Understanding the Medigap trap is crucial for long-term healthcare planning. In the Medicare Advantage model, you save money when you are healthy, but face a "trap" if you become ill and want to switch to the more predictable original Medicare/Medigap model, only to find you no longer qualify for Medigap coverage due to your health.

For a healthy 65-year-old, Medicare Advantage looks like a win. You save $2,000+ per year in Part D and Medigap premiums and get "free" dental and vision care. However, if you develop a chronic condition, such as cancer or heart disease, at age 72, you may suddenly be drowning in costly copays that add up.

When you try to switch to Medigap to stop those bills, the insurance company "underwrites" you. Because of your diagnosis, they can legally deny your application, leaving you stuck in the higher-cost plan.

You'll want to know those rules as you navigate Medicare. Don't worry if you miss an answer; you can follow the links below the quiz to brush up on your knowledge.

More on Medicare, from the Kiplinger retirement team:

• Watch Out for the ‘Medigap Trap’
• What’s the Best Medigap Plan?
• The Rules for Making a Medigap Switch
• How Medigap Insurance Is Affected by Preexisting Conditions
• 12 FAQs About Medicare: Your Medicare Questions Answered
• 11 Costly Medicare Mistakes You Should Avoid Making
• Can You Sign Up for Medicare While Still on an Employer Health Plan?
• Medicare Open Enrollment Occurs Annually from October to December — Here's What You Need to Know
• Medicare Advantage Open Enrollment Runs from January 1 to March 31

Medicare provides health insurance to 69 million Americans. During Medicare open enrollment, which runs from October 15 to December 7 this year, people can enroll in the program or change plans.

You can also switch from original Medicare to a Medicare Advantage plan (or vice versa), and weigh your Part D prescription drug plan coverage against other options.

If you choose original Medicare (Part A and Part B), you can also buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company to cover services and out-of-pocket costs not covered by original Medicare.

It's important to note that you can only buy Medigap if you have original Medicare. That means you must sign up for Medicare Part A and Part B before you can buy a Medigap policy.

Medigap Open Enrollment

According to Medicare, you have a six-month Medigap Open Enrollment period, which starts the first month you have Medicare Part B (medical insurance). During these six months, you can enroll in any Medigap policy, and you can’t be denied coverage for any pre-existing health problems.

After six months, you might not be able to buy a Medigap policy, and if you can, it could cost more. The Medigap Open Enrollment period only happens once and doesn’t repeat yearly such as Medicare Open Enrollment.

Stay tuned for live updates: Medicare Open Enrollment 2026 Live Updates: We'll Be Back on December 1 for the Final Week of Open Enrollment

What is Medigap?

Most states offer 10 different Medigap plans sold by private insurance companies. They're named A-D, F, G, and K-N, and the price is the only difference between the plans.

Medigap Plan G provides the most comprehensive coverage and continues to be the most popular plan in 2025, accounting for approximately 39% of all policyholders, according to KFF. Plan F came in second (36%).

You might also be able to buy another type of Medigap policy called Medicare SELECT, which is only available in some states. If you choose a SELECT policy, you have the right to change your mind and switch to a standard Medigap policy within 12 months.

If you live in Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized differently. Medigap must follow federal and state laws meant to protect you, but illegal practices by insurance companies can happen, so do your research when shopping for a Medigap policy.

What does Medigap cover?

Medigap policies help cover out-of-pocket costs, such as co-insurance, copayments and deductibles associated with original Medicare — nationwide. Some Medigap policies might also cover foreign travel emergency care, which gives you an extra layer of well-being when you travel outside the U.S.

Note: Although plans E, H, I and J are no longer sold, they still cover foreign travel emergency care if you're enrolled in one of these plans. If you want prescription drug coverage, you can enroll in a separate Medicare drug plan (Part D).

What does Medigap not cover?

Although Medigap plans cover all or part of original Medicare’s additional fees, it doesn’t cover everything, such as long-term care, elective surgeries, hearing aids, eyeglasses, vision and dental care and private-duty nursing.

Not all plans cover Part B deductibles. It's also worth noting that Medigap plans sold after 2005 don’t include prescription drug coverage.

Pros and cons of Medigap insurance

Medigap covers items and services not covered by original Medicare and significantly extends hospital, skilled nursing and travel coverage. But there are a few disadvantages worth looking at before you sign up.

Medigap and Medicare have different Open Enrollment windows and policies

The initial enrollment period for Medicare is a seven-month window, which starts three months before your 65th birthday, the month you turn 65 and the three-month period after your birth month.

If you fail to enroll for Original Medicare during the initial enrollment period, you’ll get another chance during Medicare Open Enrollment, which happens from October 15 through December 7, 2025.

You have a six-month Medigap Open Enrollment period, which starts the first month you have Medicare Part B (medical insurance). During these six months, you can enroll in any Medigap policy, but after the six-month period, you might not be able to buy a Medigap policy, or it might cost more if you do.

The Medigap Open Enrollment period only happens once and doesn’t repeat every year such as Medicare Open Enrollment. Time is of the essence.

Still working? You can sign up for Medicare even if you’re still on your employer’s health plan.

Read: Seven Medicare Changes Coming in 2026.

Related Content

• Prior Authorization Coming to Traditional Medicare Starting in 2026
• Medicare Premiums 2026: Projected IRMAA Brackets and Surcharges for Parts B and D
• Brace for Higher Health Costs in 2026: A Look at Projected Medicare Premiums
• 2026 Social Security COLA is 2.8%: What You Need to Know

For years, David Haas has been something of the unofficial Medigap expert of Franklin Lakes, N.J.

That’s because whenever the financial planner’s clients reach that magic age of Medicare eligibility, they have some serious financial decisions to make about getting supplemental coverage — and don’t know where to turn.

The alphabet soup of plan options, the complexity of what’s covered and what’s not, the challenge of figuring out what Future You is going to need: It’s overwhelming and confusing.

So Haas set out to learn “anything and everything” about Medigap plans, to help steer his friends and clients in the right direction (with no personal financial interest). But this year, that information came in handy for him.

Haas hit 65 this year. He had to make his own Medigap selection, one that will have ramifications for years.

“Think of it as a permanent decision,” says Haas. “You need to think about yourself in the future, not just in the present, which people have trouble doing. This choice is extremely important.”

A high-stakes choice

There are a number of reasons why this Medigap choice looms so large, with fallout that can reverberate for years.

Getting care through traditional or original Medicare can be expensive, which is why most beneficiaries who choose it over a private Medicare Advantage plan opt for an added private policy, known as Medicare Supplement Insurance or, more colloquially, Medigap.

So who needs Medigap plans? Anyone with traditional Medicare who wants help with out-of-pocket costs like coinsurance and co-pays — especially since those costs aren’t picked up by Medicare, and there is no cap on them. (Some Medigap plans also cover deductibles, but those are not available for Part B deductibles for those who become eligible for Medicare after Jan. 1, 2020). You can’t get a Medigap plan if you have a Medicare Advantage plan.

As such, Medigap is a good fit for frequent users of healthcare services. This holds true for your needs as you age because you may be locked in to your initial selections even as your health declines. Basically you are choosing predictability in costs, by paying a premium up-front, rather than risking that a serious illness or extended hospital stay could severely damage your finances.

Medigap makes sense for frequent travelers, since some Medigap plans cover emergency medical expenses while abroad.

But there are so many different options at so many different prices and offered by so many different providers that retirees often feel confused and frozen.

So they put it off until later, or make the wrong choice. Either way, it’s something that can affect them for the rest of their lives.

“It is 100 percent overwhelming,” says Kevin Moss, senior editor at the nonprofit Consumers’ Checkbook. “It’s such a consequential decision: It forces you to think about what you need right now, what you will need in five or 10 years, and what you will need all the way to the end of your life.”

