Executive Summary
Medicare Supplement Insurance, usually called Medigap, is private insurance that helps pay some costs left after Original Medicare pays. It is not a replacement for Medicare and is not Medicare Advantage.
Medigap can make covered Original Medicare expenses more predictable, but it adds a separate monthly premium and generally does not cover prescriptions, routine dental or vision care, hearing aids, or long-term custodial care. Benefits are standardized by plan letter in Florida, while premiums and company practices can differ. Enrollment timing matters because acceptance may depend on a protected right or medical underwriting.
Quick Takeaways
- Medigap only works with Original Medicare.
- It generally cannot pay Medicare Advantage costs.
- The same plan letter has the same core benefits.
- Identical benefits can have different premiums.
- Your one-time open enrollment lasts six months.
- Outside protected periods, underwriting may apply.
- Modern Medigap policies do not include Part D.
- Premiums can rise after enrollment.
The Foundation
What Medigap Is, Why It Exists, and How It Works
Original Medicare pays much, but not all, of the cost of covered Part A and Part B services. Depending on the service, a beneficiary may owe deductibles, copayments, or coinsurance. Original Medicare also has no annual out-of-pocket ceiling. A Medigap policy is designed to fill specified portions of those gaps.
Provider bills
A Medicare-participating or Medicare-enrolled provider submits the covered claim.
Medicare decides
Original Medicare determines coverage and pays its share of the Medicare-approved amount.
Medigap follows
Claim information is usually sent to the Medigap insurer, which pays the policy's share.
You pay the rest
You pay any amount not covered by Medicare or the selected Medigap plan.
Medigap does not turn a non-covered service into a covered one. It normally supplements cost sharing for Medicare-covered care.
What Medigap does not cover
- Long-term custodial care, such as ongoing help with bathing or dressing.
- Routine dental and vision care, eyeglasses, hearing aids, and private-duty nursing.
- Most outpatient prescription drugs; policies sold after 2005 do not include drug coverage.
- Medicare Advantage premiums, deductibles, copayments, or coinsurance.
- A spouse: each person needs a separate policy.
Standard Benefits
The Standardized Medigap Plans
In Florida and most states, plan letters identify standardized benefit packages. If two insurers sell Plan G, their standardized Plan G medical benefits are the same. Premiums, customer service, household discounts, rate history, and administrative experience may differ. Insurers do not have to offer every letter, although any insurer selling Medigap must offer Plan A and must also offer Plan C or F to people eligible for those plans, and Plan D or G to people new to Medicare on or after January 1, 2020.
| Benefit | A | B | D | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| Part A coinsurance + 365 extra hospital days | 100% | 100% | 100% | 100% | 100%* | 100%* | 100% | 100% |
| Part B coinsurance/copays | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% less allowed copays |
| First 3 pints of blood | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A hospice cost sharing | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled nursing facility coinsurance | No | No | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A deductible | No | 100% | 100% | 100% | 50% | 75% | 50% | 100% |
| Part B deductible | No | No | No | No | No | No | No | No |
| Part B excess charges | No | No | No | 100% | No | No | No | No |
| Foreign travel emergency | No | No | 80% | 80% | No | No | 80% | 80% |
*Plans K and L pay 100% of Part A hospital coinsurance and the additional 365 hospital days. Their other listed basic benefits generally pay 50% or 75% until the annual limit and Part B deductible conditions are met. In 2026, the K limit is $8,000 and the L limit is $4,000.
Why Plans C and F are limited
Federal law generally prevents people who became newly eligible for Medicare on or after January 1, 2020 from buying plans that cover the Part B deductible. Plans C and F remain available to some people who were eligible for Medicare before that date, even if they enrolled later. Existing policyholders may keep eligible coverage. This is an eligibility-date rule—not a statement that Plan F disappeared.
