Medigap
A Medicare Supplement pays what Original Medicare leaves behind. Every insurer sells the same lettered policies with the same benefits, so the only things that differ are the premium, the rate history and the service.
What it is
You keep Original Medicare. Medicare pays its share of an approved claim first, and the Supplement pays the share Medicare left — deductibles, coinsurance, the extra hospital days, the skilled nursing coinsurance. There is no network, because the policy follows Medicare rather than making its own rules: if the provider takes Medicare, the policy works.
That is the entire proposition. A higher fixed monthly cost, in exchange for a much smaller variable one and the freedom to be treated anywhere in the country without asking anyone first.
The live choices
Ten letters exist. These are the four a person newly eligible today is realistically choosing between, and what each one is actually for.
The most complete policy still open to everyone.
Plan G pays everything Original Medicare leaves behind except the once-a-year Part B deductible. After that deductible is met, a Plan G holder generally sees no further bill for Medicare-approved care. It is the plan most people mean when they say they want the one where nothing else arrives in the post.
SuitsSomeone who wants predictability above all and is willing to pay a fixed monthly premium to get it.
Plan G with small copays, in exchange for a lower premium.
Plan N covers the same ground as Plan G with two differences. You may pay a copay of up to $20 for some office visits and up to $50 for an emergency room visit that does not lead to admission, and Plan N does not cover Part B excess charges — what a doctor who has not accepted Medicare assignment may bill above the approved amount.
SuitsSomeone who sees a doctor a few times a year, lives where excess charges are rare or prohibited, and would rather hold the premium down.
Cost sharing at 50%, with a hard annual ceiling.
Plan K pays half of most of the gaps rather than all of them, and in return carries an annual out-of-pocket limit that CMS resets each year. Once you reach that limit and have met the Part B deductible, the policy pays 100% of covered services for the rest of the calendar year.
SuitsSomeone who wants a low premium and a guaranteed worst case, and can absorb ordinary costs along the way.
The same idea as K at 75%, with a lower ceiling.
Plan L works exactly like Plan K but pays 75% of the shared benefits instead of 50%, and its annual out-of-pocket limit is lower. The premium sits between K and N.
SuitsSomeone who likes the ceiling that K provides but wants less exposure on the way to it.
Benefit by benefit
The same table an agent works from. Nothing here is a matter of opinion — it is the federal standardisation, set out in full.
Scroll the table sideways to see Plans G, N, K and L.
| Benefit | G Plan G | N Plan N | K Plan K | L Plan L |
|---|---|---|---|---|
| Part A hospital coinsurance Plus 365 extra hospital days after Medicare benefits are used up. | 100% Covered in full | 100% Covered in full | 100% Covered in full | 100% Covered in full |
| Part A deductible Charged once per benefit period, not once per year. | 100% Covered in full | 100% Covered in full | 50% Partly covered | 75% Partly covered |
| Part B coinsurance or copayment The 20% Original Medicare leaves you with on most outpatient care. | 100% Covered in full | 100% less copays Conditional | 50% Partly covered | 75% Partly covered |
| Part B deductible No plan sold to people newly eligible since 2020 may cover this. | Not covered Not covered | Not covered Not covered | Not covered Not covered | Not covered Not covered |
| Part B excess charges What a non-participating doctor may bill above the Medicare rate. | 100% Covered in full | Not covered Not covered | Not covered Not covered | Not covered Not covered |
| Skilled nursing facility coinsurance Days 21 to 100 of a qualifying skilled nursing stay. | 100% Covered in full | 100% Covered in full | 50% Partly covered | 75% Partly covered |
| First three pints of blood The three pints a year Original Medicare does not pay for. | 100% Covered in full | 100% Covered in full | 50% Partly covered | 75% Partly covered |
| Part A hospice coinsurance Respite care and outpatient drugs under the hospice benefit. | 100% Covered in full | 100% Covered in full | 50% Partly covered | 75% Partly covered |
| Foreign travel emergency Care in the first 60 days of a trip, up to a $50,000 lifetime maximum. | 80% Partly covered | 80% Partly covered | Not covered Not covered | Not covered Not covered |
| Annual out-of-pocket limit Only K and L have one. CMS resets the amount every year. | None Not covered | None Not covered | Yes — higher Conditional | Yes — lower Conditional |
Medigap policies are standardised by federal law, so a Plan G is a Plan G whoever sells it — only the price, the service and the rate history differ. Massachusetts, Minnesota and Wisconsin standardise their policies differently. Plans F and C are closed to anyone newly eligible for Medicare on or after 1 January 2020. The annual out-of-pocket limits on Plans K and L are reset by CMS each year.
The part nobody explains
Your Medigap Open Enrollment Period is the six months that begin the first month you are both 65 or older and enrolled in Part B. Inside it, an insurer must sell you any policy it offers, at its best available rate, and may not consider your health at all.
Outside it, in most states, it may. It can ask about your conditions, your medications and your recent treatment, and it can decline you. This is the single most consequential difference between Medigap and Medicare Advantage, and it is why moving from Advantage to a Supplement years later is not always the free option people assume.
Guaranteed-issue rights exist outside that window in specific situations — your plan leaves the area, you lose employer coverage, a plan misled you, or you are inside a trial right in the first twelve months of your first Advantage plan. Some states go further: New York and Connecticut do not allow underwriting at all.
The clock starts on the first day of that month, not on your birthday.
Any policy the insurer offers, at its best rate, regardless of your health.
In most states the insurer may underwrite. Approval is no longer automatic.
Specific circumstances reopen the door. They are narrow and time-limited.
Plans F and C
Federal law closed Plans F and C to anyone who became newly eligible for Medicare on or after 1 January 2020, because both covered the Part B deductible and Congress decided that first-dollar coverage should end for new entrants.
If you were eligible before that date you may still be able to buy Plan F where it is offered. If you already hold one you can keep it — but the pool of people in it is now closed and only ages, which is worth understanding when a rate increase arrives.
For everyone else, Plan G is the closest equivalent: identical cover, except that the Part B deductible is yours to pay, once a year.
Two Plan G policies pay identically and can differ by hundreds of dollars a year, and the cheap one is not always the one that stays cheap. We will show you both numbers.
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