And this is a choice being puzzled over by millions. In 2023 Medigap plans covered 13.6 million people, who paid $35.5 billion in premiums, according to the National Association of Insurance Commissioners.

Medigap vs Medicare Advantage

There are essentially two major paths you can take when you are choosing supplemental Medicare coverage.

One is Medigap, and the good news is that most people like it. In one 2023 study, 93% of beneficiaries said they were happy with their choice, with 80% saying they were either “very” or “extremely” satisfied. The other is Medicare Advantage — not quite as beloved, with 73% saying they are satisfied with their current plan, according to an AARP survey.

The Medicare Advantage plans are the ones you might be familiar with from all those incessant TV commercials. This is the private insurance alternative to traditional Medicare that typically charges modest (or even no additional) premiums and typically includes prescription drug coverage. It also often has extras, like coverage of vision and dental. But it limits you to a network of providers, and makes you jump through hoops by requiring prior authorizations for more expensive services. This can lead to delays or even denials of some coverage.

Others go with traditional government-run Medicare, which doesn’t have such limits on providers and has fewer requirements for prior authorizations. However, out-of-pocket costs can be much higher, so many traditional Medicare beneficiaries add a Medigap plan, which you can think of as a wrapper around the traditional Medicare plan.

For that, you pay additional premiums (an average of $217 a month in 2023, more than the standard 2025 $185 monthly Part B premium). (Keep in mind traditional Medicare does not cover prescription drugs, for which you will need a standalone Part D policy at an added cost.)

Pairing Medigap with traditional Medicare means you get help with out-of-pocket costs and can see any of the 98% of non-pediatric doctors who accept Medicare. In 2022 12.5 million people, or 42% of those in traditional Medicare, had a Medigap policy as well, according to KFF (formerly the Kaiser Family Foundation).

“With Medigap you can start right away when you’re 65 with no underwriting, which is so important to people with underlying conditions,” says Sally Greenberg, CEO of the National Consumers League. “Basically you can go to whatever doctor you want, and can sign up for any Medigap plan you choose. That’s pretty good.”

Alphabet soup

If you choose the Medigap path, that’s only the first step. Then you have additional choices to make. There are 10 standardized levels of plans: A, B, C, D, F, G, K, L, M, N. These are administered at the state level, so the policies you are offered depend on your particular location; insurers might offer some, but not all.

That’s a lot of letters, so to help narrow those down: Almost all Medigap enrollees are in Plans F or G, which are the most comprehensive options. Each of those plans amounts to 41% of Medigap policyholders — although F is no longer available to new signups. Plan N (and its lower premiums) is the third most popular at 11%.

Another thing to know: Even though plan types are standardized in terms of what they cover, premiums are not set at the same rate; different insurers charge different premiums for the same plan, which is why shopping around is critical. They also may raise rates differently; One analysis last year found, for example, that larger insurers implemented larger increases.

There are a few more major tripwires ahead, and you have to pick your way through this minefield very carefully.

To understand the point, consider a common scenario: A new retiree chooses to go with a Medicare Advantage plan with its lower premiums and extra offerings. After all, younger retirees may not have the serious health problems that would benefit from better access to specialists and less red tape from prior authorizations.

But as they age, they can find themselves locked into their Medicare Advantage plan, because traditional Medicare carries too many additional costs. Mitigating the costs with a Medigap plan is blocked at this point because of underwriting requirements.

This is why it’s so important to get it right the first time.

Compare Medigap plan benefits

Here are the benefits of the three most popular Medigap insurance plans. For a table including all plans, go to Medicare.gov.

*Plans F and G offer a high-deductible plan in some states.

**Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits.

Note: Plan F isn’t available if you turned 65 on or after Jan. 1, 2020, and to some people under age 65. You might be able to get these plans if you were eligible for Medicare before Jan. 1, 2020, but not yet enrolled.

Source: Medicare.gov

Timing is key

The timeline is to first get Medicare Part A (which covers hospital charges) and Part B (doctors), and then consider a Medigap plan.

There is a limited time window for getting Medigap done with no underwriting. This is known as “guaranteed issue,” and it applies for the first six months after you become eligible for Medicare (typically age 65, although potentially younger for those with disability).

And what if you are still working, and enjoying employer health coverage, past 65? In that case you can delay Medicare — meaning that the clock on your Medigap decision is also stopped. (Note that that clock only starts when you select Medicare Part B.) After you stop working or lose employer health coverage, you have an eight-month special enrollment period for Medicare.

But wait beyond these time windows for your Medigap choice, and you may have a problem.

“This is a one-time opportunity that does not repeat,” says Nancy Ochieng, a senior policy analyst with KFF. “If you miss that window, you can be charged higher premiums, or be denied a Medigap policy.”

As a result, you want to do your research before turning 65, so you don’t get caught flat-footed. NCL’s Greenberg suggests starting your homework well in advance — as much as 18 months beforehand.

Switching is a challenge

If you don’t like your initial selection, switching plans later on or getting a new plan can be difficult, expensive or impossible.

If you do want to swap Medigap plans without underwriting, you can do so, but only within that six-month Medigap open enrollment period (after you have signed up for Medicare). After that, you may not qualify for “guaranteed issue,” which could mean higher premiums or outright denial.

Practically speaking, if you miss that period and develop serious health issues, you can feel trapped in your existing plan. “People might think they can easily switch out at any time, but you can’t,” says Greenberg. “I don’t like that model at all. You’re stuck in a service you no longer want.”

There are, however, some exceptions, depending on where you live. Connecticut, Massachusetts and New York, for instance, offer continuous or guaranteed issue at any age, and Maine offers it during a one-month period every year (although only one plan type, Plan A). Next year, Minnesota, as well, is slated to allow enrollees a one-time opportunity to get a Medigap plan, at a potentially higher cost after their initial enrollment period.

Eight states have a so-called “birthday rule” that allows switching without underwriting to a Medigap policy that is similar or less comprehensive than the one you have.

Specific qualifying events also come into play in 35 different states, according to KFF tabulations. Those might include losing retiree coverage from your previous employer, moving out of a plan’s service area or losing Medicaid eligibility.

Paying the bill

There are a lot of things to like about Medigap, but there is no denying that there is a bill attached, which could become bigger.

“Plan G is the most popular Medigap plan, and in that plan for major medical care — doctors, hospitals, imaging — you won’t face any costs out-of-pocket,” says Moss. (It does not cover Part B deductibles.) “But that does come at a cost, which is that you have to pay the Medigap premium.”

Those premiums can vary widely from state to state, and provider to provider. The average of all Medigap policies is $217 monthly, according to MedPAC data. But that ranges from $191 in Alaska, to $267 in New York.

And with the popular Plan G, the average is $164 nationally — but only $140 in Hawaii and New Mexico, and $236 in New York.

“Focus groups generally say they are satisfied with their Medigap plans, but premiums remain one of the primary concerns,” says KFF’s Ochieng. “Because Medigap is regulated at the state level, the state sets the rules, and that makes premiums vary a lot. That makes it very important to compare policies and consider the premiums.”

There are different pricing systems you might encounter: It might be a “community rated,” where everyone in your location is charged a similar amount, regardless of age. Or pricing might be “issue-age rated,” based on how old you were when you got the policy; or “attained-age rated,” meaning that your premiums will go up over time.

To wit: Year-over-year Medigap premium increases from 2023-24 ranged from 0% to 18%, for insurers with over a million Medigap members, according to the American Association for Medicare Supplement Insurance. For companies with between 400,000 and a million members, the price hike ranged from 7.5% to 20%.

One positive is that there are a fair amount of deals available, similar to those you find elsewhere in the insurance world. “There are a lot of discounts,” says Moss. “For example, you might qualify for discounts for women, or non-smokers, or married people, or whether you pay on an annual basis, or if you buy directly from an insurer instead of through an agent.”