Compare standardized benefits at Medicare.gov →Plan Details
Plan G, Plan N, High-Deductible G, and Medicare SELECT
Plan G is popular because it covers all listed standardized gaps except the annual Part B deductible and includes Part B excess-charge protection and limited foreign travel emergency coverage. Popularity does not make it automatically best; premium, health use, travel, and risk preferences still matter.
| Feature | Plan G | Plan N |
|---|---|---|
| Part B deductible | You pay it | You pay it |
| Part B coinsurance | Covered after deductible | Covered after deductible, except up to $20 for some office visits and up to $50 for some ER visits not resulting in admission |
| Part B excess charges | Covered | Not covered |
| Foreign travel emergency | 80%, within plan limits | 80%, within plan limits |
| Decision focus | Premium for broader standardized cost sharing | Potential premium difference versus accepted copays and excess-charge exposure |
High-Deductible Plan G
Where offered, high-deductible Plan G uses the same benefit categories as Plan G but does not begin paying until the annual high deductible is met. The 2026 high deductible is $2,950. The premium may be lower, but a beneficiary should be prepared to fund the deductible and understand which expenses count.
Medicare SELECT
Medicare SELECT is a standardized Medigap policy that may require use of specified hospitals and, in some cases, providers for full benefits except emergencies. Original Medicare still pays its share of approved care, but SELECT may pay less or nothing outside its network. Medicare says a person who buys SELECT has a 12-month right to switch to a standard Medigap policy; moving out of the SELECT service area may create additional rights.
What You Pay
Monthly Premiums, Deductibles, Pricing Methods, and Increases
You pay the Medigap insurer a monthly premium in addition to the Part B premium and any Part D premium. Premiums can differ by plan letter, company, ZIP code, age, tobacco use, household discount, sex where permitted, and enrollment or underwriting status. An initial premium is not a lifetime rate.
Annual increases can reflect medical inflation, claim trends, age under attained-age pricing, or changes to discounts. A company's past increases cannot guarantee future increases. Compare current premium, pricing method, rate history, financial and complaint information from regulators, and how a future switch might involve underwriting.
Foreign travel emergency benefit
Plans C, D, F, G, M, and N generally pay 80% of qualifying emergency care during the first 60 days of a trip, after a $250 calendar-year deductible, up to a $50,000 lifetime limit. Confirm the policy terms and keep itemized foreign bills and proof of payment.
Part B excess charges
A provider who does not accept Medicare assignment may, where allowed, charge up to the Medicare limiting charge. Plans F and G cover standardized Part B excess charges; the other current letters do not. State rules may limit excess charges, and not every nonparticipating provider charges them.
Your One-Time Window
The Medigap Open Enrollment Period
Your federal Medigap Open Enrollment Period lasts six months. It begins the first month you are both age 65 or older and enrolled in Part B. During this period, an insurer cannot use medical underwriting to deny a policy it sells or charge more because of health problems. This period is different from the October 15–December 7 Medicare Open Enrollment Period and generally does not repeat annually.
Before Part B
Research letters, companies, timing, Part D, and any employer coverage. Do not start Part B solely to trigger Medigap without understanding coordination.
Month 1
At 65+ with Part B effective, the six-month window starts. Applications may often be submitted before the requested effective date.
Months 1–6
Compare and enroll without health-based denial for a policy the insurer sells. A limited pre-existing condition waiting period can apply in some cases.
After month 6
Unless another protection applies, an insurer may use underwriting, charge differently, or deny an application where permitted.
Someone covered through current employment may qualify to delay Part B. When Part B later begins at age 65 or older, the one-time Medigap window generally starts then. Confirm employer coordination and enrollment timing.
Protected Situations
Guaranteed Issue Rights and Trial Rights
A guaranteed issue right is a limited protection outside Medigap Open Enrollment. When the federal right applies, an insurer must sell specified plan letters, cover pre-existing conditions, and cannot charge more because of health. The available letters and deadlines depend on the situation and on whether you were newly eligible for Medicare before 2020.
| Common federal situation | Typical protection | Timing to verify |
|---|---|---|
| Medicare Advantage plan leaves Medicare, stops serving the area, you move out, or a qualifying significant network change occurs | If returning to Original Medicare, specified plans A, B, C*, D*, F*, or G* | Generally from 60 days before coverage ends through 63 days after |
| Employer/union coverage that pays after Medicare ends | Specified A, B, C*, D*, F*, or G* | Generally no later than 63 days after coverage ends |
| Medigap insurer goes bankrupt or coverage ends through no fault of yours | Specified A, B, C*, D*, F*, or G* | Generally no later than 63 days after coverage ends |
| Insurer misled you or did not follow applicable rules | Specified A, B, C*, D*, F*, or G* | Generally no later than 63 days after prior coverage ends |
| First trial right: joined Medicare Advantage at first Part A eligibility at 65 and leave within 12 months | Any Medigap policy sold in your state for which you are eligible | Apply as early as 60 days before and no later than 63 days after MA ends |
| Second trial right: dropped Medigap to try Medicare Advantage for the first time and return within 12 months | Prior Medigap policy if available; otherwise specified alternatives | Coordinate before MA ends; federal deadline generally 63 days after |
| Move out of Medicare SELECT service area | Options through current insurer or specified guaranteed-issue plans | Confirm before moving and within the applicable deadline |
*Plans C and F are only available under the pre-2020 eligibility rules; Plan D and G substitutions apply to people newly eligible on or after January 1, 2020. Exact rights depend on the facts and current federal and state law.
