Medicare Supplement

What Medigap Covers Beyond Original Medicare in Troutdale

TROUTDALE, Ore. — If you have Original Medicare, you already know it doesn't pay for everything. Part A and Part B leave you on the hook for deductibles, coinsurance, and copays that can add up fast. That's where Medicare Supplement insurance — better known as Medigap — comes in.

Medigap is private insurance you can buy to help cover those out-of-pocket costs. It doesn't replace Medicare. It sits alongside it, picking up some of the bills Original Medicare passes to you. Here's how it works, and what the standardized letter plans actually mean.

What Medigap does

Medigap policies help pay costs that Original Medicare leaves behind — things like the Part A hospital deductible, coinsurance for hospital stays, and the 20% coinsurance you'd normally owe under Part B for doctor visits and outpatient care.

You keep your red, white, and blue Medicare card and use Medicare as your primary coverage. When a bill comes in, Medicare pays its share first, then your Medigap policy pays its share of what's left. You pay a monthly premium to the private insurance company for that extra coverage.

Medigap is only for people enrolled in Original Medicare (Part A and Part B). If you're on a Medicare Advantage plan, you can't also use a Medigap policy — the two don't work together.

How the standardized letters work

Here's the part that trips people up. In most states, Medigap plans are standardized and labeled with letters: 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.

"Standardized" means the benefits inside each letter plan are set by federal rules. A Plan G sold by one company covers the same core benefits as a Plan G sold by another. What can differ is the monthly premium, customer service, and whether the company offers extras like a gym benefit.

Two big things to keep in mind:

• Medigap doesn't include prescription drug coverage. If you want help paying for medications, you'll need a separate Part D plan.
• Medigap doesn't cover most dental, vision, hearing, or long-term care. Those are separate purchases or, in some cases, benefits offered through Medicare Advantage plans instead.

Why the enrollment window matters

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period — the six months that start when you're 65 or older and enrolled in Part B. During that window, insurance companies can't turn you down or charge you more because of health problems.

Outside that window, in most states, insurers can look at your health history (medical underwriting) and either raise your price or decline your application. Oregon has some added protections, but the six-month window is still the cleanest time to enroll. If you're weighing your options in Troutdale, this timing detail matters more than the plan letter itself.

Medigap vs. Medicare Advantage

This is where a lot of confusion starts. Medicare Advantage (Part C) is a different way to get your Medicare benefits — it replaces Original Medicare with a private plan that often bundles in drug coverage and extras. Medigap works with Original Medicare, not instead of it.

Troutdale is in Multnomah County, where dozens of Medicare Advantage plans are offered each year through private carriers. That's the county-level availability — plan choices are set at the county level, not the city level. Medigap, on the other hand, isn't tied to a county network. You can generally use it with any provider in the U.S. who accepts Medicare.

Neither path is universally "better." It depends on your health, your doctors, your prescriptions, and your budget.

What's changing in 2026 for drug costs

Even though Medigap doesn't cover prescriptions, most people who buy a Medigap policy also enroll in a Part D drug plan. A few 2026 figures worth knowing:

• Part D has a new $2,100 out-of-pocket cap on covered drugs.
• The maximum Part D deductible is $615.
• The old coverage gap (the "donut hole") is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter.
• IRMAA surcharges — extra premiums for higher earners — kick in above $109,000 in income for a single filer in 2026.

Mark your calendar: Medicare's Annual Enrollment Period runs October 15 through December 7, and the Medicare Advantage Open Enrollment Period runs January 1 through March 31.