The Plans With No Out-of-Pocket Maximum Are the Ones Most People Buy
Here’s something that surprises a lot of people when they first start looking at Medigap: the most popular Medicare supplement plans — Plan G and Plan N — don’t technically have an out-of-pocket maximum at all. Not in the traditional sense. What they have is something arguably better: they cap your exposure so tightly that in most years, your costs are predictable and low. But they’re not zero, and they’re not formally capped with a single number the way employer insurance or Medicare Advantage plans are.
Understanding how each Medigap plan handles your potential out-of-pocket costs is one of the most useful things you can do before picking one. So let me walk you through the real picture, ranked from most protective to least, with actual 2026 numbers and honest opinions about who each plan makes sense for.
How Medigap Plans Actually Limit What You Pay
Original Medicare by itself has no out-of-pocket maximum. None. If you’re hospitalized repeatedly, your Part A deductible resets every 60 days (the 2026 Part A deductible is $1,676 per benefit period). Part B covers 80% of approved outpatient costs, leaving you with 20% of whatever the bill is — with no ceiling. That’s the exposure Medigap exists to address.
Medigap plans limit your costs in one of two ways. Most plans do it by paying specific cost-sharing buckets — deductibles, coinsurance, copays — so you never face those bills in the first place. A smaller set of plans uses a defined out-of-pocket maximum, after which they cover everything. Knowing which approach each plan takes changes how you think about the value you’re getting.
| Plan | Part A Deductible Covered? | Part B Deductible Covered? | Part B Coinsurance Covered? | Formal OOP Maximum | Estimated Annual Exposure (Typical Use) |
|---|---|---|---|---|---|
| Plan G | Yes | No | Yes (100%) | None (but exposure is just the Part B deductible) | $257 (2026 Part B deductible) |
| Plan F | Yes | Yes | Yes (100%) | None needed — pays everything | $0 |
| Plan N | Yes | No | Yes (with copays) | None | $257 + up to $20/visit copays + possible excess charges |
| High-Deductible Plan G | After deductible | After deductible | After deductible | $2,870 (2026) | Up to $2,870 |
| Plan K | 50% | No | 50% | $7,220 (2026) | Up to $7,220 |
| Plan L | 75% | No | 75% | $3,610 (2026) | Up to $3,610 |
A quick note on Plan F: it’s only available to people who turned 65 before January 1, 2020. If you’re newly eligible for Medicare in 2026, it’s off the table. I won’t spend much time on it here for that reason, but if you do qualify, it’s worth a look.
The Plans With Formal Out-of-Pocket Maximums (And Why I’m Not Wild About Them)
Plans K, L, and High-Deductible Plan G are the three Medigap plans that use a defined out-of-pocket maximum. Once you hit that number in a calendar year, the plan pays 100% for the rest of the year. That sounds appealing on paper. In practice, I think these plans are frequently misunderstood and sometimes sold to people who’d be better served elsewhere.
Plan K has a 2026 out-of-pocket maximum of $7,220. Before you hit that ceiling, it only covers 50% of most cost-sharing. That means you’re absorbing half of your Part A hospital coinsurance, half of skilled nursing facility costs, half of hospice coinsurance. For someone who’s in and out of the hospital regularly, that 50% share can pile up fast before you hit the cap.
Plan L is better. Its 2026 maximum is $3,610, and it covers 75% of cost-sharing before the cap kicks in. For a 68-year-old in decent health who wants some protection without paying full Plan G premiums, Plan L can make sense. But it’s still a plan where you’re taking on meaningful exposure in a bad year.
High-Deductible Plan G is the one I actually think deserves more attention. The 2026 deductible is $2,870 — you pay all costs up to that amount, and after that, it works exactly like standard Plan G. The monthly premiums are dramatically lower, often $40-$70/month compared to $120-$180 for standard Plan G depending on your state and age. If you’re 65, healthy, and can absorb up to $2,870 in a rough year, this plan often wins mathematically over a 5-10 year horizon.
The Common Mistake: Confusing “Low Premium” With “Low Risk”
I’ve seen a lot of people make this mistake, and it’s an expensive one. They look at Plan K’s low monthly premium, see “out-of-pocket maximum” on the marketing materials, and assume it’s a budget-friendly safety net. It’s not, at least not in the way they think.
Here’s the thing. A $7,220 out-of-pocket maximum means your downside in a catastrophic year is $7,220 plus your premiums. For someone on a fixed income, that’s a significant financial hit. If you’re paying $60/month for Plan K instead of $150/month for Plan G, you’re saving $1,080 a year in premiums. But it only takes one bad hospitalization with complications to wipe out years of premium savings and then some.
