Medicare Supplement

Medigap in Santa Fe: a separate policy, not Advantage

SANTA FE, N.M. — If you've been reading about Medicare and keep tripping over the word "Medigap," you're not alone. Medicare Supplement insurance — its formal name — is one of the most misunderstood pieces of the Medicare puzzle. It doesn't replace Medicare, and it isn't the same as a Medicare Advantage plan. It's a separate policy that helps pay some of what Original Medicare leaves behind.

Here's a plain-language look at what Medigap does, how the lettered plans work, and how to think about whether one fits your situation.

What Medigap actually does

Original Medicare (Part A and Part B) pays a big share of your hospital and doctor bills, but not all of it. You're still responsible for deductibles, coinsurance, and copayments — and there's no yearly cap on what you could owe out of pocket.

A Medigap policy, sold by private insurance companies, is designed to fill in some of those gaps. Depending on the plan letter you pick, it can help cover things like:

• The Part A hospital deductible and coinsurance
• Part B coinsurance (usually 20% of the Medicare-approved amount)
• The first three pints of blood
• Skilled nursing facility coinsurance
• Some foreign travel emergency care

Medigap does not cover prescription drugs, dental, vision, hearing aids, or long-term care. For drug coverage, you'd need a separate Part D plan.

How the standardized letters work

This is the part that trips people up. Medigap plans are standardized by the federal government and labeled with letters: A, B, C, D, F, G, K, L, M, and N. (Plans C and F are only available to people who became eligible for Medicare before Jan. 1, 2020.)

Standardization means that a Plan G from one insurer covers the exact same benefits as a Plan G from any other insurer. The company logo on the card changes; the benefits don't. What can differ is the premium — the monthly cost — and the customer service experience.

Massachusetts, Minnesota, and Wisconsin standardize their plans a little differently, but the same idea applies: same letter, same benefits within that state.

When you can buy one — and why timing matters

The best window to buy a Medigap policy is your Medigap Open Enrollment Period: the six months that begin the month you're 65 or older and enrolled in Part B. During this window, insurers can't turn you down or charge you more because of your health history.

Outside that window, in most states, insurers can use medical underwriting. That means they can look at your health and either deny coverage or raise the price. There are some "guaranteed issue" rights — for example, if you lose other coverage — but they're narrow.

If you're weighing Medigap against a Medicare Advantage plan, know that switching later isn't always simple. It's worth understanding the timing before you commit.

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, bundled through a private plan that often includes drug coverage and extras. Medigap works alongside Original Medicare and doesn't replace it.

You cannot have both a Medigap policy and a Medicare Advantage plan at the same time. It's one path or the other.

What this looks like in Santa Fe

Santa Fe is in Santa Fe County, where the Medicare rules and Medigap standardization work the same as everywhere else in New Mexico. Availability and pricing of specific Medigap plans, though, are set by the insurers licensed in the state — so two neighbors might see different premiums for the same lettered plan depending on the carrier, age, and rating method.

New Mexico residents can get free, unbiased help from the state's SHIP program (Senior Health Insurance Assistance Program), which counsels people one-on-one at no cost.

A few 2026 numbers worth knowing

Even if Medigap itself doesn't change year to year in structure, the broader Medicare program does. For 2026:

• The Part D out-of-pocket cap is $2,100.
• The Part D deductible can be no more than $615.
• The old coverage gap (the "donut hole") is gone, replaced by a simpler three-phase drug benefit.
• IRMAA — the income-related surcharge on Part B and Part D — begins above $109,000 for a single filer.
• Annual Enrollment runs Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment runs Jan. 1 – March 31.

Medigap enrollment isn't tied to those windows the same way, but the numbers matter when you're mapping out your full coverage.