If yes, use that broad protection. If no, continue.
Save termination notices, move records, and plan letters. Compare the event with the official guaranteed-issue chart.
Identify whether this was your first MA enrollment at 65 or your first switch from Medigap.
Do not assume acceptance. Ask insurers about underwriting and get a written approval and effective date before ending existing coverage.
Changing Policies
Medical Underwriting, Switching, and Florida Replacement Rules
Medical underwriting is the insurer's review of health history, medications, treatment, and other permitted factors to decide whether to issue a policy and at what rate. It generally cannot be used during your Medigap Open Enrollment Period or for a plan protected by guaranteed issue. At other times, rules and insurer criteria vary; an application is not an approval.
| Situation | Underwriting generally? | Safer process |
|---|---|---|
| Six-month Medigap Open Enrollment | No health-based denial for policies offered | Compare all available letters and companies |
| Verified guaranteed-issue right | No for the protected plan choices | Submit proof and meet the deadline |
| Voluntary company switch later | Often possible | Apply first; wait for written approval |
| Moving within Florida without losing coverage | May apply | Ask whether the move creates a state or federal right |
| Changing plan letters later | May apply | Do not assume moving to fewer benefits is automatic |
When replacing one Medigap policy with another in Florida, disclose the replacement on the application. Do not cancel the old policy until the new policy is issued, its effective date is confirmed, and you decide to keep it. Florida provides a 30-day free-look period after delivery; when switching, you may pay both premiums during that period. Canceling the old policy can be irreversible.
Do not disenroll from Medicare Advantage, cancel Medigap, or end other coverage based only on a quote or submitted application. Coordinate election rights, underwriting approval, effective dates, and Part D.
Separate Coverage
Medigap and Prescription Drugs
Medigap policies sold after 2005 do not include outpatient prescription drug coverage. Someone who wants drug coverage generally enrolls in a separate Part D plan. Part D has its own premium, formulary, pharmacy network, cost sharing, and enrollment rules. A gap of 63 or more consecutive days without Part D or other creditable drug coverage may trigger a late enrollment penalty.
Some older Medigap policies still contain drug benefits. A person who joins Part D must tell the Medigap insurer to remove the older drug coverage, and it generally cannot be added back. Review whether that older coverage is creditable and coordinate dates before changing.
Two Legitimate Paths
Medigap Compared with Medicare Advantage
These are different ways to organize Medicare coverage. Neither is universally preferable. Medigap supplements Original Medicare; Medicare Advantage is a private-plan way to receive Part A and Part B benefits. Individual fit depends on providers, travel, prescriptions, budget, benefit preferences, and tolerance for networks and variable cost sharing.
| Question | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| How Part A/B are delivered | Federal Original Medicare pays first; Medigap supplements | Medicare-approved private plan administers benefits |
| Providers | Any U.S. provider accepting Medicare patients; assignment affects excess charges | Networks, service areas, and plan acceptance often apply |
| Medical cost structure | Separate premium; standardized gaps covered by selected letter | Plan premium, deductibles, copays/coinsurance, and annual medical out-of-pocket limit |
| Drug coverage | Usually separate Part D | Most plans include Part D |
| Prior authorization | Original Medicare rules; limited prior authorization programs | Plan may require authorization for specified services |
| Routine dental/vision/hearing | Generally separate or out of pocket | May include plan-specific supplemental benefits |
| Changing later | New Medigap may require underwriting without a protected right | Plan changes require an election period; return to Original Medicare does not itself guarantee Medigap |
| Annual change | Standardized benefits stable; premiums can change | Benefits, costs, formulary, and network may change annually |
State Context
Florida-Specific Considerations
Medigap is governed by federal standards and Florida insurance law. Florida's Department of Financial Services provides consumer information and complaint assistance. Premiums and available companies can vary by Florida location. Florida provides a 30-day free-look period after policy delivery and regulates replacement disclosures and protections.