Agents and incentives

There’s an entire industry of brokers and agents who can walk you through this choice. That can be both good and bad. After all, they have a financial incentive for their work; they work on commission.

Your first stop should be State Health Insurance Assistance Programs, at www.shiphelp.org. You can get one-on-one, unbiased help from trained counselors. “That’s the primary resource that should be used,” says KFF’s Ochieng.

As for brokers: As long as you know how they’re compensated, and don’t feel pressured into choosing the wrong plan, then you use them to gather information.

“I think it’s a wise idea for people to take advantage of those folks,” says Greenberg. “If I were trying to make my own decision, I would talk to several different brokers and get their views. I’m that kind of consumer.”

Other things to watch out for: Perhaps an agent works with a particular company or companies, and since they don’t work with all providers, they may not be showing the entire menu of plans available to you. (Check your state insurance website for a fuller picture, and to research complaint data.)

Or they might be given perks by providers for sales, and be incentivized to steer you into certain plans. That was the main focus of Senator Elizabeth Warren’s (D-Mass.) 2023 report “Sales Before Seniors: How Medigap Insurers’ Sales Rewards Hurt Seniors on Medicare.”

Its findings: Six million beneficiaries purchased Medigap plans from companies that offered salespeople rewards like cash bonuses or trips to places like the Bahamas, Maui and Aruba.

That’s not illegal — but creates “incentives for them to steer older adults to Medigap products that may not be the best fit for their financial and healthcare needs,” the report says.

As for David Haas, he opted for the Plan G high deductible version, which charges much lower premiums, but still protects him in those catastrophic health crises that can really blow up his finances. He hopes he made the right choice.

Medicare Open Enrollment for 2026

The annual Medicare Open Enrollment period for 2026 starts Oct. 15 and runs through Dec. 7. You can make changes to your coverage, such as switching to a Medicare Advantage plan, enrolling in or dropping a Part D plan or switching back to Original Medicare.

Where to turn

Given the complexity of the subject and the volume of information about Medigap plans, how can you make sense of it all? A few places to start:

State Health Insurance Assistance Programs: When it comes to plan particulars, it’s state-level information you want, since that’s where programs are administered. Use the SHIP locator at SHIPhelp.org, or call 877-839-2675.

Medicare Plan Finder: This is a helpful federal site (www.medicare.gov/plan-compare) for walking you through supplemental coverage options. Enter your zip code, and get an immediate display of Medigap plan options available, from A though N.

MedPAC: MedPAC advises Congress on Medicare policy. To learn what plans are most popular, a breakdown of benefits, how premiums are set and so on check out the “Preliminary Work on Medigap” presentation.

Independent reviews: Some financial information sites rate Medigap plans. NerdWallet recently outlined its picks for 2025. (Overall winner: AARP/United Healthcare.) Or ValuePenguin makes suggestions based on plan type, rather than particular companies. Its selection for most people: Plan G.

Note: This item first appeared in Kiplinger Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice that’s right on the money.

Related content

• What’s the Best Medigap Plan?
• What You Must Know About the Different Parts of Medicare
• Brace for Higher Health Costs in 2026: A Look at Projected Medicare Premiums
• Watch Out for the 'Medigap Trap'

Retirement planning has as much to do with amassing and spending your nest egg as it does with determining your health care needs.

Nobody wants to think about getting ill or injured when they get old, but it’s inevitable for many. How inevitable?

Roughly 70% of Americans age 65 and older will require long-term care at least once in their lifetimes, according to the U.S. Department of Health and Human Services. That encompasses everything from a nursing home to in-home care. The amount of care a person needs depends on their unique circumstances, but either way, it isn't cheap.

A semi-private room in a nursing home, on average, costs $9,581 per month, while a private room is $10,798 a month, according to Genworth’s 2025 Cost of Care survey. A home health aide will cost you $6,673 per month.

Even if you are in perfect health during retirement, it can be expensive. Fidelity Investments estimates that a 65-year-old retiring this year will spend $172,500 in health care. That’s up 4% from $165,000 in 2024.

In 2002, the first year Fidelity put out an annual estimate, the cost was $80,000. That doesn't account for any unforeseen illnesses or injuries that might require additional care.

“Health is wealth,” says Nilay Gandhi, a senior wealth adviser at Vanguard. “Without health, there’s not much anyone can do, regardless of how much wealth they have. Health care expenses are one piece of the puzzle for retirees and pre-retirees.”

1. Decide what kind of health care you want in retirement

To prepare for health costs, Gandhi encourages investors and their financial planners to follow a multistep process (PDF) that begins with determining the type of care you want and how much you can afford.

If you need round-the-clock assistance, do you prefer it at home or within a facility? If you get injured or ill, do you want insurance to cover the cost of care, or do you want to pay for it out of savings?

Once you decide on the type of care, create the necessary documents to ensure your wishes are met if you're ever incapacitated and can’t make your own decisions.

Some of those documents include a will, a financial power of attorney and an advance health care directive or living will.

After that, it's time to figure out how you’ll pay for it. You have options. Insurance is one; using your savings is another.

2. Know what Medicare does and doesn't cover

Any health planning for retirement should first factor in Medicare, which kicks in at age 65. Most retirees will have to choose between original Medicare or Medicare Advantage, which will have a direct impact on health expenditures.

Original Medicare tends to have what Vanguard says are substantial deductibles, as well as co-insurance. There is no limit on what out-of-pocket costs you might owe. Since Medicare doesn't cover dental, vision and hearing exams, you'll need a supplemental Medigap insurance plan.

A Medigap insurance plan is health insurance that private companies sell to help cover some of the costs that an original Medicare plan does not cover.

Another option is a Medicare Advantage Plan, which is sold by a select group of private insurers and replaces original Medicare coverage. These plans tend to have lower costs and more benefits, but the doctors within the network can be limited.

"If cost is the primary concern, Medicare Advantage will usually lead to lower health care costs over time (though it may be more expensive in specific years in which you experience poor health outcomes)," according to Vanguard. "Original Medicare with a supplement will tend to provide a more flexible choice of health providers and more predictable costs, regardless of your health status in any particular year."

3. Decide when insurance makes sense

Long-term care insurance is a popular choice because it makes it easy. You pay a monthly premium, and if you ever get sick, your insurance covers it. You get peace of mind, but there’s a catch.

Depending on your age and health, it can be pricey, ranging from $100 and up per month. The older you are, the higher the monthly premiums.

There are also limitations on what it covers. For it to kick in, you need to be considered chronically ill, unable to perform at least two activities of daily living (ADLs) without assistance or experiencing cognitive decline and requiring supervision.

Something to keep in mind: While prices are supposed to be the same over time, it's not uncommon for premiums to jump.

Long-term care insurance has its perks
There are tax benefits with LTC insurance. For one, the benefit payout amounts aren’t taxed. Some premiums are deductible as a medical expense if they contribute to medical expenses exceeding 7.5% of your adjusted gross income. As you get older, the deductible amount of the premiums increases.

You can purchase traditional LTC insurance or hybrid LTC insurance. With the latter, the LTC benefit is part of a life insurance policy or annuity. The benefit is always paid, and premiums are guaranteed. If the LTC insurance coverage is not used, it is transferred as a death benefit or cash value if it is an annuity.

It's also more expensive, easily over $1,000 per month, depending on the bells and whistles.

According to Vanguard, you would benefit from LTC insurance if:

• You can afford the premiums.
• Your family or trusted friends can handle the paperwork and claims process for you.
• You crave peace of mind that comes with insurance.
• You are healthy enough to meet underwriting guidelines.

4. Determine if sharing the costs is a better option than insurance

If you're healthy, your family history is void of any chronic or debilitating illnesses or diseases and you’ve saved for your retirement, long-term care insurance might not be the best option.

