Medicare Supplement

Durham Medigap in 2026: plan-letter rules, the Part B reset and how to check rate filings

Durham, N.C. — If you are shopping a Medicare Supplement (Medigap) policy in Durham this fall, a few things worth knowing shift with the calendar. The menu of standardized plan letters you can buy depends on when you became eligible for Medicare, the Part B deductible that Plans G and N are built around resets every January, and insurers refile their Medigap rates with the state on their own schedules. Here is a plain-English guide to what changes for the coming year, and where to look for the numbers that apply to you.

Medicare SupplementDurham, NC

What is actually changing for the coming year

Three things move on a yearly cycle and are worth checking before you sign anything:

1. The Part B deductible. Plans G and N (and high-deductible Plan G) are designed around it — Plan G, for example, kicks in after you have paid the Part B deductible for the year. CMS sets the new amount each fall for the following January. 2. Rate filings. Medigap premiums are not federally set. Insurers file proposed rates with the North Carolina Department of Insurance, and those filings can raise or hold premiums for existing policyholders as well as new applicants. 3. Company footprints. Insurers can enter or leave the North Carolina Medigap market, or stop selling certain plan letters to new applicants. That does not cancel an in-force policy, but it does change what a new shopper in Durham can buy.

The plan-letter rules have not changed — but they still trip people up

Medigap policies are standardized by letter, which means a Plan G from one company covers the same federally defined benefits as a Plan G from another. What differs is price and service.

The key eligibility rule: Plans C and F are closed to anyone who became eligible for Medicare on or after January 1, 2020. If that is you, the letters available are A, B, D, G, G-HD, K, L, M and N. People who were already eligible before that date can still apply for C or F if an insurer offers them.

Two other rules worth remembering:

• Your best pricing protection is the six-month Medigap Open Enrollment Period that starts when you are 65 or older and enrolled in Part B. During that window, insurers cannot deny you a policy or charge more because of your health.
• Outside that window, North Carolina generally lets insurers use medical underwriting, so approval and price are not guaranteed.

Why Plans G and N depend on the Part B reset

Plan G covers nearly all Part A and Part B cost sharing after you meet the annual Part B deductible. Plan N works similarly, with some copays for office and emergency visits. High-deductible Plan G asks you to meet a separate, higher plan deductible before coverage begins.

Because the Part B deductible resets every January, the first medical bill of the year is usually the one you pay out of pocket under a G or N policy. The 2026 figure is published by CMS on medicare.gov — check it there rather than relying on last year's number.

Rate-adjustment season: how to check what a Durham policy will cost

Because we cannot list carrier-by-carrier premiums, here is the practical path:

• Medicare.gov Medigap policy search. Enter a Durham ZIP code to see which insurers sell each plan letter in Durham County and get quotes.
• North Carolina Department of Insurance Medigap rate guide. The state publishes a comparison document showing premiums by company and plan letter, updated as filings come in.
• North Carolina SHIP (Seniors' Health Insurance Information Program). Free, unbiased counseling from trained volunteers who can walk through the rate guide with you.

When you compare, ask each insurer how they price the policy (community-rated, issue-age or attained-age), because that determines how premiums may rise as you get older, independent of the yearly rate filing.

Insurers entering or leaving North Carolina

Company participation in the Medigap market changes from year to year. There is no single "in-network" list for Medigap — any policy licensed and sold in North Carolina works with any provider who accepts Medicare. If you already have a policy and your insurer stops selling new business in the state, your existing coverage generally continues; only new applications are affected. The Medicare.gov search and the state rate guide are the two authoritative places to confirm which companies are currently taking Durham applicants.

A quick word on Part D, since it changes at the same time

Medigap does not include drug coverage, so most Medigap enrollees also carry a stand-alone Part D plan. For 2026, Part D has a $2,100 out-of-pocket cap, a maximum deductible of $615, and the old coverage gap ("donut hole") has been eliminated as of 2025 in favor of a simpler three-phase design. The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly payments if you choose. Higher-income enrollees pay IRMAA surcharges on Part B and Part D; for a single filer in 2026, IRMAA begins above $109,000 in income.

Dates to keep on the fridge

• October 15 – December 7: Medicare Annual Enrollment Period (Part D and Medicare Advantage changes).
• January 1 – March 31: Medicare Advantage Open Enrollment Period.
• Medigap does not follow these windows. You can apply any time, but outside your one-time six-month Medigap Open Enrollment (or a limited guaranteed-issue situation), insurers may underwrite.