Medicare Supplement

Medigap explained for Cleveland readers sorting Medicare mail

CLEVELAND, Tenn. — If you're new to Medicare — or helping a parent sort through the mail piling up on the kitchen table — you've probably run into the term "Medigap." It sounds like jargon, but the idea behind it is simple: Original Medicare doesn't pay for everything, and Medigap is designed to help cover some of what's left.

Here's a plain-English look at what Medicare Supplement insurance does, how the lettered plans work, and the mistakes that trip people up most often.

What Medigap actually is

Medigap, also called Medicare Supplement insurance, is a private policy you can buy to work alongside Original Medicare (Part A hospital coverage and Part B doctor coverage). It doesn't replace Medicare. Instead, it helps pay some of the out-of-pocket costs Original Medicare leaves behind — things like coinsurance, copayments, and deductibles.

A few key points to keep straight:

• Medigap only works with Original Medicare. It does not work with a Medicare Advantage plan.
• Medigap policies generally do not include prescription drug coverage. For drugs, you'd add a stand-alone Part D plan.
• You pay a monthly premium for Medigap on top of your Part B premium.

How the lettered plans work

This is the part that confuses almost everyone. Medigap plans are sold by private insurance companies, but the benefits inside each lettered plan are standardized by the federal government. That means Plan G from one company covers the same medical costs as Plan G from another company. The price and customer service can differ — the benefits cannot.

In most states, the plans currently available to new enrollees are labeled with letters like A, B, D, G, K, L, M, and N. Plans C and F are still around, but they're generally only available to people who were eligible for Medicare before January 1, 2020.

Because the benefits are set by law, comparing Medigap plans is mostly about three things:

1. Which letter plan matches the coverage you want. 2. What each company charges for that plan. 3. How the company handles rate increases over time.

Massachusetts, Minnesota, and Wisconsin standardize their Medigap plans a little differently, so residents there should check medicare.gov for specifics.

What Medigap does — and doesn't — cover

Depending on the letter, Medigap plans can help with costs like Part A hospital coinsurance, Part B coinsurance, the first three pints of blood, hospice coinsurance, skilled nursing facility coinsurance, and some foreign travel emergency care.

What Medigap generally does not cover:

• Prescription drugs (that's Part D).
• Routine dental, vision, or hearing care.
• Long-term custodial care.
• Hearing aids or eyeglasses.

If those benefits matter to you, you'll need to plan for them separately.

The enrollment window most people miss

Here's where families in Cleveland — and everywhere else — get burned. The best time to buy a Medigap policy is during your Medigap Open Enrollment Period: the six-month window that starts the month you're 65 and enrolled in Part B.

During that window, insurance companies can't turn you down or charge you more because of your health history. Miss it, and outside of a few special situations, insurers in most states can use medical underwriting — meaning they can look at your health, raise your price, or deny coverage altogether.

This is one of the most costly mistakes in Medicare, and it's easy to avoid if you know the window exists.

How Medigap fits with the rest of Medicare

Cleveland is in Bradley County, where residents choose between two broad paths:

• Original Medicare + (optional) Medigap + (optional) Part D drug plan.
• A Medicare Advantage plan, which bundles Parts A and B and often drug coverage into one private plan.

You can't use Medigap with Medicare Advantage. If you switch from Advantage back to Original Medicare, you may or may not be able to buy a Medigap policy without medical underwriting, depending on timing and state rules.

A few 2026 program facts worth keeping in mind, even if you go the Medigap route and add a stand-alone drug plan:

• Part D has a new $2,100 out-of-pocket cap for covered drugs in 2026.
• The Part D deductible can be no higher than $615.
• The old "donut hole" is gone as of 2025 — Part D now has three simpler 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.
• IRMAA surcharges — higher premiums for higher earners — kick in above $109,000 in income for a single filer in 2026.