Alternatively, you can share in the costs beyond what Medicare covers out of pocket. There are a few ways to do that, including an annuity and a Health Savings Account.

With an annuity, you pay an upfront lump sum and, in return, get a lifetime of regular payments which you can use for medical expenses.

How much the annuity costs depends on your life expectancy, whether you have inflation protection, and whether there is a guaranteed minimum payment amount. You can purchase an annuity to begin paying out right away or defer payments for a future date.

Qualified longevity annuity contracts (QLACs) are annuities that are purchased with money from an IRA or 401(k). These vehicles lower your required minimum distribution balances, which can help defer taxes when you have to take RMDs.

5. Max out a Health Savings Account

Many people view a Health Savings Account, or HSA, as a means of saving for health care expenses in the present, rather than the future.

But an HSA can be a tax-advantaged way to save for future medical needs. With an HSA, the money you invest can roll over year after year. There is no use-it–or-lose-it rule attached to an HSA.

HSAs are triple tax-free. You get a deduction when you contribute, they grow tax-free, and you don’t pay taxes when you withdraw them for qualifying medical expenses.

There are limitations. For 2026, the limit is $4,400 for self-only coverage and $8,750 for family coverage. If you're 55 or older, you can contribute an additional $1,000. An HSA is only available with a high-deductible health plan.

“You can invest it and let it grow so you are prepared for your health care needs,” says Scott Cutler, CEO of HealthEquity.

Don’t wait until it's too late

Declining health might not be avoidable, but it doesn’t have to leave you destitute or a burden to your loved ones. A little planning now can go a long way later.

If insurance is the route you're going, the younger you are when you take out a policy, the cheaper it is. If you plan to use investment options or savings, the sooner you start planning, the better off you'll be.

“Everyone should have a health care plan regardless of age,” says Gandhi. “A long-term plan boils down to does somebody want to inherit that risk, want to share that risk or transfer the risk completely?”

Related content

• Don't Let Health Care Costs Wreck Your Retirement: Here's How
• Average Cost of Health Care by Age
• How to Pay for Long-Term Care
• We're Retired With $4.6 Million. My Wife Chose Our Medicare Advantage Plan for the $0 Premium, But I Want Original Medicare’s Freedom. Is It Too Late?

A bit of foresight can save you from the Medigap trap — yet one more rule to learn when navigating Medicare and Medicare Advantage (MA). In short, it’s a mistake to plan to enroll in MA when you’re relatively healthy, thinking you can just switch to traditional Medicare as you get older and sicker, says David A. Lipschutz, co-director of the Center for Medicare Advocacy.

MA can be attractive when first enrolling in Medicare for beneficiaries who aren’t worried about network restrictions on doctors or pre-approval requirements for high-level care.

Technically, people who choose an MA plan can change their minds every year during open enrollment and move to traditional government-run Medicare with its unrestricted access to providers who take Medicare. It may be tempting to think about switching when health declines or there’s a need to see providers not in the MA network. But it’s not that easy. Welcome to the Medigap Trap.

The Medigap trap

“There's not free movement between traditional Medicare and Medicare Advantage in large part because of the barriers to picking up a Medigap policy,” Lipschutz says.

Medigap is the umbrella name for an array of private insurance policies that supplement traditional Medicare, making out-of-pocket costs for care more manageable. Without Medigap, out-of-pocket costs for traditional Medicare enrollees can be overwhelming.

While MA plans cap annual out-of-pocket spending, traditional Medicare does not. And the charges can add up quickly. To start, without Medigap, traditional Medicare patients must pay 20% of the cost for covered medical services after meeting a deductible. And patients who are hospitalized for a long period are charged as much as $816 per day. A separate Medigap policy can pick up a lot of those costs, making treatment covered by Medicare more affordable.

But if a Medicare participant doesn’t enroll in a Medigap plan when first signing up for Medicare, supplemental coverage may be unavailable later. In most states, Medigap plans are automatically available only in the first six months after an enrollee becomes eligible for Medicare. After that, health screening may be required and the plans can refuse coverage or charge higher rates for those with health issues.

Where you live matters

Only four states — Connecticut, Massachusetts, Maine and New York — prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions.

An enrollee in another state who wants to switch from MA to traditional Medicare may be unable to get or afford Medigap. While they retain the option to make this switch during open enrollment, the higher cost of care may make a traditional plan unworkable.

Says Lipshutz: “Unless you're in one of those handful of states, you very well might find that you cannot purchase a Medigap policy and then it could be very expensive.”

Note: This item first appeared in Kiplinger Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice that’s right on the money.

Read More

• What’s the Best Medigap Plan?
• The Rules for Making a Medigap Switch
• Problems with Medicare Advantage Plans Keep Mounting
• 11 Costly Medicare Mistakes You Should Avoid Making

If you're on traditional Medicare, you already know the importance of having a Medigap plan. Medigap is private supplemental insurance that helps fill gaping holes in traditional Medicare's government-administered coverage, like the $1,676 Part A deductible for hospital care or Part B coinsurance for doctor services, typically 20% in addition to this year's $257 Part B deductible.

There are 10 types of Medigap plans, each labeled by a letter from A to N, and every plan with the same letter has identical benefits, even if the insurer is different. But the monthly premiums can be worlds apart. Depending on the insurer, a 65-year-old male in Florida could pay anywhere from $237 to $409 a month for Medigap Plan G, even though the coverage is identical.

That price differential is why it pays to periodically test the market.

"I'd say about 50% of people are paying too much for their Medigap plans," Kelly Maxwell, owner of the insurance brokerage Seniors Mutual in Austin, Texas, tells Kiplinger. Hill says insurers often offer attractive, teaser rates to lure newcomers, who have just turned 65 and joined Medicare, before hiking those premiums later on.

Maxwell explains that "companies have lower rates for new enrollees at, say, 75, than current policyholders at 75. This is due to the new customers having to go through underwriting. Because of this, the company knows the new people are healthy — at least healthier compared to existing policyholders that have developed health conditions."

He said that he thinks it is worth it to shop for a new policy every five years or so. If you switch, companies may offer lower rates due to your needing to pass health underwriting to qualify. "That can save people up to $100 per month, just a guess," he said. "But you have to be healthy. Any serious issues, and you can't qualify."

Just how easy is it to switch Medigap plans, and are you still guaranteed coverage the way you were during your initial enrollment?

Rules and restrictions on making a Medigap switch

The good news is you can switch Medigap plans any time and not just during Medicare's annual open enrollment from October 15 to December 7.

The bad news is you aren't guaranteed to qualify for a different plan, including one with the same letter. That guaranteed acceptance, regardless of your health, only lasts for the six months after you turn 65 and first sign up for Medicare Part B.

After that, medical underwriting applies. Most applicants are "likely to qualify for a new plan, unless they have something serious like diabetes or a heart condition," Hill says.

The decision will vary by insurer. You could be denied coverage outright, accepted but charged a higher premium, or face a waiting period of up to six months after you enroll before a preexisting condition is covered. During that time, only Parts A and B would cover the condition, leaving you to foot the bill for any coverage gaps.

A few states, such as California, Connecticut, Massachusetts, New York, and Vermont, make it easier to switch plans and still qualify for coverage. But even these states "usually have limits to ensure that people can only switch to equal or lesser coverage, not to upgrade their coverage," says Louise Norris, an author with medicareresources.org.

You are also guaranteed coverage if you must switch Medigap plans through no fault of your own — for instance, if your insurer goes bankrupt. Otherwise, acceptance isn't guaranteed, so don't cancel an existing policy until you're sure you've qualified for a new one.

Medicare Advantage exceptions

The same Medigap underwriting restrictions also apply if you switch to traditional Medicare from its private insurance alternative, a Medicare Advantage plan, also known as Part C, with three notable exceptions.

