Medigap is private supplemental insurance for people enrolled in Original Medicare, and it is not a substitute for comparing enrollment rights, premiums, and state rules. It can pay specified deductibles, coinsurance, and copayments left by Medicare Parts A and B. It cannot be used with Medicare Advantage, does not include routine prescription drug coverage, and does not automatically cover every healthcare expense.
This guide explains a federal 2026 comparison framework. It does not recommend a plan or insurer, determine eligibility, interpret state law, or provide individualized insurance, medical, tax, legal, or investment advice.
What does Medigap cover, and what does it leave out?
Original Medicare generally pays its share of covered Part A hospital and Part B medical services, while the beneficiary remains responsible for applicable deductibles and cost sharing. Original Medicare by itself has no annual out-of-pocket maximum for covered Part A and Part B services. A Medigap policy pays only the Medicare gaps included in its standardized benefit design.
Medigap generally does not cover long-term care, routine dental or vision care, hearing aids, eyeglasses, private-duty nursing, or most outpatient prescriptions. Someone who needs outpatient drug coverage commonly evaluates a standalone Part D plan separately. Medicare coverage rules still control whether a service is covered; a supplement does not turn a noncovered service into a covered one.
A Medigap policy supplements Original Medicare only. An insurer cannot knowingly sell a Medigap policy to someone enrolled in Medicare Advantage unless that person is switching back to Original Medicare. Leaving Medicare Advantage and qualifying to buy Medigap are related but separate decisions; the Medicare coverage comparison guide explains that boundary.
What does standardized really mean?
In most states, policies use standardized letters. Every insurer offering the same letter must provide the same core benefits, but that does not make the policies identical in every practical respect. Premiums, discounts, rating method, rate-increase history, customer service, underwriting, availability, and financial strength can differ. Massachusetts, Minnesota, and Wisconsin use different standardized designs.
| Plan feature | Federal 2026 rule | What the shopper must verify |
|---|---|---|
| Core benefits | Standardized by plan letter in most states | Correct letter and state-specific design |
| Part B deductible | Plans sold to newly eligible beneficiaries cannot cover it | Medicare eligibility date and Plan C/F eligibility |
| Annual Medigap limit | Plans K and L have explicit 2026 limits | Which expenses count and when full coverage begins |
| Foreign travel emergency | Included only in specified plan letters and subject to limits | Deductible, percentage, lifetime cap, and trip timing |
| Premium | Not standardized | Current quote, discounts, rating method, and rate history |
| Eligibility outside protected rights | May involve medical underwriting | Federal right, state rule, and written insurer decision |
Plans C and F are unavailable to people who became newly eligible for Medicare on or after January 1, 2020 because those plans cover the Part B deductible. A person eligible before that date may still be able to keep or buy one if an insurer offers it and applicable enrollment rules are met.
How do Plans G, N, K, L, and high-deductible options differ?
Plan G covers the standardized gaps shown in Medicare's comparison chart except the Part B deductible. Plan N also leaves the Part B deductible unpaid, does not cover Part B excess charges, and can require up to a $20 copayment for some office visits and up to $50 for an emergency-room visit that does not result in inpatient admission. Those differences do not establish which policy is better for a particular person.
Plans K and L share a percentage of certain covered costs until the beneficiary meets the yearly limit and the annual Part B deductible. For 2026, the Medigap out-of-pocket limit is $8,000 for Plan K and $4,000 for Plan L. After the applicable limit and Part B deductible are met, the policy pays 100% of covered services for the rest of the calendar year. Other standardized letters should not be described as having the same explicit annual Medigap limit.
High-deductible versions of Plans F and G require $2,950 of Medicare-covered costs in 2026 before the policy begins paying. Plan F eligibility remains limited by the January 1, 2020 rule. The deductible design can reduce premiums, but it also changes the timing and amount of costs a household must fund. Compare total annual cost under routine, moderate, and high-use scenarios instead of relying on generic premium-savings claims.
The 2026 Part B deductible is $283. It is separate from a high-deductible Medigap amount and from premiums. For each candidate, document which expenses count toward each threshold and which expenses remain outside the policy.
When is the federal Medigap Open Enrollment Period?
The federal Medigap Open Enrollment Period is a one-time six-month period beginning the first month a person is age 65 or older and enrolled in Medicare Part B. During this period, an insurer generally cannot use medical underwriting to deny a policy or charge more because of health problems. The period does not repeat every year and is different from Medicare's fall Open Enrollment Period.
Federal law generally does not require insurers to sell Medigap to people under 65 who qualify for Medicare because of disability or end-stage renal disease. States can provide broader availability or additional enrollment periods. A beneficiary should check the state insurance department before assuming either that coverage is available or that it is unavailable.