- Confirm that the company and agent are licensed in Florida.
- Ask for the exact premium for your Florida ZIP code and household circumstances.
- Request the pricing method, available discounts, and rate-change history.
- For replacement, keep the old policy active through written approval and the new effective date.
- People under 65 with Medicare may have different availability and pricing; verify current Florida requirements.
- Florida residence alone does not create a yearly right to change Medigap without underwriting.
State protections can change and facts matter. Confirm a claimed replacement, open-enrollment, or guaranteed-issue right with the Florida Department of Financial Services and the insurer before acting.
Florida Medicare Supplement consumer overview →Educational Illustrations
How Medigap Rules Can Play Out
Same letter, different premium
Lena compares two Plan G policies. Core standardized benefits match, but premiums, discounts, and pricing approaches differ.
Part B starts at 67
Marcus delayed Part B while covered through current work. His six-month Medigap window starts when Part B begins at age 67.
October confusion
Nora learns that October 15 does not create a new Medigap open enrollment period. A switch may be underwritten.
Plan N office visit
After meeting Part B's deductible, Eli may owe an allowed office copay under Plan N and checks assignment status.
Excess charge
A nonparticipating provider does not accept assignment. Tasha checks the limiting charge and knows Plan N does not cover excess charges.
High-deductible G
Sam compares the lower premium with the ability to pay up to the 2026 $2,950 high deductible before policy benefits begin.
Foreign emergency
June receives emergency care within the first 60 days abroad and keeps itemized bills for the deductible, 80% benefit, and lifetime-limit review.
First MA trial
Andre joined Medicare Advantage when first eligible at 65 and wants Original Medicare within 12 months. He verifies his trial right before changing.
Returning later
Priya leaves Medicare Advantage after several years. Returning to Original Medicare is possible during an election period, but Medigap is not automatically guaranteed.
Plan departure
Cal's MA plan leaves his area. He saves the notice and checks the federal guaranteed-issue choices and application deadline.
Replacing a policy
Wanda keeps her old Medigap policy until the new one is issued, then uses Florida's 30-day free-look period to evaluate it.
Premium increase
Howard's standardized benefits have not changed, but his premium rises. He asks why and explores options without assuming underwriting approval.
Separate Part D
Mia buys Medigap and separately selects Part D after checking her prescriptions and pharmacies.
Medicare SELECT travel
George learns that Original Medicare may pay while his SELECT policy pays less outside its network for non-emergency care.
Spouses choose separately
Ruth and Ben each need an individual policy and may choose different letters or companies based on their own circumstances.
Common misunderstandings and mistakes
Original Medicare remains primary.
Medigap cannot pay MA cost sharing.
Ask the provider directly.
Compare benefits first, then companies within a letter.
Consider rating method, discounts, history, and service.
Modern Medigap policies exclude Part D.
A quote or application is not acceptance.
The federal six-month window is generally one time.
Print and Use
Medigap Plan Selection Checklist
Frequently Asked Questions
Medigap FAQ
What is Medigap?
It is private Medicare Supplement Insurance that helps pay specified deductibles, coinsurance, and copayments left by Original Medicare.
Does Medigap replace Original Medicare?
No. Original Medicare decides and pays covered claims first; Medigap supplements according to its standardized benefits.
Can I use Medigap with Medicare Advantage?
Generally no. Medigap cannot pay Medicare Advantage premiums or cost sharing, and you cannot buy it while in Medicare Advantage unless switching to Original Medicare.
Do I need both Part A and Part B?
Generally yes. You must have Original Medicare Parts A and B to buy Medigap and keep paying the Part B premium.
Are Medigap plans standardized?
Yes in Florida and most states. The same letter has the same basic benefits regardless of insurer; Massachusetts, Minnesota, and Wisconsin standardize differently.
Why do identical plan letters have different premiums?
Insurers set their own premiums and may use different rating methods, discounts, locations, and underwriting rules.
Is Plan G always the best?
No. It is popular, but no letter is universally best. Compare benefits, premiums, risk tolerance, travel, and personal needs.