If you signed up for an Advantage plan right after joining Medicare, you have a 12-month trial window, and the same is true if you have a Medigap plan and drop it to join Medicare Advantage for the very first time.

During that trial window, "you can leave your Advantage plan, switch to original Medicare, and you'll have limited guaranteed-issue access to Medigap," says Norris. You'll be allowed to switch back to your previous Medigap plan, or if you didn't have one before, sign up for any Medigap plan in your area.

If you move to a place not covered by your Advantage plan or the insurer stops providing coverage, you get another Medigap guaranteed-issue period. But Medigap enrollees who move to another region don't, because Medigap plans offer nationwide coverage.

Outside of these exceptions, Advantage plan members who switch to traditional Medicare and want a Medigap plan will face underwriting. What's more, Advantage policyholders will only be allowed to switch at set times: during traditional Medicare's open enrollment each fall and Medicare Advantage's annual open enrollment from January 1 to March 31.

Related Content

• What’s the Best Medigap Plan?
• How Medigap Insurance Is Affected by Preexisting Conditions
• What You Must Know About the Different Parts of Medicare

Older Americans have important decisions to make each year regarding their Medigap and Medicare coverage. Although there is no annual open enrollment period for Medigap insurance, you might want to change your Medigap policy to accommodate any changes to original Medicare.

During the annual Medicare Open Enrollment period, which runs from October 15 to December 7 every year, including for 2027 coverage, all Medicare participants can switch to a new Medicare Advantage plan or return to original Medicare.

The best time to buy a policy is during your only Medigap open enrollment period, when you first become eligible for Medicare. Under federal law, you have a six-month Medigap open enrollment period that starts the first month you have Medicare Part B, and you’re 65 or older. Insurance underwriting is suspended during your open enrollment period, making it cheaper and easier to enroll in the policy of your choice.

After this period, if you have any pre-existing conditions, you might not be able to buy a Medigap policy, or it might cost more to buy a policy. I want to stress that your Medigap open enrollment period is a one-time opportunity that doesn’t repeat annually. But as with most rules, there are exceptions. We discuss these in more detail below.

Why you need Medigap 

• Medicare coverage doesn't cover gaps in coverage
• Part B of Medicare only covers 80% of your medical expenses after hitting your deductible
• Medicare Part A covers inpatient hospital stays, but you’re responsible for your deductible and daily co-insurance after a certain number of days
• Medigap is designed to help pay the out-of-pocket costs that original Medicare (Parts A and B) doesn't cover, such as copays, co-insurance and deductibles

Original Medicare provides several great benefits to enrollees, but this coverage has some gaps.

For instance, Part B will cover only 80% of your medical expenses, after you hit the deductible, with no out-of-pocket maximum. That means you could be on the hook for a significant bill if you become gravely ill. Part A will only pay for the first 60 days you spend in the hospital after a deductible is met, before you must start paying co-insurance.

Medigap plans generally help cover your share of costs for services that are covered by original Medicare Parts A and B. These policies help cover out-of-pocket costs, such as copayments, co-insurance, and deductibles.

Because of these gaps in original Medicare coverage, many beneficiaries choose to enroll in either a Medicare Advantage plan or a supplemental policy to help cover those costs.

For more on Medicare Advantage, see Is a Medicare Advantage Plan Right for You?

What is Medigap insurance?

• Medigap is private insurance that helps pay the out-of-pocket costs that original Medicare (Parts A and B) doesn't cover
• Medigap works only with original Medicare
• Medigap plans come in 10 letter designations: (A through D; F; G; and K through N)
• Not all states treat Medigap insurance the same

If you opt to enroll in original Medicare, you'll have some expenses in addition to your Medicare Part B and Part D premiums. Medigap policies help cover your out-of-pocket costs associated with original Medicare, which include your copayments for doctor visits and prescriptions, co-insurance and deductibles.

While Medigap plans are there to cover what your original Medicare plan doesn't, they generally don’t cover long-term care, private-duty nursing, vision or dental care, hearing aids or eyeglasses.

If you decide to go with a Medicare supplement policy (or more commonly called Medigap), you then must select the plan you want. Medigap plans are administered by private insurance companies. These plans come in 10 letter designations (A through D; F; G; and K through N). All plans with the same letter have the same coverage, but prices can vary based on the insurance company.

Three states where Medigap policies are standardized in a different way. If you live in Massachusetts, you only have two plans from which to choose. In Minnesota, there are three plans. In Wisconsin, Medigap plans offer additional benefits such as coverage for certain preventive services, according to Medigap.com

The 10 different types of Medigap insurance

The Medigap plan that's best for you depends on how much medical care you think you might need in a year, as well as your personal preferences

• Some Medigap plans (F and G) let you pay a higher deductible in exchange for lower monthly premiums
• Plans C and F are no longer available if you became eligible for Medicare after January 1, 2020
• Unlike Medicare Advantage plans, all Medigap plans (including F and G) don't include an out-of-pocket maximum

What plan is right for you depends on your personal preferences and how much medical care you expect to need that year. The plans offer a range of benefits, with some covering many of your Medicare costs while others require more cost-sharing. Some plans offer a high-deductible option; others have out-of-pocket maximums that will pay 100% of your costs for approved services after meeting your maximum and Part B deductible.

The range of options gives you some flexibility to find one that fits your needs, budget or both.

Plans C and F. Plans C and F are no longer available to those who became eligible for Medicare after January 1, 2020. Why? Medigap plans are no longer allowed to cover Part B deductibles. Since both plans cover that expense, insurance companies can no longer offer them to new beneficiaries. Fortunately, those already enrolled in those plans can keep that insurance. Premiums, however, are likely to rise as these plans can no longer accept new enrollees.

Plan F became the most popular plan because of its generous benefits. It covers the Medicare Part A hospital deductible and co-payments, the Part B deductible and some emergency care outside the U.S.

Plan C covers many of the same benefits as Plan F, except it won’t pay for the Part B excess charge. This happens when a provider charges Medicare more than the amount approved by the program. The beneficiary is then responsible for that excess amount.

If you were considering Plan F, then take a look at Plan G. It provides the same coverage as Plan F except the Part B deductible.

Plan G. Plan G is now the plan of choice for many because it includes most of the same coverage as the popular Medigap Plan F, which is only available to those who became eligible for Medicare before January 1, 2020.

It comes closer to matching Plan F's coverage than any other plan. The glaring difference is that Plan G does not cover the Part B deductible, which is $283 in 2026 (up from $257 in 2025).

Plan G covers “excess charges” charged by doctors who don’t accept the full Medicare-approved amount as full payment. These doctors can charge you up to 15% above the Medicare-approved amount for services or procedures. Notably, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont have banned excess charges.

Plan D. Plan D is similar to Plan G, as it covers more than most Medigap plans, but unlike Plan G, it doesn't cover excess charges.

Plan M. Plan M is nearly identical to Plan D, but while Plan D covers the full Medicare Part A deductible, Plan M covers only half.

Plans K and L. Medicare Supplement Plan K and Plan L are cheaper than other Medigap policies. These two plans have a lower monthly cost because you’ll share the cost of co-insurance for your Plan K and L bills (50% for K and 25% for L) up to an annual out-of-pocket limit.

Your cost-sharing ends once you reach that annual Plan K or L out-of-pocket limit. The 2026 out-of-pocket (OOP) limits for Medigap plans K and L are $8,000 and $4,000, respectively.

If you don’t anticipate having many doctor visits, consider Plan N, which usually has lower premiums in return for some cost sharing.

Plan N. Plan N is the third-most-popular plan type, covering about 10% of all Medigap members. Plan N has lower premiums than other popular options such as Plan G and Plan F. Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits.

In 2026, Plan N copays are up to $20 for doctor visits and up to $50 for emergency room visits after the Part B deductible is met. Plan N also covers the Part A deductible, which is $1,736 in 2026. Plan N doesn't cover Part B excess charges.

