Medicare Supplement

Why the same Medigap letter means identical benefits in Newberg

NEWBERG, Ore. — If you've turned 65 recently, or you're helping a parent sort through the mail piling up on the kitchen table, you've probably run into the term "Medigap." It sounds technical, but the idea behind it is simple: Medigap — also called Medicare Supplement insurance — helps pay some of the costs Original Medicare leaves behind.

Here's a plain-English look at what Medigap does, what it doesn't do, and how those standardized letter plans (A, B, G, K, L, N, and more) actually work.

What Medigap is designed to do

Original Medicare — Part A (hospital) and Part B (doctor and outpatient) — pays a big chunk of your medical bills, but not all of it. You still owe deductibles, coinsurance, and copays, and there's no yearly limit on what you could spend out of pocket.

Medigap policies are sold by private insurance companies and are designed to fill some of those gaps. Depending on the plan letter you choose, a Medigap policy may help pay:

• The Part A hospital deductible and coinsurance
• The Part B coinsurance (usually 20% of covered services)
• The first three pints of blood
• Skilled nursing facility coinsurance
• Hospice care coinsurance
• Some foreign travel emergency care

Medigap only works alongside Original Medicare. It does not work with Medicare Advantage (Part C). You pick one lane or the other.

Why the plans are labeled with letters

This is the part that trips people up. Medigap plans are standardized by the federal government. That means Plan G from one insurance company covers the exact same core benefits as Plan G from another company. The price can vary — sometimes a lot — but the benefits inside a given letter plan are the same.

In most states, including Oregon, the plans available today include A, B, C, D, F, G, K, L, M, and N. Two of those — Plans C and F — are only available to people who became eligible for Medicare before January 1, 2020. If you turned 65 after that date, those two are off the table.

Plans K and L are cost-sharing plans, meaning you split the covered costs with the insurer up to an annual out-of-pocket limit. Plan N has a similar approach with small copays for some office and ER visits. Plans G and, for older enrollees, F tend to be the most comprehensive.

What Medigap does NOT cover

This is just as important as knowing what it does cover. Medigap generally does not pay for:

• Prescription drugs (you need a separate Part D plan for that)
• Routine dental, vision, or hearing care
• Hearing aids or eyeglasses
• Long-term care (nursing home stays beyond skilled nursing)
• Private-duty nursing

If you want drug coverage with your Original Medicare + Medigap setup, you'll enroll in a stand-alone Part D plan. For 2026, Part D has a maximum deductible of $615 and — this is a big one — a $2,100 annual cap on what you pay out of pocket for covered drugs. The old "donut hole" coverage gap is gone as of 2025.

Newberg and the local picture

Newberg is in Yamhill County, where seniors have a choice between staying with Original Medicare (often paired with a Medigap policy and a Part D drug plan) or enrolling in a Medicare Advantage plan that bundles benefits together. Medigap availability is regulated at the state level in Oregon, and multiple insurance companies sell the standardized letter plans here.

One thing worth knowing: the best window to buy a Medigap policy is your Medigap Open Enrollment Period — the six months that start when you're 65 or older and enrolled in Part B. During that window, insurers can't turn you down or charge you more because of your health. Outside that window, in most cases, they can.

When you can make changes

A few key dates to keep in your back pocket:

• October 15 – December 7: Medicare Annual Enrollment Period. This is when you can change Part D or Medicare Advantage plans.
• January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're in an Advantage plan, you can switch to another one or return to Original Medicare.
• Medigap: Unlike Part D and Advantage, Medigap doesn't have a single yearly window. You can apply anytime, but outside your initial six-month Open Enrollment Period, insurers can use medical underwriting.

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

A quick FAQ

Do I need Medigap if I already have a Medicare Advantage plan? No — and legally, an agent can't sell you one to go with a Medicare Advantage plan. Medigap only works with Original Medicare.

Is Plan G the same everywhere? The core benefits are, yes. But premiums are set by each insurance company, so it's smart to compare prices from multiple carriers for the same letter plan.

What if I have a health condition — can I still get Medigap? During your six-month Medigap Open Enrollment Period, insurers must sell you a policy regardless of health. After that, they can ask health questions in most cases. There are also some "guaranteed issue" situations that protect you.

Does Medigap cover my prescriptions? No. You'll need a separate Part D plan for drug coverage.

Where to get trustworthy answers

Medicare decisions are personal, and the "right" setup depends on your health, budget, and the doctors you want to keep. Before signing anything, use official sources:

• Medicare.gov — the plan finder and Medigap comparison tools
• 1-800-MEDICARE (1-800-633-4227), available 24/7
• Oregon SHIBA — the state's free Senior Health Insurance Benefits Assistance program, part of the national SHIP network, offers one-on-one counseling at no cost

Take your time. The letter plans aren't going anywhere, and getting a clear answer today is worth more than a rushed decision tomorrow.