What Medigap Plan Is Best for Your Needs?

Medicare Supplement Insurance, commonly known as Medigap, helps manage healthcare expenses for individuals enrolled in Original Medicare. Its primary purpose is to help cover some of the out-of-pocket costs that Original Medicare (Parts A and B) does not cover, such as deductibles, copayments, and coinsurance. This supplementary coverage provides financial predictability. Understanding which Medigap plan is most suitable is a personalized decision, as the “best” plan varies significantly based on an individual’s unique health needs, financial situation, and risk tolerance.

Understanding Medigap Basics

Medigap policies work with Original Medicare, not as a replacement. They help bridge the financial “gaps” in coverage that Original Medicare leaves behind, such as deductibles, copayments, and coinsurance. You must have Medicare Part A and Part B to purchase a Medigap policy.

These policies are sold by private insurance companies, and beneficiaries pay a separate monthly premium in addition to their Medicare Part B premium. Medigap policies are standardized across most states, meaning a Medigap Plan A, for example, offers the exact same basic benefits regardless of which insurance company sells it. However, Massachusetts, Minnesota, and Wisconsin have different standardization policies.

Medigap policies do not cover prescription drug coverage (Medicare Part D), long-term care, vision care, dental care, hearing aids, or private-duty nursing. A separate Medicare Part D plan is necessary for prescription drug coverage.

Key Differences Among Plans

Medigap policies are standardized into different plans, each identified by a letter (A, B, C, D, F, G, K, L, M, N), with each plan offering a distinct set of benefits. Premiums for the same standardized plan can vary between insurance companies.

Plan A

Plan A provides the most basic Medigap coverage. It covers:
Medicare Part A coinsurance and hospital costs for an additional 365 days after Medicare benefits are exhausted.
Part B coinsurance or copayment.
Part A hospice care coinsurance or copayment.
The first three pints of blood.

Plan B

Plan B offers the same benefits as Plan A but adds coverage for the Medicare Part A deductible. The Part A deductible is applied per benefit period, not annually.

Plan C

Plan C provides comprehensive coverage. It covers:
Medicare Part A coinsurance and hospital costs.
The Part A deductible.
Part A hospice care coinsurance or copayment.
Part B coinsurance or copayment.
The Medicare Part B deductible.
Skilled nursing facility care coinsurance.
The first three pints of blood.
Foreign travel emergency coverage.
However, Plan C is only available to individuals who were eligible for Medicare before January 1, 2020.

Plan D

Plan D covers:
Medicare Part A coinsurance and hospital costs.
The Part A deductible.
Part A hospice care coinsurance or copayment.
Part B coinsurance or copayment.
Skilled nursing facility care coinsurance.
The first three pints of blood.
80% of foreign travel emergency costs up to plan limits.
Plan D does not cover the Medicare Part B deductible or Part B excess charges.

Plan F

Plan F has historically been the most comprehensive Medigap plan, covering nearly all out-of-pocket costs associated with Original Medicare. It covers:
Medicare Part A and B deductibles.
Part A coinsurance.
Part B coinsurance.
Part A hospice care coinsurance or copayment.
Skilled nursing facility care coinsurance.
The first three pints of blood.
Medicare Part B excess charges.
Foreign travel emergency care.
Like Plan C, Plan F is only available to those who became eligible for Medicare before January 1, 2020.

Plan G

Plan G has become the most comprehensive option for new Medicare enrollees since Plans C and F are no longer available to those newly eligible. It covers all the benefits of Plan F, except for the Medicare Part B deductible.

Plan K

Plan K offers a cost-sharing approach with a lower premium. It covers:
100% of Medicare Part A coinsurance and hospital costs.
50% of the Part A deductible.
50% of Part A hospice care coinsurance or copayment.
50% of Part B coinsurance or copayment.
50% of skilled nursing facility care coinsurance.
50% of the first three pints of blood.
Plan K has an annual out-of-pocket limit, which was $7,220 in 2025, after which the plan pays 100% of approved costs for the remainder of the year. It does not cover the Part B deductible or Part B excess charges.

Plan L

Plan L also features a cost-sharing structure and an annual out-of-pocket limit, which was $3,610 in 2025. It covers:
100% of Medicare Part A coinsurance and hospital costs.
75% of the Part A deductible.
75% of Part A hospice care coinsurance or copayment.
75% of Part B coinsurance or copayment.
75% of skilled nursing facility care coinsurance.
75% of the first three pints of blood.
It does not cover the Part B deductible or Part B excess charges.