Plans A and B. Plan A is ideal if you don’t plan to use a lot of health care services. Plan A includes only the basics for Medigap plans — the benefits that every Medigap plan covers. Plan A doesn't pay anything towards your Part A deductible or Part B excess charges.

It does cover Part B co-insurance and copayments. Plan B provides the same benefits as Plan A, plus coverage for hospitalization by paying the Part A deductible. The premiums are lower for Plans A and B, and while you won’t pay for extra coverage you might not use, you may have some occasional extra out-of-pocket costs.

High-deductible plans. Medigap Plans F and G can be sold with a high-deductible option. High-deductible Plan G is available to anyone enrolled in original Medicare, while the high-deductible version of Plan F is only available to those who signed up for Medicare before January 1, 2020.

Before June 1, 2010, Medigap Plan J could also be sold with a high deductible. The annual deductible amount for these three plans is $2,950 in 2026. The deductible amount for the high-deductible version of plans G, F, and J represents the annual out-of-pocket expenses (excluding premiums) that you must pay, at which point your coverage will kick in.

The Plan N copays stayed the same, while the Part A deductible and high-deductible plans increased from 2025.

Guaranteed issue rights

• You have guaranteed-issue rights to buy a Medigap policy without medical underwriting during your six-month open enrollment starting at age 65 (and Part B), or within 63 days of losing certain other coverage
• Guaranteed-issue rights mean insurers can't deny you a Medigap policy or charge you more because of your health, but must sell it to you at the lowest available rate offered to everyone
• Under Federal law, you have guaranteed-issue rights if you meet certain requirements.

Outside your six-month open enrollment period that begins the month you turn age 65, you also have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage.

When you have a guaranteed issue right, insurance companies can't use underwriting to evaluate your health and determine your eligibility and costs, and must sell you a Medigap policy at the best available rate. Guaranteed issue rights also prevent companies from imposing a waiting period for coverage of pre-existing conditions.

Read Watch Out for the ‘Medigap Trap’ to fully understand the consequences if you choose Medicare Advantage and plan to switch to traditional Medicare later as your needs change.

Outside of your initial enrollment period, you might have a guaranteed issue right if:

States that have their own Medigap rules

• Four states prohibit insurers from denying Medigap policies to eligible applicants, including people with pre-existing conditions
• Some states are required to issue Medigap policies at any time during the year
• Some states let you switch Medigap plans without medical underwriting at specific times (such as your birthday month or annually)

Four states, Connecticut, Massachusetts, Maine and New York, prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions.

In Connecticut, Massachusetts and New York, insurers are required to issue Medigap policies at any time during the year. Maine, which has a one-month guaranteed issue period each year, only requires insurers to offer Medigap Plan A policies. Minnesota has enacted legislation to institute annual guaranteed issue protections, which are set to go into effect in August 2026.

The birthday rule. Other states waive underwriting requirements and permit you to change plans at certain times. For example, if you live in California, you can select a different Medigap plan that has the same or fewer benefits if you make a decision to change within 30 days after your birthday each year.

In addition to California, there are 11 other states that have a Medigap birthday rule: Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah, Virginia and Wyoming all have a form of the birthday rule. In 2026, a birthday rule will take effect in Indiana.

Medicare Select

• Medicare Select is a Medigap policy similar to an HMO: You must use specific network hospitals and doctors (except in an emergency)
• Because of the restrictions, these plans might offer lower monthly premiums than non-network Medigap policies
• Medicare Select is available only in certain states

In some states, it's possible to buy another type of Medigap policy called Medicare SELECT.

Medicare Select is a type of Medigap policy that requires insureds to use specific hospitals and, in some cases, specific doctors (except in an emergency) to be eligible for full benefits, similar to an HMO. Other than the limitation on hospitals and providers, Medicare Select policies must meet all the requirements that apply to a Medigap policy. Medicare Select policies might have lower premiums because of this requirement.

If you use a Medicare Select plan, how your medical bills are paid depends on whether you stay in-network.

In-network: Medicare pays its share of the approved charges, and your insurance company covers all supplemental benefits outlined in your plan.

Out-of-network (non-emergency): While Medicare will still pay its share of the approved charges, your Medicare Select plan isn't required to pay any benefits.

The availability of Medicare Select coverage is limited to the geographic areas of the state served by the particular policy’s network of hospitals and doctors.

This type of policy lets you switch to a standard Medigap policy within 12 months if you change your mind and no longer want this type of coverage.

Help choosing the right Medigap plan 

• The Medicare website allows you to compare Medigap plans and plan coverage
• The site also offers a tool to help you compare plans in your area
• When you visit the site, you can also find the price range for each available plan and a list of insurers who offer the coverage

The Medicare website provides a chart that outlines what each Medigap plan covers. You can see which plans provide skilled nursing facility care co-insurance, a blood benefit and offer some foreign travel emergency health coverage.

Medicare also has a tool that allows you to compare different Medigap plans available in your area. Enter your ZIP code, age, gender, and whether you smoke, and Medicare will provide a price range for each available plan and a list of insurers who offer the coverage.

Related Content

• The Rules for Making a Medigap Switch
• How Medigap Insurance Is Affected by Preexisting Conditions
• Medicare Premiums 2026: IRMAA Brackets and Surcharges for Parts B and D

Question: Do you have any advice to help me choose which type of Medicare supplement plan to buy? - M.R., Folsom, Calif.

Answer: Medicare supplement policies (medigap plans), which pay out-of-pocket costs not covered by Medicare, come in 10 letter designations (A through D; F; G; and K through N). All plans with the same letter have the same coverage, but prices can vary by company. Plan F has been the most popular. It covers the Medicare Part A hospital deductible and co-payments, the Part B deductible, and some emergency care outside the U.S. Plan F will be discontinued for new Medicare enrollees in 2020 (but people who already have Plan F can keep it). Plan G provides the same coverage except for the $185 Part B deductible. If you don’t anticipate having many doctors’ visits, consider Plan N, which usually has lower premiums in return for some cost sharing.

Most state insurance departments describe the types of medigap policies and list the premiums for plans in their area. Find your state’s insurance department at naic.org/map.

If you're on traditional Medicare, buying a supplemental “Medigap” policy may seem like a no-brainer. After all, Medigap helps pay co-payments, deductibles and other costs that Medicare doesn’t cover. But getting access to these policies—and determining which plan is right for you—may be anything but simple.

You’re guaranteed access to a supplemental policy during your Medigap open enrollment period—the six-month period that starts when you are 65 or older and also enrolled in Part B. Many people who miss that window do not have “guaranteed issue” rights, meaning Medigap insurers can charge them extra based on their health status or deny coverage altogether. That’s a potential headache for the millions of people on traditional Medicare who lack supplemental coverage as well as Medicare Advantage enrollees looking to switch to traditional Medicare and pick up Medigap.

The Medigap hurdles complicate decision-making during the annual fall Medicare open enrollment period, which extends through December 7. Open enrollment is a time for seniors to reassess their coverage and switch between traditional Medicare and Medicare Advantage plans offered by private insurers—but many who prefer traditional Medicare may find they’re effectively locked out of the Medigap market.

Upcoming changes to Medigap plans are generating added confusion. Starting in 2020, two of the most comprehensive Medigap plans—those that cover the Part B deductible—will no longer be available to people newly eligible for Medicare. “Agents have been using the 2020 changes to convince people to change coverage,” says Bonnie Burns, a consultant at California Health Advocates—even though the changes don’t affect current Medicare beneficiaries.