Missing the federal six-month period does not prove permanent denial. Outside it, an applicant may face underwriting unless a federal guaranteed-issue right, trial right, or state protection applies. The correct question is which right applies to the person's event, dates, prior coverage, state, and requested plan letter.
What other rights can protect a Medigap application?
Federal guaranteed-issue rights apply to defined events, such as certain losses of employer or union coverage, a Medicare Advantage plan leaving Medicare or the service area, or moving out of a plan's service area. Available plan letters depend on the right and on whether the person became eligible for Medicare before January 1, 2020.
Many federal guaranteed-issue windows permit an application as early as 60 calendar days before coverage ends and generally no later than 63 calendar days after it ends. Exact timing varies by event, and the applicant may need termination notices, claim denials, letters, or envelopes proving the date. Do not cancel coverage or discard notices before documenting the right.
Federal trial rights can protect some people who try Medicare Advantage for the first time. The result depends on whether the person joined when first eligible at 65 or dropped a prior Medigap policy to join, whether the change occurs within the first year, and whether the former policy or insurer remains available. A trial right is not a general promise that any Medigap policy can be purchased after any Medicare Advantage enrollment.
An insurer can impose a waiting period of up to six months for coverage of a pre-existing condition in some circumstances, even when a policy must be sold. Prior continuous creditable coverage can reduce or eliminate that waiting period. This is different from delaying the policy effective date, excluding unrelated covered services, or denying Medicare coverage itself.
How should Medigap premiums be compared?
Insurers can use community-rated, issue-age-rated, or attained-age-rated pricing, subject to state rules. Community-rated policies charge the same base premium without using age; issue-age-rated premiums reflect age when the policy is purchased; attained-age-rated premiums can rise as the policyholder gets older. Premiums under any method can still change for reasons such as medical inflation, geography, tobacco status, discounts, or an approved rate increase.
No rating method is universally the best long-term value. Ask each insurer for the same effective date and household profile, then record the quote, rating method, discount conditions, recent rate history, and whether a discount can disappear. Compare the standardized benefit, current premium, plausible increases, and insurer service together. The lowest first-year quote is not automatically the lowest lifetime cost.
Medigap premiums are separate from Part B, Part D, IRMAA, deductibles, noncovered care, and other insurance premiums. The 2026 IRMAA guide explains why an income-related Medicare adjustment should not be attributed to a Medigap insurer.
How can someone switch policies without creating a gap?
A person can apply for another Medigap policy at any time, but acceptance and pricing may involve underwriting unless a protected right or state rule applies. During a protected event, carefully match the available plan letters and deadline. During an underwritten change, do not terminate the existing policy based only on a quote or submitted application.
After a new Medigap policy is issued, federal guidance provides a 30-day free-look period. The policyholder generally keeps the old policy during that period and pays both premiums. The new policy should be reviewed for the requested letter, premium, effective date, waiting period, discounts, and disclosures before the old policy is canceled.
For a move from Medicare Advantage to Original Medicare with Medigap and Part D, coordinate all effective dates. Confirm that an enrollment period permits leaving the Advantage plan, that Parts A and B will be active, that the Medigap application is accepted under the expected right, and that prescription coverage will begin when needed.
A practical Medigap comparison workflow
- Write down Medicare eligibility dates, Part A and Part B effective dates, current coverage, and desired effective date.
- Use Medicare's current benefit chart to identify plan letters that meet the intended cost-sharing design.
- Confirm whether Plans C or F are legally available based on the original Medicare eligibility date.
- Collect quotes for the same letter, date, ZIP code, age, tobacco status, household, and payment method.
- Ask about rating method, discounts, rate history, underwriting questions, waiting periods, and state protections.
- Model premiums plus remaining deductibles, copayments, coinsurance, excess charges, drugs, and noncovered care.
- Keep written proof of open-enrollment, guaranteed-issue, or trial-right eligibility and every deadline.
- Verify acceptance and coordinated effective dates before ending any existing policy or plan.
- Review the new policy during the 30-day free-look period and retain confirmations.
The RetireStride methodology explains why the retirement calculator accepts a user-entered healthcare budget but does not select insurance. A future Medigap workspace should preserve plan year, state, ZIP code, plan letter, insurer, quote date, rating method, discounts, rights, deadlines, and unresolved questions rather than generate a universal recommendation.
RetireStride provides educational retirement-planning information, not individualized insurance, medical, Medicare, tax, legal, or investment advice. Benefits, premiums, insurer participation, underwriting, rights, deadlines, health needs, and state and federal rules can change. Confirm details with Medicare, the insurer, the State Health Insurance Assistance Program, the state insurance department, and qualified professional advice.