Medicare Supplement

Medigap, explained: what it covers and how the plan letters work

MEDFORD, Ore. — If you have Original Medicare and you've ever opened a hospital bill wondering why you still owe hundreds of dollars, you've bumped into the gap that Medicare Supplement insurance — better known as Medigap — was designed to fill.

Medigap is private insurance you can buy to help pay some of the out-of-pocket costs Original Medicare leaves behind, like coinsurance, copayments and deductibles. It doesn't replace Medicare. It works alongside it. And unlike most insurance, Medigap plans are standardized: a plan with the same letter offers the same core benefits from company to company.

Here's what that actually means for people sorting through their options in Medford this fall.

What Medigap actually pays for

Original Medicare covers a lot, but it doesn't cover everything. Part A (hospital) has a deductible each benefit period. Part B (doctors and outpatient care) generally pays 80% of approved costs after you meet its deductible, leaving you responsible for the other 20% — with no annual cap.

Medigap plans help pick up those leftover pieces. Depending on the letter you pick, a plan may cover:

• Part A hospital coinsurance and extra hospital days
• Part B coinsurance or copayments
• The first three pints of blood in a medical procedure
• Hospice care coinsurance
• Skilled nursing facility coinsurance
• Part A and, in some older plans, Part B deductibles
• Emergency care during foreign travel (up to plan limits)

What Medigap does not cover: prescription drugs, dental, vision, hearing aids, long-term custodial care, or private-duty nursing. For drugs you need a stand-alone Part D plan.

How the standardized letters work

In most states, including Oregon, Medigap plans are sold by letter: A, B, C, D, F, G, K, L, M and N. Each letter is a package of benefits set by federal rules. That's the important part — Plan G from Company X covers the same core benefits as Plan G from Company Y. The differences are premium, customer service, and how the insurer handles rate increases over time.

Two notes worth knowing:

• Plans C and F (which cover the Part B deductible) are no longer sold to people newly eligible for Medicare on or after Jan. 1, 2020. If you were eligible before that date, you may still be able to buy them.
• Plans K and L have lower premiums but ask you to share more of the cost through out-of-pocket limits.

Plan G and Plan N tend to be the most talked-about options for people newly eligible today, but the right fit depends on your health, budget and how much predictability you want in a bill.

Medigap vs. Medicare Advantage — pick one lane

This trips people up: you cannot use Medigap with a Medicare Advantage (Part C) plan. Medigap only works with Original Medicare.

Medicare Advantage plans bundle Parts A, B and usually D into one plan run by a private insurer, often with network rules. Medigap keeps you in Original Medicare — you can see any provider nationwide who accepts Medicare — and layers on extra coverage for the gaps.

Medford is in Jackson County, where residents can choose from a range of Medicare Advantage and stand-alone Part D plans during Annual Enrollment (Oct. 15 – Dec. 7). Medigap, by contrast, isn't tied to that fall window — you can apply any time — but when you apply matters a lot, which brings us to the next point.

Timing: your one guaranteed window

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period — a 6-month window that starts the month you're 65 or older and enrolled in Part B. During this period, insurers can't turn you down or charge you more because of your health.

Outside that window, in most states insurers can use medical underwriting. That means a pre-existing condition could result in a higher premium or a denial. There are some limited "guaranteed issue" rights (for example, if you lose other coverage), but the 6-month window is the cleanest path.

Oregon has some additional consumer protections around Medigap, so if you're unsure whether a special right applies to your situation, it's worth asking before you assume the door is closed.

What Medigap does not touch: your drug plan

Medigap does not include prescription drug coverage. For that, you'll want a stand-alone Part D plan.

Some 2026 Part D facts worth keeping in mind:

• The Part D deductible is capped at $615.
• Once you hit $2,100 in out-of-pocket drug spending, you pay $0 for covered drugs the rest of the year.
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases instead of four.
• If a big pharmacy bill early in the year would strain your budget, the Medicare Prescription Payment Plan lets you spread those costs across the calendar year in monthly installments.

Higher-income beneficiaries should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that begins above $109,000 in income for a single filer in 2026.

Getting personalized help

Medigap is one of those decisions where the "right" answer depends on your health, your budget and how much billing surprise you can tolerate. Free, unbiased help is available:

• Medicare.gov — official plan finder and Medigap information
• 1-800-MEDICARE (1-800-633-4227) — 24/7 phone help
• Oregon SHIBA — the state's SHIP program, which offers free one-on-one counseling for Medford-area residents