Medicare Supplement

Medigap in Mount Lebanon: What Those Letter Plans Really Cover

MOUNT LEBANON, Pa. — If you've ever looked at a Medicare Supplement brochure and wondered why the plans are named after letters of the alphabet, you're not alone. Medicare Supplement insurance — often called Medigap — is one of the more misunderstood corners of Medicare, and for good reason. The names are dry, the choices feel similar, and the sales pitches can blur together.

Making sense of Medicare Supplement insurance in Mount Lebanon

Here in Mount Lebanon, where a large share of neighbors are on Medicare or heading toward it, understanding what Medigap actually does (and doesn't do) can save a lot of second-guessing later.

What Medigap is — and what it isn't

Medigap is a private insurance policy that works alongside Original Medicare (Part A and Part B). It helps pay for some of the out-of-pocket costs Original Medicare leaves behind — things like coinsurance, copayments, and, in some cases, the Part A hospital deductible.

A few important points from Medicare.gov:

• Medigap only works with Original Medicare. If you're enrolled in a Medicare Advantage plan, you generally can't also use a Medigap policy.
• Medigap does not include prescription drug coverage. For drug coverage, you'd add a separate Part D plan.
• Medigap doesn't cover dental, vision, hearing aids, long-term care, or private-duty nursing. Those are separate needs handled by other coverage or out-of-pocket.
• You pay a monthly premium for a Medigap policy in addition to your Part B premium.

In short, Medigap is a cost-sharing helper, not an all-in-one benefits package.

Why the plans are named with letters

Medigap policies are standardized by the federal government. That means a Plan G sold by one company covers the same basic benefits as a Plan G sold by another company. The letter tells you what's covered; the company sets the price and customer service experience.

The currently sold plans are labeled with letters like A, B, D, G, K, L, M, and N. (Plans C and F are still held by some longtime enrollees but are no longer sold to people newly eligible for Medicare on or after January 1, 2020, because those plans covered the Part B deductible.)

Each letter offers a different mix of benefits, such as:

• Part A hospital coinsurance and extra hospital days
• Part B coinsurance or copayments
• The first three pints of blood
• Hospice care coinsurance
• Skilled nursing facility coinsurance
• The Part A deductible
• Foreign travel emergency care (up to plan limits)

Plans K and L work a little differently — they share costs at a set percentage until you hit an annual out-of-pocket limit, then pay 100% of covered services for the rest of the year.

Because the benefits are standardized, the smartest comparison isn't "which letter is best" in the abstract — it's which letter fits how often you use care, and then which company offers a fair price and stable service.

The Mount Lebanon (and Pennsylvania) angle

Mount Lebanon is in Allegheny County, where residents have access to Original Medicare plus a healthy market of both Medicare Advantage plans and Medigap carriers. Pennsylvania follows the federal standardized-letter system for Medigap, so a Plan G here covers the same core benefits as a Plan G anywhere else in the country that uses the standard chart.

What can differ locally:

• Premiums. Two companies can charge very different monthly rates for the identical lettered plan.
• How premiums are rated. In Pennsylvania, insurers may price Medigap using community-rated, issue-age, or attained-age methods, which affects how your premium changes over time.
• Which carriers actively sell in your ZIP code.

For personalized help sorting this out, Pennsylvania's APPRISE program — the state's SHIP (State Health Insurance Assistance Program) — offers free, unbiased Medicare counseling to Allegheny County residents.

Timing matters: your Medigap Open Enrollment window

One of the most important things to know about Medigap is that it has its own enrollment window, separate from the fall Annual Enrollment Period.

Your 6-month Medigap Open Enrollment Period starts the month you're 65 or older and enrolled in Part B. During this window, you have a guaranteed issue right — insurers can't turn you down or charge you more because of health conditions.

Outside that window, in most states including Pennsylvania, insurers can use medical underwriting. That means a health condition could affect whether you're accepted or how much you pay. There are limited "guaranteed issue" situations later on (for example, if certain coverage ends involuntarily), but the initial 6-month window is by far the simplest time to buy.

This is different from Medicare's other well-known dates:

• Annual Enrollment Period: October 15 – December 7 (for Part D and Medicare Advantage changes)
• Medicare Advantage Open Enrollment: January 1 – March 31

Those windows don't govern Medigap the same way, which is a common source of confusion.

How Medigap fits with Part D and 2026 drug costs

Because Medigap doesn't include drug coverage, most people who choose Original Medicare + Medigap also enroll in a standalone Part D plan for prescriptions.

A few program-level facts to keep in mind for 2026:

• The Part D out-of-pocket cap is $2,100 for the year.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap was eliminated in 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly amounts instead of paying big bills at the pharmacy counter.
• IRMAA surcharges — higher Part B and Part D premiums for higher incomes — start above $109,000 in income for a single filer in 2026.

These figures apply nationally, including here in Mount Lebanon.