Medigap is a critical backstop for millions of seniors because traditional Medicare requires beneficiaries to pay a significant share of costs and has no cap on out-of-pocket spending. In 2018, for example, beneficiaries typically pay 20% of the Medicare-approved amount for doctor services and a $1,340 deductible for inpatient hospital services. Medigap can also help make health costs more predictable and, in some cases, offer benefits not available in traditional Medicare, such as emergency health coverage overseas.

To buy Medigap, you must be enrolled in Medicare Parts A and B. (Part D is optional.) Enrollees in Medicare Advantage plans, which place caps on annual out-of-pocket spending, can’t use Medigap policies.

Even if you have a Medigap plan that you like, you should keep an eye on other supplemental insurance options. You may be able to save hundreds or even thousands of dollars a year with another Medigap policy that offers the same benefits. Here’s how to find the right policy, maximize your Medigap dollars and overcome the obstacles to accessing these plans.

Get Medigap Outside Open Enrollment

For most people, the best time to buy a supplemental policy is during their six-month Medigap open enrollment period. So what happens if you’re beyond that window?

A few other circumstances can qualify you for a guaranteed-issue Medigap policy under federal law. These include losing employer-sponsored retiree coverage or other supplemental coverage and moving to a new location that’s outside your Medicare Advantage plan’s coverage area. You may also have Medigap guaranteed-issue rights if you sign up for a Medicare Advantage plan but decide to switch to traditional Medicare within the first 12 months.

These are minimum federal requirements; states offer a hodgepodge of additional protections. Twenty-eight states, for example, offer guaranteed-issue rights to people whose employer-sponsored retiree health coverage has changed, and nine offer these rights to people who have lost Medicaid eligibility, according to the Kaiser Family Foundation. Four states—Connecticut, Maine, Massachusetts and New York—provide guaranteed-issue protections either continuously or on an annual basis to all Medicare beneficiaries age 65 and older, Kaiser found. Some insurers may also offer guaranteed-issue protections that go beyond state law.

People under age 65 who are eligible for Medicare because of a disability or disease face a particular challenge. “Under federal law, if you’re not 65 or over, the Medigap company doesn’t have to sell you a policy,” says David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. But 31 states require insurers to offer at least one type of Medigap policy to Medicare beneficiaries under age 65, according to Kaiser.

To pin down the guaranteed-issue protections available in your state, contact your state health insurance assistance program. Go to shiptacenter.org to find your local program.

If you don’t have any guaranteed-issue protections, don’t give up. “That doesn’t necessarily mean you can’t get Medigap,” Burns says. “It just means you’ll have to go through the medical screening, which isn’t—for most companies—very intense.” It’s worth trying multiple insurers because one may accept applicants with a particular medical condition that another rejects.

Once you have a Medigap policy, it’s guaranteed renewable. Your coverage will continue as long as you pay the premiums.

Find the Right Medigap Policy

In most states, there are 10 types of Medigap policies, identified by letters A through N. (Plans E, H, I and J are no longer sold.) Each type offers a different set of standardized benefits. The plans offer varying levels of coverage of Part B co-insurance or co-payments. Most cover some or all of the Part A deductible, some cover a portion of foreign travel emergency costs, and two—Plans C and F—cover the Part B deductible. To compare plan benefits side by side, go to Medicare.gov and type “compare Medigap” in the search box. To find all plans available in your area, go to medicare.gov.

The 2020 changes to Plans C and F have spawned much misinformation that can lead seniors astray. These plans are closing only to people who become newly eligible for Medicare after the start of 2020. People who are Medicare-eligible before then can still buy C and F in 2020 and beyond, “and it’s available to that entire group of people ad infinitum,” says William Schiffbauer, a Washington, D.C., attorney who works with Medigap insurers.

But some companies seeking to sell Medigap policies would have seniors believe otherwise, claiming that current Medicare beneficiaries who want Medigap to cover the Part B deductible should enroll in Plan C or Plan F before 2020. Salespeople “are circulating all kinds of phony information,” Burns says.

While the 2020 changes shouldn’t trigger any panicked Medigap plan shopping, you may have other reasons to shop around—such as potentially saving thousands of dollars per year on premiums. Considering that policies of the same letter type must offer the exact same benefits, you might think they’d be similarly priced. But that’s not the case at all. A 65-year-old male in Connecticut, for example, could pay anywhere from $2,898 to $7,405 a year for Plan F, while a 65-year-old woman in Texas could pay $1,678 to $5,272 for Plan C, according to Weiss Ratings. “Whatever you do, don’t simply look at the insurer that you know and love, because you might find they are charging you hundreds or thousands of dollars more,” says Gavin Magor, director of ratings at Weiss Ratings.

You may find a real head-scratcher when you compare premiums for Plan F versus Plan G. The only difference between these plans is that Plan F covers the Part B deductible—$183 in 2018—and Plan G does not. Yet on average, Plan F costs nearly $450 more than Plan G for men and roughly $380 more for women, according to Weiss. While it’s a convenience to have the Part B deductible covered, Burns says, financially it may make more sense to simply pay it out of pocket.

In addition to the initial premium, pay attention to each plan’s premium “rating” system, which helps you “anticipate how premiums will rise in the plan over time,” says Gretchen Jacobson, associate director of Kaiser’s program on Medicare policy. States can regulate which of three rating systems insurers may use, and you may have a choice of plans using various systems. In “community rated” policies, typically all enrollees are charged the same premium, regardless of age or gender. In “issue-age rated” policies, the premium is based on your age when you buy the policy. And in “attained-age rated” policies, the premium is based on your current age—potentially leading to unpredictable rate increases as you grow older.

For help comparing plans, contact your state health insurance assistance program. Weiss also offers personalized reports listing all policies available in your area, along with their premiums, pricing method and insurer safety rating. Retirement Report readers can buy the report at a discounted rate of $49 at weissmedigap.com.

Medigap, also called Medicare Supplement Insurance, is additional insurance you can buy from private health insurance companies to help pay the out-of-pocket costs, such as copays and deductibles, associated with original Medicare. You must have original Medicare, Part A, and Part B, to buy a Medigap policy. Medicare Advantage plan participants can't buy Medigap insurance.

A Medigap policy pays out after both you and Medicare have paid your share of the medical costs. However, unlike Medicare, there are circumstances when insurance companies factor in preexisting conditions when deciding whether to offer you a Medigap policy or when setting premiums. In some cases, Medigap will also cover emergency medical expenses if you travel outside of the U.S.

Although there are ten Medigap plans available — A, B, C, D, F, G, K, L, M, and N — some of these plans (C, F, E, H, I and J) are no longer available to new enrollees in Medicare. However, if you are already enrolled in one of these plans, you can keep it for now. If you were eligible for Medicare before January 1, 2020, you can still buy Plan C or F.

Medigap open enrollment only happens once

You get a six-month “Medigap Open Enrollment” period that starts the first month you have Medicare Part B and you’re 65 or older. During this period, you have what is called 'guaranteed issue rights' that protect you from denial of coverage for preexisting conditions and higher premiums. An insurance company can’t use medical underwriting to decide whether to accept your application or upwardly adjust your costs.

Keep in mind that after your Medigap open enrollment period is over an insurer can deny you coverage if you don’t meet their medical underwriting requirements, and you may have to pay more and there may be fewer options for you to consider.

Remember, the Medicare open enrollment period is October 15 to December 7.

How preexisting conditions can affect your Medigap eligibility 

Many people don’t realize that even though preexisting conditions can’t affect your ability to get other types of health insurance, such as Medicare, the rules are very different for Medigap policies.

You can pick any Medigap plan available in your area within six months after you initially sign up for Medicare Part B. But after that, Medigap insurers in almost all states can reject you or charge more based on your health.

It can be challenging to switch to another insurer with better Medigap rates or if you had a Medicare Advantage plan for more than a year and want original Medicare and a Medigap policy instead.