What does Plan G not cover?
Among standardized Medicare cost-sharing gaps, it does not cover the Part B deductible. It also generally does not cover routine dental, vision, hearing aids, long-term custodial care, or outpatient prescriptions.
How is Plan N different from Plan G?
Plan N allows certain office and emergency-room copays and does not cover Part B excess charges; both leave the Part B deductible to you.
Can I buy Plan F?
Only if you were eligible for Medicare before January 1, 2020 and otherwise qualify. Existing eligible policyholders may keep it.
What is high-deductible Plan G?
It requires you to pay Medicare-covered costs up to an annual high deductible before the policy pays. The deductible is $2,950 in 2026.
What is Medicare SELECT?
It is standardized Medigap that may require specified hospitals or providers for full benefits, except emergencies.
What is my Medigap Open Enrollment Period?
It is the one-time six months beginning the first month you are both 65 or older and enrolled in Part B.
Does Medigap Open Enrollment happen every fall?
No. The October 15–December 7 Medicare Open Enrollment Period is primarily for Medicare Advantage and Part D, not a yearly Medigap right.
Can I be denied during Medigap Open Enrollment?
An insurer cannot deny you because of health for a Medigap policy it offers during your protected six-month period.
Can a pre-existing condition waiting period apply?
In limited circumstances, coverage of related out-of-pocket costs may be delayed up to six months, reduced by qualifying prior creditable coverage. Guaranteed-issue rights prohibit that waiting period.
What is medical underwriting?
It is an insurer's health review used outside protected periods to decide whether to issue coverage and at what permitted rate.
Does submitting an application guarantee acceptance?
No. Unless a protected right applies, wait for written approval and a confirmed effective date before ending existing coverage.
What is a guaranteed issue right?
It is a protection in specified situations requiring insurers to offer certain Medigap plans without health-based denial or pricing.
What is a Medigap trial right?
It is a federal protection allowing certain people to leave Medicare Advantage within the first 12 months and buy specified Medigap coverage.
Can I switch Medigap policies anytime?
You may apply anytime, but outside a protected right the new insurer may use underwriting. Do not cancel the existing policy before written approval.
What is Florida's free-look period?
Florida provides 30 days after policy delivery to return a Medigap policy for a premium refund; replacement may require paying both premiums temporarily.
Does Medigap include prescription drugs?
Policies sold after 2005 do not. You generally need a separate Part D plan for outpatient prescription coverage.
Does Medigap cover dental, vision, or hearing?
Standardized benefits generally do not cover routine dental or vision care, eyeglasses, or hearing aids.
Does Medigap cover long-term care?
No. It does not cover ongoing custodial long-term care.
Does Medigap cover foreign travel?
Plans C, D, F, G, M, and N include a limited 80% foreign emergency benefit after a deductible, subject to time and lifetime limits.
What are Part B excess charges?
They are permitted charges above the Medicare-approved amount from certain providers who do not accept assignment, subject to the federal limiting charge and state rules.
Can my Medigap premium increase?
Yes. Premiums can rise because of rating method, age, inflation, claims experience, or discount changes even though standardized benefits stay the same.
Does my spouse share my policy?
No. A Medigap policy covers one person; spouses apply and pay separately.
Where can I verify my rights?
Use Medicare.gov, the official Choosing a Medigap Policy guide, Florida's Department of Financial Services, or SHINE, Florida's SHIP counseling program.
Official Resources
Verify Current Medigap Information
Individual Questions
Ask Steve About Medigap
Bring your Medicare dates, current coverage, preferred providers, travel pattern, prescriptions, budget, and any termination notices. Steve can help you organize questions and compare standardized options without assuming a particular plan or company is right for everyone.
Steve Hamilton
Hamilton Insurance Agency
Florida License W792922
Phone: 352-232-9295
Email: steve@medicarebrooksvillefl.com
Medicare Disclaimer
This guide provides general educational information and does not replace individualized Medicare, legal, tax, medical, or financial advice. Medigap availability, premiums, underwriting criteria, rights, deadlines, and state rules can change. Confirm current information with Medicare, CMS, the Florida Department of Financial Services, the insurer, and other appropriate professionals before making decisions.
Hamilton Insurance Agency is not connected with or endorsed by the U.S. government or the federal Medicare program.