If your monthly budget is tight, having to write a $600 check after a hospital stay, even knowing you’re covered after that, creates stress. Standard Plan G removes that variability completely. Some people genuinely sleep better paying more each month to avoid the unknown.

You’re also responsible for the 2026 Part B deductible of $257. This is the same for both High Deductible and standard Plan G. Neither plan covers the Part B deductible. That $257 counts toward your $2,870 High Deductible threshold, but it doesn’t change the fact that you’re paying it either way.

Frequent medical users will lose money. If you see specialists regularly, manage a chronic condition, or have recurring hospitalizations, you’ll likely hit the deductible every year. At that point, you’ve paid the deductible AND a lower premium that probably doesn’t fully offset your costs. The plan stops making financial sense once your expected annual out-of-pocket is consistently near $2,870.

Tracking costs across providers is a headache. With standard Plan G, you essentially ignore billing. With High Deductible Plan G, you need to track your progress toward the deductible across multiple providers. That’s not complicated, but it’s more administrative work. I’ve talked to people in their 70s who found it stressful and switched back to standard Plan G specifically because of this.

Head-to-Head: High Deductible vs. Standard Plan G

This table shows how the two plans compare across the factors that actually matter to most people shopping in 2026.

Factor	Standard Plan G	High Deductible Plan G
Typical monthly premium (age 65)	$130 to $175	$55 to $90
Annual deductible (2026)	None (after Part B deductible)	$2,870
Coverage once deductible met	Same	Same
Part B deductible covered?	No ($257 in 2026)	No ($257 in 2026)
Best for	Frequent medical users, fixed-income budgeters	Healthy, low-utilization, comfortable with some risk
Annual premium savings (rough estimate)	Baseline	$900 to $1,400/year
Break-even health year	N/A	Need less than ~$1,200-$1,400 in covered expenses

The Mistake I See People Make All the Time

Here’s the misconception that costs people real money: assuming that “high deductible” means this plan is risky or barely worth having. It doesn’t mean that at all.

I’ve watched healthy 65-year-olds get steered toward standard Plan G by agents who never ran the numbers. The agent presents the high deductible as a scary number, the prospect imagines a hospital stay, and they sign up for a plan that costs them $1,200 more a year in premiums they’ll never get back. Over five years of minimal health expenses, they’ve given away $6,000 in unnecessary premiums. That’s not protecting yourself. That’s just paying more for nothing.

The flip side of this mistake is a healthy person assuming they’ll always stay healthy. A 68-year-old who’s been fine for three years decides to stay with High Deductible Plan G after a diagnosis that means two or three specialist visits and lab work every quarter. Now they’re hitting the deductible every January and the math has completely flipped. The plan didn’t change. Their health did. You have to reassess.

The real mistake, in both directions, is treating this as a one-time decision that never gets revisited. Your health trajectory changes. The deductible amount adjusts with inflation each year. What made sense at 65 might not make sense at 72. Check in on this every two or three years, especially if your health situation shifts.

Bottom Line

If you’re in good health at 65, have some savings set aside as a buffer, and don’t have recurring specialist visits or chronic conditions requiring regular treatment, High Deductible Plan G is likely the smarter financial choice. The premium savings are real, the catastrophic protection is solid, and most years you’ll come out ahead. That said, if you’re already managing a chronic condition, you’re on a very fixed income where surprise bills cause real hardship, or you just can’t stomach financial uncertainty, standard Plan G is worth the higher premium for the peace of mind it genuinely delivers.

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Frequently Asked Questions

How does the $2,870 deductible work with High Deductible Plan G in 2026?

The $2,870 deductible is the total amount you pay toward Medicare-covered costs before your Medigap coverage starts paying. This includes your Part A hospital costs, your Part B deductible ($257 in 2026), and coinsurance or copayments. Once you’ve paid $2,870 in a calendar year, your plan covers costs the same way standard Plan G does. The deductible resets every January 1.

Does High Deductible Plan G cover prescription drugs?

No. Like all Medigap plans, High Deductible Plan G doesn’t cover prescription drugs. You need a standalone Medicare Part D plan for drug coverage. This is the same for standard Plan G, so it’s not a disadvantage unique to the high deductible version.

Can I switch from High Deductible Plan G to standard Plan G later if my health changes?

You can apply to switch, but in most states you’ll need to pass medical underwriting. That means the insurer can ask about your health history and potentially deny you or charge more based on pre-existing conditions. This is different from your initial enrollment period, when you have guaranteed issue rights. It’s one reason to think carefully upfront rather than assuming you can easily switch later.

Is High Deductible Plan G available in every state?

It’s widely available but not universal. A handful of states have their own Medigap rules (Massachusetts, Minnesota, and Wisconsin standardize their plans differently), and not every insurance company offers this plan variant in every state where it’s allowed. You’ll want to check availability with an independent broker or directly through your state insurance department to see what carriers are offering it where you live.