Plan M

Plan M covers:
Medicare Part A coinsurance and hospital costs.
Part A hospice care coinsurance or copayment.
Part B coinsurance or copayment.
Skilled nursing facility care coinsurance.
The first three pints of blood.
50% of the Medicare Part A deductible.
Foreign travel emergency coverage.
It does not cover the Part B deductible or Part B excess charges.

Plan N

Plan N offers a balance between comprehensive coverage and potentially lower premiums. It covers:
Medicare Part A coinsurance and hospital costs.
The Part A deductible.
Part A hospice care coinsurance or copayment.
Skilled nursing facility care coinsurance.
The first three pints of blood.
Part B coinsurance, but may require copayments of up to $20 for some office visits and up to $50 for emergency room visits if not admitted.
Foreign travel emergency coverage.
It does not cover the Part B deductible or Part B excess charges.

Factors Guiding Your Choice

Selecting a Medigap plan involves an assessment of various personal factors to align coverage with individual needs and financial capacity. The decision should reflect one’s current health status, anticipated medical needs, budgetary constraints, and comfort with financial risk. Each plan type offers a different balance of coverage and cost, making a personalized evaluation.

An individual’s health status and future health needs play a role in determining the most suitable plan. If a person anticipates frequent doctor visits, potential hospitalizations, or has chronic conditions, a plan offering more comprehensive coverage, such as Plan G, might be better. Such plans reduce potential out-of-pocket expenses for services like copayments and coinsurance, providing financial predictability. Conversely, individuals who are generally healthy and expect minimal medical needs might find a plan with lower premiums and higher potential out-of-pocket costs, like Plans K, L, or N, suitable.

Budget and affordability are important considerations. Monthly premiums for Medigap plans can vary depending on the plan chosen and the insurance company offering it. A higher premium corresponds to more comprehensive coverage and fewer out-of-pocket costs at the point of service. Individuals must balance the cost of the premium against the potential savings on deductibles, copayments, and coinsurance. A plan with a lower premium might seem attractive initially, but it could lead to higher out-of-pocket expenses if medical care is needed.

Tolerance for financial risk also guides the choice of a Medigap plan. Some plans, like Plan K and Plan L, feature a cost-sharing model where the beneficiary pays a portion of the costs until an annual out-of-pocket limit is reached. These plans are appropriate for individuals comfortable with assuming some financial risk in exchange for lower monthly premiums. For those who prefer predictability and minimal out-of-pocket costs when receiving care, plans with more extensive coverage, even with higher premiums, provide peace of mind.

Specific coverage needs, such as foreign travel emergency coverage or protection against Medicare Part B excess charges, should be considered. Not all Medigap plans offer these benefits. Individuals who travel internationally frequently might prioritize a plan that includes foreign travel emergency coverage. Those concerned about providers charging more than the Medicare-approved amount (excess charges) would benefit from plans that cover these costs.

Enrollment Considerations

Understanding the process of enrolling in a Medigap plan is important once a decision on the type of plan has been made. The timing of enrollment can impact the availability and cost of a Medigap policy. Specific periods and rights protect beneficiaries.

The Medigap Open Enrollment Period is a one-time, six-month window. This period begins the first day of the month in which an individual is 65 or older and enrolled in Medicare Part B. During this timeframe, insurance companies are required to sell any Medigap policy they offer to an eligible person, regardless of their health status. Insurers cannot deny coverage or charge higher premiums based on pre-existing health conditions through medical underwriting. After this period concludes, an insurer may use medical underwriting to assess an applicant’s health, potentially leading to higher premiums or denial of coverage.

Guaranteed Issue Rights provide protections outside of the initial Medigap Open Enrollment Period. These rights ensure that an insurer must sell an individual a Medigap policy under certain circumstances, without medical underwriting. Common scenarios that trigger guaranteed issue rights include losing employer-sponsored group health coverage that supplemented Medicare, changes in a Medicare Advantage plan, or when an individual’s Medigap policy ends through no fault of their own. The conditions and timeframes for exercising these rights are defined by federal law and may have additional state-level protections.

The process of applying for a Medigap policy involves contacting private insurance companies that offer these plans. Compare premiums for the same standardized Medigap plan from multiple insurers, as costs can vary. When applying, individuals should be aware of the policy’s effective date, which begins the first of the month after the application is submitted and approved. Some states may offer additional protections or rules beyond the federal guidelines, so checking state-specific regulations can be beneficial.