What Is Medigap?
Updated Medicare Costs for 2026
We’re currently filming an updated video for this page. While that’s in progress, you can reference the correct Medicare cost information for 2026 below.
Costs shown are standard 2026 Medicare amounts and may change annually.
Unlocking the Mysteries of Medigap: Your Ultimate Guide
Welcome to Medicare School Daily, your ultimate resource for all things Medicare. Join us today as we explore the intricacies of Medigap, an often perplexing aspect of Medicare.
When it comes to using Medicare insurance, you have two main routes. Either you enroll with Original Medicare (Part A & B) and get a supplemental Medigap policy, or you opt to have all of your benefits provided by a Medicare Advantage Plan, also known as Part C. Today, we’re concentrating on the supplementary route, exploring the ins and outs of Medigap and how this method of insurance coverage works.
Understanding Original Medicare and its Gaps
To understand Medigap, we go back to the roots, Original Medicare, which is divided into two parts: the A and B. Part A covers everything related to inpatient hospital care and skilled nursing. Part B, on the other hand, covers everything outpatient-related, all doctor-related services, and durable medical equipment. These two parts of Medicare, while beneficial, have some shortfalls referred to as ‘gaps.’
Medicare Part A Gaps – Hospital and Skilled Nursing Fees
Gap 1: involves a deductible that covers up to 60 days in the hospital, whether you stay for one or 60 days. Currently, the Part A deductible stands at $1,736.
Gap 2: If you stay in the hospital beyond 60 days, you’re now in the second gap, where a $434 daily copay is necessary for days 61 to 90. If you’re hospital stay is over 90 days, you’ll face a daily copay of $868 for days 91 – 150.
Gap 3: relates to skilled nursing. While Medicare covers the first 20 days of skilled nursing for free, days 21 to 100 attract a $217 daily copay.
Medicare Part B Gaps – Outpatient and Doctor Services
Gap 4: encompasses the annual deductible which is presently set at $283.
Gap 5: Once you meet the deductible, Medicare transforms into an 80/20 plan, with you footing 20% of the bill. This gap, known as coinsurance, never stops.
Gap 6: Referred to as excess charge, this gap occurs when a doctor sees you as a Medicare patient, but does not take Medicare-approved reimbursement rates as full payment. They add an additional 15% to the bill, which you’re responsible for covering.
Decoding the Medigap Policy
The Medigap policy acts as the solution to fill these ‘gaps,’ allowing you to transfer the liability of these financial gaps to an insurance company.
Today, there are ten letter-designated Medigap policies – A, B, C, D, F, G, L, M, and N. Each letter represents a different policy, but by far, the most popular are the F, G, and N plans.
Here’s a brief breakdown of what each plan encompasses:
Medigap F Plan
Considered the full coverage plan, the F plan covers all six gaps. However, eligibility for purchasing the F plan is limited to individuals with Medicare eligibility prior to 2020. If your birth date is on or before January 1, 1955, you meet the eligibility criteria for the F plan; otherwise, you do not qualify.
Medigap G Plan
With the G plan, all but one gap, the Medicare B deductible of $283, is covered. It typically offers a lower premium compared to the F plan and is currently the most popular choice among individuals eligible for Medicare after January 2020.
Medigap N Plan
The N plan stands as another viable option, albeit with more caveats. It covers four of the six gaps, addressing everything except the Part B deductible and excess charges. It also subjects you to a $20 copay for doctor visits and a $50 copay for ER visits.
Please note that while the insurers differ, the coverage remains the same per policy since they are standardized by Medicare.
Final Thoughts
“Insurance companies cannot alter the coverage provided. Therefore, we shouldn’t pick carriers because we think they will offer better pay, but instead focus on factors like rate stability, and overall ratings”.
Indeed, Medigap policies go beyond the boundary of traditional insurance policies. They offer a lifetime of convenience and portability, moving with you wherever you go in the country.
Opting for Medigap means you’ll experience fewer pre-authorizations and have the peace of mind that your plan won’t be canceled at the provider’s discretion. Additionally, Medigap offers consistent coverage regardless of the state you reside in. Unlike Medicare Advantage plans, Medigap policies are not restricted to a specific network or service area.
With a Medigap system in place, Medicare takes care of its share first, and then the remaining bill is passed on to your Medigap insurer. They will cover the rest of the balance based on the specific policy letter you have chosen. By paying your premium, you are essentially eliminating most of your healthcare liability through this comprehensive coverage plan.
If you would like help securing the most optimal coverage for your situation, please feel encouraged to reach out to us. By choosing our services, you can trust that you will receive the guidance and support needed to make a well-informed and confident decision.
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