Key Takeaways

• Medigap plans help fill the cost gaps left by Original Medicare, covering things like copayments, coinsurance, and deductibles.

• Choosing the right Medigap plan in 2025 requires understanding your health needs, enrollment timing, and how standardized plan types work.

Why Medigap Exists in the First Place

If you’re enrolled in Original Medicare (Part A and Part B), you might be surprised by how much you still have to pay out of pocket. Things like hospital deductibles, doctor visit copayments, and long-term coinsurance can add up quickly. That’s where Medigap—or Medicare Supplement Insurance—comes in.

Medigap is designed to help you manage these out-of-pocket costs. It works alongside Original Medicare, meaning it doesn’t replace your current coverage. Instead, it acts as a financial buffer so you’re not hit with unexpected medical bills.

How Medigap Works With Original Medicare

Here’s what happens when you receive medical care:

• Medicare pays its share of the approved amount for covered services.

• Your Medigap plan pays its share based on the policy you choose.

This partnership helps reduce the financial burden from things like:

• Part A coinsurance and hospital costs after 60 days

• Part B coinsurance or copayments

• First three pints of blood

• Hospice care coinsurance

• Skilled nursing facility coinsurance

• Part A and B deductibles (depending on the plan)

• Foreign travel emergency coverage (for some plans)

Understanding the Standardized Plan Types

Medigap plans are standardized by the federal government. That means each plan type offers the same basic benefits no matter which private company sells it. In 2025, you’ll see plans labeled with letters: A, B, D, G, K, L, M, and N.

Each plan type offers a different mix of benefits. Here’s a basic overview:

• Plan A: The most basic coverage—all Medigap insurers must offer this if they sell any plan.

• Plan G: One of the most comprehensive options available for those newly eligible after 2020.

• Plan N: Offers lower premiums with cost-sharing (like copays for office visits and ER).

• Plans K and L: Lower premiums but higher out-of-pocket limits.

Plans C and F are not available if you became eligible for Medicare after January 1, 2020.

Enrollment Timing Matters

Timing is everything when it comes to Medigap. You get a six-month Medigap Open Enrollment Period that begins the month you’re both 65 or older and enrolled in Medicare Part B. During this time:

• You can buy any Medigap plan available in your area.

• You can’t be denied coverage based on your health condition.

• You won’t be charged more due to pre-existing conditions.

After this six-month window, things change:

• You might be denied coverage based on medical underwriting.

• You could be charged a higher premium.

Some states have extended protections or additional open enrollment rights, but these vary.

What Medigap Doesn’t Cover

It’s important to be clear: Medigap only helps with costs related to services that Original Medicare covers. It does not cover:

• Prescription drugs (you’ll need a separate Part D plan)

• Vision or dental care

• Hearing aids

• Long-term care or custodial care

• Private-duty nursing

If you want coverage for any of these, you’ll need to look at separate standalone policies or programs.

Costs You Still Need to Budget For

Even with a Medigap plan, you’re still responsible for some ongoing healthcare expenses. In 2025, here’s what you should expect to budget for:

• Monthly premium for the Medigap plan

• Monthly premium for Medicare Part B ($185 in 2025)

• Part D premium if you need drug coverage

• Copayments or coinsurance for services not fully covered

Some Medigap plans include annual out-of-pocket limits, like Plans K and L. Once you reach that limit, the plan covers 100% of approved costs for the rest of the year.

Comparing Medigap to Medicare Advantage

You may be weighing Medigap against a Medicare Advantage Plan. The two options are very different:

• Medigap: Works only with Original Medicare. You keep the flexibility to see any doctor or hospital that accepts Medicare nationwide.

• Medicare Advantage: Replaces Original Medicare. Usually has provider networks and may include additional benefits like dental or vision.

You can’t have both at the same time. You’ll need to pick the route that fits your priorities—whether it’s predictable costs and wide access (Medigap) or bundled benefits and network-based care (Medicare Advantage).

When Can You Switch Plans?

In most cases, switching Medigap plans after your initial enrollment window is difficult. However, there are a few scenarios where it might be allowed:

• You’re within a trial right period (e.g., returning to Original Medicare after trying a Medicare Advantage Plan for the first time).

• Your insurer goes bankrupt or you lose your plan through no fault of your own.

• You move to a different state and your current plan is no longer available.

Some states allow annual switching without medical underwriting, but not all. Always check your state’s rules before assuming you can change easily.

2025 Updates to Keep in Mind

While Medigap benefits remain standardized in 2025, here are a few updated points to consider:

• The Part B deductible has increased to $257 this year. Plans that don’t cover it (like Plan G) will require you to pay it out of pocket.

• The foreign travel emergency benefit remains capped, so consider if this is a priority for you when choosing your plan.

• As of 2025, more insurers are using household discounts if multiple members of the same home enroll in a Medigap policy.

Choosing the Right Plan for Your Needs

Picking the right Medigap plan means thinking ahead about your health and finances. Ask yourself:

• Do you travel often within or outside the U.S.?

• Are you expecting frequent doctor visits or specialist care?

• Would you rather pay a higher monthly premium or risk more out-of-pocket costs?

• Do you need predictable budgeting or are you okay with variable costs?

Answering these questions can help you identify the plan that works best for you.

Why Some People Skip Medigap

Some people choose not to get a Medigap plan for a few key reasons:

• They can’t afford the monthly premium.

• They’re comfortable taking the risk of paying out-of-pocket costs.

• They choose a Medicare Advantage Plan instead.

While Medigap offers valuable protection, it’s not a requirement. It’s one of several tools available to manage your healthcare expenses under Medicare.

Things to Watch Out For

Before you commit to a Medigap plan, keep these points in mind:

• Premiums can increase over time. While benefits stay the same, rates may rise due to age or inflation.

• Plans may not be available in every area. Not every insurer offers every Medigap plan.

• Make sure you understand what you’re buying. Some plans look similar but differ in cost-sharing rules.

• Don’t wait too long. Missing your initial enrollment window could make things harder later.

Being informed can save you from surprises down the road.

Final Thoughts on Making Medigap Work for You

Understanding your Medigap options doesn’t have to be overwhelming. When you break it down, it’s about figuring out how much financial risk you want to take on versus how much you’re willing to pay in premiums. With standardized benefits, a structured enrollment window, and consistent cost categories, you can make a confident choice that fits your lifestyle and needs.

If you still have questions or want help reviewing your choices, reach out to a licensed agent listed on this website for professional advice tailored to your situation.