Medicare Supplement

Medigap, explained: how the letter plans work in Ashland

# Medicare Supplement insurance, explained: what Medigap does and doesn't…

ASHLAND, Ore. — If you've ever looked at a Medicare bill and wondered why Original Medicare didn't pay all of it, you've bumped into the gap that Medicare Supplement insurance — often called Medigap — is designed to help fill.

Medigap is private insurance that works alongside Original Medicare (Part A and Part B). It doesn't replace Medicare. Instead, it helps pay some of the out-of-pocket costs Medicare leaves behind, like coinsurance, copayments, and deductibles. Here in Ashland, where many neighbors rely on Asante Ashland Community Hospital and Providence clinics across the Rogue Valley, understanding how Medigap works can make your care feel a lot less complicated.

What Medigap actually does

Original Medicare pays a big share of your hospital and doctor costs, but not all of it. You're still responsible for things like the Part A hospital deductible, Part B's 20% coinsurance, and daily costs for longer hospital stays. There's no yearly out-of-pocket limit on Original Medicare by itself.

A Medigap policy steps in to help pay those leftover pieces. Depending on the letter plan you choose, it may cover:

• Part A hospital coinsurance and extra days after Medicare's benefits are used up
• Part B coinsurance or copayments
• The first three pints of blood each year
• Skilled nursing facility coinsurance
• Part A deductible (in most plans)
• Foreign travel emergency care (in some plans)

Medigap does not cover prescription drugs, dental, vision, hearing aids, long-term custodial care, or private-duty nursing. For prescriptions, you'd add a separate Part D drug plan.

How the standardized letter plans work

Here's the part that trips up a lot of people: Medigap plans are standardized by the federal government. That means Plan G sold by one insurance company covers the same basic benefits as Plan G sold by another. The differences come down to price, customer service, and extras a company might add on.

In most states, including Oregon, ten standardized plans are available, labeled 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 January 1, 2020. Plans K and L have lower premiums but require you to share more of the cost until you hit an annual out-of-pocket limit.

Because the benefits are standardized, comparing Medigap plans is really about comparing price and the insurer behind the policy — not decoding wildly different benefit charts.

When to enroll — and why timing matters

Your Medigap Open Enrollment Period is a six-month window that starts the first month you're both 65 or older and enrolled in Medicare Part B. During this window, insurers must sell you any Medigap policy they offer at their best available rate, regardless of your health history.

After that window closes, insurers in most states can use medical underwriting. That means they can look at your health and either charge you more or turn you down. Oregon has some additional protections in certain situations (called guaranteed issue rights), but the safest time to shop is that first six months.

Medigap vs. Medicare Advantage

It's important to know Medigap and Medicare Advantage (Part C) are two different paths, and you can't use both at the same time.

• Original Medicare + Medigap + Part D = pay-as-you-go with a supplement helping cover the gaps, plus a separate drug plan.
• Medicare Advantage = a private plan that bundles Part A, Part B, and usually Part D, often with an HMO or PPO network.

Ashland is in Jackson County, where residents have access to both Medicare Advantage plans and Medigap policies from a range of carriers. Which route fits you depends on your doctors, your budget, how you feel about networks, and how predictable you want your monthly costs to be.

What to check before you buy

Before signing on the dotted line, walk through this short checklist:

1. Am I inside my Medigap Open Enrollment Period, or would I face underwriting? 2. Do I have — or will I add — a Part D drug plan to cover prescriptions? 3. Have I compared prices from multiple insurers for the exact same lettered plan? 4. Do I understand that Medigap works only with Original Medicare, not Medicare Advantage?

A quick note on 2026 numbers

While Medigap itself is separate from Part D, most people pair the two. For 2026, Part D has a $2,100 annual out-of-pocket cap on covered drugs and a maximum deductible of $615. The old coverage gap ("donut hole") has been gone since 2025. If drug costs strain your monthly budget, ask about the Medicare Prescription Payment Plan, which lets you spread drug costs across the year. And remember: Medicare's Annual Enrollment Period runs October 15 to December 7, while the Medicare Advantage Open Enrollment Period runs January 1 to March 31.