Medicare Supplement

What Medicare Supplement covers in South Sioux City

SOUTH SIOUX CITY, Neb. — If you've ever looked at a Medicare bill and wondered why Original Medicare didn't pay all of it, you're not alone. That leftover portion — the deductibles, the coinsurance, the hospital costs — is exactly what Medicare Supplement insurance, better known as Medigap, is designed to help with.

Medicare Supplement insurance, explained

Medigap isn't part of Medicare itself. It's a private policy you can buy to work alongside Original Medicare (Part A and Part B). Here in South Sioux City, which sits in Dakota County, residents shop for Medigap under the same federal rules that apply everywhere else in Nebraska — with some state-level details worth knowing.

What Medigap actually does

Original Medicare pays a big share of your hospital and doctor costs, but not all of it. You're still on the hook for things like the Part A hospital deductible, the 20% coinsurance under Part B, and other out-of-pocket amounts that have no annual cap on their own.

A Medigap policy fills in some or all of those gaps, depending on which plan you pick. Once you have one, Medicare pays its share first, then your Medigap plan pays its share of what's left.

A few key ground rules from Medicare.gov:

• You must be enrolled in both Part A and Part B to buy a Medigap policy.
• Medigap only works with Original Medicare — it does not work with Medicare Advantage.
• Medigap policies cover one person. Spouses each need their own.
• Most Medigap plans do not include prescription drug coverage. For that, you'd add a stand-alone Part D plan.

How the standardized letters work

This is the part that trips people up. Medigap plans are sold by private insurance companies, but the benefits inside each plan are standardized by the federal government. That means a Plan G from one carrier covers the same core benefits as a Plan G from another carrier. What differs is the price, the company's customer service, and sometimes small extras.

In most states, including Nebraska, Medigap plans are sold using letter names: A, B, C, D, F, G, K, L, M, and N. (Massachusetts, Minnesota, and Wisconsin do it a little differently.)

A few things to know about the letters:

• Plans C and F are only available to people who became eligible for Medicare before Jan. 1, 2020. If you turned 65 in 2020 or later, you can't buy these.
• Plan G has become one of the most common choices for newer enrollees because it covers most gaps except the Part B deductible.
• Plans K and L have lower premiums but include cost-sharing and an annual out-of-pocket limit.
• Plan N has lower premiums than Plan G but may include small copays for office and ER visits.

Medicare.gov publishes a full benefits chart showing exactly what each letter covers.

The best time to buy: your Medigap Open Enrollment Period

There's one enrollment window that matters more than any other for Medigap: your six-month Medigap Open Enrollment Period. It starts the month you're 65 or older and enrolled in Part B.

During this window:

• Insurance companies must sell you any Medigap plan they offer.
• They can't charge you more because of health problems.
• They can't turn you down.

Outside that window, in most states, insurers can use medical underwriting — meaning your health history can affect whether you're accepted or what you'll pay. Nebraska generally follows the federal rules here, so timing really matters. If you're approaching 65 in South Sioux City, mark that six-month window on your calendar.

Medigap vs. Medicare Advantage — not the same thing

This is a common mix-up. Medicare Advantage (Part C) is an alternative way to get your Medicare benefits, usually through a network-based plan that often includes drug coverage and extras. Medigap, on the other hand, works with Original Medicare to cover gaps in cost-sharing.

You can't have both at the same time. Choosing between them is a personal decision that depends on your doctors, your medications, your travel habits, and your comfort with networks versus predictable cost-sharing.

The local picture in Dakota County

South Sioux City is in Dakota County, and residents here have access to Medigap policies from multiple private insurers licensed to sell in Nebraska. Because the plan benefits are standardized by letter, the smartest thing to do is compare premiums and company reputation for the same letter across carriers — apples to apples.

You can search available Medigap policies by ZIP code using the Medigap Plan Finder at Medicare.gov.

A few 2026 facts worth knowing

Even though Medigap doesn't cover prescriptions, most people pair it with a Part D drug plan. For 2026, a few program-level numbers are set by Medicare:

• Part D out-of-pocket cap: $2,100 for the year.
• Part D maximum deductible: $615.
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly amounts, if that helps your budget.
• IRMAA income surcharges kick in above $109,000 for a single filer in 2026.
• Annual Enrollment Period: Oct. 15 – Dec. 7 (this is for Advantage and Part D — Medigap has its own rules).