The better framing for any Medigap plan isn’t just the out-of-pocket maximum in isolation. It’s the total worst-case annual cost: your premiums plus your maximum possible cost-sharing. Here’s what that looks like for a 65-year-old in a mid-cost state like Ohio in 2026:
| Plan | Est. Monthly Premium (Age 65, Ohio) | Annual Premium | Max Annual OOP | Worst-Case Annual Total |
|---|---|---|---|---|
| Plan G | $130 | $1,560 | $257 | $1,817 |
| High-Deductible Plan G | $55 | $660 | $2,870 | $3,530 |
| Plan N | $105 | $1,260 | $257 + copays + excess | ~$1,800-$2,200 |
| Plan L | $75 | $900 | $3,610 | $4,510 |
| Plan K | $55 | $660 | $7,220 | $7,880 |
When you look at it that way, Plan K stops looking like a deal. Plan G’s worst-case total in 2026 is under $1,900. Plan K’s worst case is nearly $8,000. The premium savings don’t come close to justifying that gap for most people.
Who Should Actually Consider Each Plan
I’d give different advice depending on your situation, so let me be specific.
Plan G is the right call for most people turning 65 in 2026. You pay the $257 Part B deductible once a year, and after that you owe nothing for Medicare-approved services. Your monthly costs are predictable. You can see any doctor who accepts Medicare, anywhere in the country. It’s not the cheapest plan, but the total cost picture is usually better than people expect.
High-Deductible Plan G makes a lot of sense if you’re 65, healthy, and have enough in savings to handle a $2,870 hit in a rough year. The math usually favors this plan over standard Plan G if you stay healthy for several years, and the protection is identical once you clear the deductible. A lot of financial-minded retirees I talk to choose this and keep the premium savings in a small reserve fund.
Plan N is worth considering if you want lower premiums than standard Plan G and you’re willing to pay up to $20 for office visits and up to $50 for ER visits. The catch is excess charges — some doctors charge more than Medicare’s approved amount, and Plan N doesn’t cover that gap. If you live somewhere with a lot of Medicare assignment (most urban areas are fine), Plan N is a solid choice. If you’re in a rural area with limited providers, check the excess charge situation first.
Plan L could work for someone who’s genuinely healthy, comfortable self-insuring up to $3,610, and focused on keeping premiums low. I’d rather see most people in Plan G, but I understand the appeal for people in their early 60s on Medicare due to disability who are managing a tight budget.
Plan K is hard for me to recommend to most people. The premium savings relative to the risk exposure rarely pencil out, and the $7,220 ceiling is genuinely scary if you’re on Social Security income.
Bottom Line
For most people turning 65 in 2026, Plan G is the right Medicare supplement plan. It keeps your annual exposure at just the $257 Part B deductible, offers complete predictability, and the worst-case total cost beats every other plan except Plan F (which you probably can’t get). If you’re healthy and cost-conscious, High-Deductible Plan G is the one plan worth genuinely comparing to standard Plan G. The others have their place, but Plan K especially should make you nervous when you run the actual numbers.
Frequently Asked Questions
Does Plan G have an out-of-pocket maximum?
Not in the formal sense, but your real-world exposure is capped at the 2026 Part B deductible of $257 per year. After you pay that once, Plan G covers 100% of Medicare-approved costs for the rest of the year. That’s functionally as good as a $257 out-of-pocket maximum for most people.
Which Medigap plan has the lowest out-of-pocket maximum?
Among plans with a formal defined maximum, High-Deductible Plan G has the lowest at $2,870 in 2026. But standard Plan G limits your real exposure to $257 (the Part B deductible) with no deductible to meet first, which makes it more protective for most people despite having no stated maximum.
Is Plan K worth it if I’m healthy?
Rarely. The low premium looks attractive, but the $7,220 out-of-pocket maximum means one serious illness could cost you far more than you saved on premiums. Unless you’re in genuinely excellent health with significant liquid savings and a clear preference for self-insuring, Plan G or High-Deductible Plan G almost always beats Plan K on total expected cost.
Can my out-of-pocket costs really be zero with a Medigap plan?
With Plan F, yes — but only if you were eligible for Medicare before January 1, 2020. With Plan G, your only guaranteed cost is the $257 Part B deductible in 2026. After that, your costs for Medicare-approved services are zero for the rest of the calendar year. That’s about as close to zero ongoing exposure as you can get in the American healthcare system.
