Medicare Supplement

Chapel Hill guide to Medigap: how the standardized plan letters work

CHAPEL HILL, N.C. — If you have Original Medicare and you've started shopping for extra coverage, you've probably noticed the alphabet soup: Plan A, Plan B, Plan G, Plan N, and a few others. Those letters aren't marketing gimmicks. They're a set of standardized Medicare Supplement Insurance plans — commonly called Medigap — and understanding how they work can make the rest of your Medicare decisions much easier.

Here in Chapel Hill, which sits in Orange County, Medigap works the same way it does across North Carolina and most of the country. The federal government sets the rules for what each lettered plan has to cover, so a Plan G from one insurer offers the same core benefits as a Plan G from another. What can differ is price, customer service, and extras — not the standardized benefits themselves.

What Medigap actually does

Original Medicare (Part A for hospital care and Part B for doctor visits and outpatient care) pays a big share of your medical bills — but not all of it. You're still responsible for deductibles, coinsurance, and copays, and Original Medicare has no annual out-of-pocket limit.

Medigap fills in some of those gaps. Depending on which letter plan you choose, it may help pay things like:

• The Part A hospital deductible and coinsurance
• Part B coinsurance (usually 20% of the Medicare-approved amount)
• Blood (first three pints)
• Skilled nursing facility coinsurance
• Foreign travel emergency care (on some plans)

You keep your red, white, and blue Medicare card. Your Medigap card is a separate card from a private insurer, and providers bill Medicare first, then your Medigap plan picks up its share.

Why the letters matter

Before 1992, Medicare Supplement policies were a confusing mess, with every company offering something different. Congress fixed that by requiring insurers to sell standardized plans labeled with letters. Today, the plans available to new enrollees are A, B, D, G, K, L, M, and N. (Plans C and F are still held by many older enrollees but are no longer sold to people who became eligible for Medicare on or after January 1, 2020.) There's also a high-deductible version of Plan G.

Because the benefits inside each letter are set by federal rules, comparing policies becomes a cleaner question: which letter fits your health and budget, and which insurer offers it at a price you're comfortable with?

When to buy — the window that matters most

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This is a one-time, six-month window that starts the first month you're both 65 or older and enrolled in Medicare Part B.

During that window, insurers in North Carolina must sell you any Medigap policy they offer at their best available rate, and they cannot turn you down or charge you more because of your health. Once that window closes, insurers can use medical underwriting in most situations, which may affect whether you qualify or what you pay.

Medigap vs. Medicare Advantage

This trips a lot of people up: Medigap and Medicare Advantage (Part C) are not the same thing, and you can't have both.

• Medigap works alongside Original Medicare. You see any provider in the country that accepts Medicare, and your Medigap plan helps with the out-of-pocket costs.
• Medicare Advantage replaces how you get your Part A and Part B benefits. These plans are offered by private insurers, usually have networks, and often include extras like dental or vision.

If you choose Medicare Advantage, you don't need a Medigap policy — and in fact, it's illegal for someone to sell you one if they know you're enrolled in Advantage.

What Medigap does not cover

A few important things Medigap generally does not pay for:

• Prescription drugs taken at home (you'd need a separate Part D plan)
• Routine dental, vision, or hearing care
• Long-term care (like a nursing home stay for custodial reasons)
• Hearing aids, eyeglasses, or private-duty nursing

For 2026, the Part D out-of-pocket cap is $2,100 and the maximum Part D deductible is $615. The old coverage gap, often called the donut hole, was eliminated in 2025, so Part D now has three phases instead of four. There's also an optional Medicare Prescription Payment Plan that lets you spread drug costs across the calendar year in monthly amounts.

Getting local help in Chapel Hill

Choosing a Medigap letter is a personal decision — it depends on how often you see doctors, how comfortable you are paying smaller out-of-pocket costs versus a higher premium, and your overall budget. Since prices for the same lettered plan can vary between insurers, it pays to compare.

North Carolina's State Health Insurance Assistance Program (SHIP) is called SHIIP (Seniors' Health Insurance Information Program), and it offers free, unbiased counseling. Orange County residents can call SHIIP through the North Carolina Department of Insurance for one-on-one help.