You may also buy a Medigap policy without concern about preexisting conditions if you move out of your Medicare Advantage plan’s service area or change your mind within 12 months of signing up for Medicare Advantage at age 65. For more information, see Medicare's When Can I Buy Medigap?

Also, your insurer may let you switch to a less-comprehensive policy regardless of your health (such as switching from a Plan G to a high-deductible Plan G). See the Medicare Rights Center’s list of what each type of Medigap policy entails.

By the way, if you currently have a Medicare Advantage Plan, it’s illegal for someone to sell you a Medigap policy. But if you are considering switching to original Medicare, you can change plans during the Medicare open enrollment period each year.

States where insurers can't deny Medigap coverage after your initial enrollment period

Four states — including Connecticut, Maine, Massachusetts and New York — have special rules that let residents switch Medigap plans regardless of preexisting conditions. These states require Medigap insurers to offer polices to beneficiaries age 65 and over on a contingent or annual basis.

The birthday rule. Other states waive underwriting requirements and permit you to change plans at certain times. For example, if you live in California, you can select a different Medigap plan that has the same or fewer benefits if you make a decision to change within 30 days after your birthday each year.

In addition to California, there are eleven other states that have a Medigap birthday rule: Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Oregon, Utah, Virginia and Wyoming all have a form of the birthday rule. In 2026, a birthday rule will take effect in Indiana.

Some states allow Medicare participants to change plans during a specified window of days around their birthday. Some limit beneficiaries to keeping the same plan, but allow them to sign up with a different insurer. If you live in one of those states, check with your local SHIP office (State Health Insurance Program) to determine how long you have to make a change to your Medigap coverage.

The Medicare Select exception

In some states, it's possible to buy another type of Medigap policy called Medicare SELECT. A person with a Medicare SELECT policy is required to use hospitals or healthcare professionals within a specific network to get the maximum benefit from their plan’s benefits. Outside of emergency treatment, enrollees who use out-of-network hospitals or doctors will likely be liable for some or all of the costs that Medicare does not pay.

If you later decide that you don't like being limited to the network or want or think Medigap is better, you are allowed to switch to a standard Medigap policy within 12 months.

Resources to help find a Medigap policy

For more information about your state’s rules, check out www.naic.org/map. Most states have consumer guides that list Medigap prices and provide information for seniors searching for a plan. Your State Health Insurance Assistance Program can also help. See www.shiptacenter.org to find your state SHIP.

Related Content

• Medicare Basics: 12 Things You Need to Know
• What’s the Best Medigap Plan?
• The Rules for Making a Medigap Switch

Question:

I understand that medigap Plan F is going away in 2020. I’ve had Plan F for years. Does that mean I have to pick a new plan?

Answer:

No, you don’t need to switch plans. Medicare supplement (medigap) policies, which help cover Medicare’s co-payments, deductibles and other out-of-pocket costs, currently come in 10 standardized plans: A through D, F, G, and K through N. Every plan with the same letter designation provides the same coverage, even though premiums can vary by company. Medigap Plan F and Plan C can’t be sold to newly eligible Medicare beneficiaries after January 1, 2020, but current beneficiaries can keep their plans.

This change is part of a 2015 law that prohibits medigap plans that cover the deductible for Part B (medical insurance) from being sold to new Medicare enrollees starting in 2020. The hope is that people will be more careful about using medical care if they have to pay a deductible, even if it’s small (the Part B deductible is $183 in 2018). Plan F and Plan C cover the Part B deductible.

New Medicare enrollees who like the coverage of Plan F (which is currently the most popular plan) should consider Plan G, which provides most of the same coverage but doesn’t include the Part B deductible. In 2018, the average premium for Plan F nationally is $2,204 per year, while the average Plan G costs $1,786, according to Weiss Ratings Medigap, which provides personalized reports to help people shop for medigap policies. Premiums can be higher or lower depending on your state, and they can also vary from company to company. Many state insurance departments post lists of the premiums for each company’s medigap policies sold in their state. See this map for links to your state insurance department. For more information about what each letter plan covers, see Medicare.gov’s How to Compare Medigap Policies.

People who are currently in Plan F can remain in the plan, but they should keep an eye out for changes to premiums in the future, when new enrollees will no longer be in the risk pool. However, it can be difficult to switch plans after you first enroll. Medigap insurers in most states can reject you for coverage or charge more because of preexisting conditions if more than six months have passed after you signed up for Part B (although some states may pass special consumer protections for people who currently have Plan F). For more information about the current rules, see the Kaiser Family Foundation’s study on the topic, Medigap Enrollment and Consumer Protections Vary Across States.

At 65, you retire, dutifully sign up for Medicare Parts A, B and D and select a Medicare supplement (medigap) policy to help cover your out-of-pocket costs. It’s not cheap, but you’re confident you have the insurance you need.

Then you decide to go back to work. Maybe you need the money. Maybe a company makes you an offer you can’t refuse. Bell-ringing bonus: The new job offers fabulous medical insurance as a fringe benefit.

Can you cancel your suddenly superfluous Medicare and medigap coverage and pocket hundreds of dollars a month in savings? Or will that threaten your ability to restart that coverage, when you really retire?

Those are the questions weighing on Barry Segulyev these days. The 75-year-old accountant lives in northern California and works an hour away in Reno, Nev. At age 65, he cut a deal with his then-employer, a nonprofit with fewer than 20 employees, to give up his employer health insurance and sign up for Medicare and medigap in exchange for some extra cash to help pay premiums. Medicare became his primary insurer.

A few years later, he switched to his current job, at a much larger firm with a company plan that provides primary coverage. Now Segulyev gets little, if any, benefit from Medicare and medigap. He’d like to drop them to save money until he leaves his current job.

The good news is that if Segulyev drops Part B, he can sign back on later with no penalty, as long as he does so within eight months after the company insurance ends. To disenroll, you must submit a special form after discussing the matter either in person or on the phone with a Social Security representative.

Things can get sticky if he drops medigap, though. Under federal law, you generally get just one opportunity to buy a supplemental policy when insurers have to sell it to you regardless of your health. That window is open for six months starting the first time you are at least age 65 and have both Medicare Parts A and B.

For Segulyev, that window closed a decade ago. If he drops his medigap policy now, he might not be able to buy a substitute plan later without medical underwriting. If he is in poor health at the time, insurers could charge him more or refuse to sell him a policy.

We say could because, although federal rules provide just one open enrollment period, Segulyev might get another bite at the apple. Casey Schwarz, senior counsel for education for the Medicare Rights Center, says it’s unlikely the medigap insurer would ask whether Segulyev had a supplemental policy in the past and, assuming he had simply delayed enrolling in Part B, would issue a policy without underwriting. He’d get the plan at the same price others of his age were paying.

It’s not guaranteed, though. “Unfortunately, the rules aren’t really super specific about what should happen in this situation,” she says.

Check Your State's Rules

Where you live comes into play, too. Schwarz points out that New York state has year-round open enrollment for medigap, making it easy to buy back into the system without underwriting. In California, where Segulyev lives, you can change medigap policies once a year, around your birthday, no questions asked. But if Segulyev drops his current coverage, that rule doesn’t help him. For your state’s rules, check with your state health insurance assistance program at shiptacenter.org.

When it comes to Part D prescription-drug coverage, you can disenroll if you get a job with coverage and reenroll later without penalty, as long as the employer coverage is at least as good as Part D coverage.

So what should Segulyev do—continue Medicare or drop it? Schwarz offers a third choice. She suggests Segulyev consider dropping his company plan. He could save that cost and rely on Medicare and medigap, and eliminate any problems re-upping his medigap.

Question: I read your column about the time frame for signing up for Medicare Part B if you’re still working past age 65. How long do you have to get Medicare supplement and Part D coverage or a Medicare Advantage plan?

Answer:

You can sign up for a Medicare supplement, or medigap, plan at any time. Medigap covers deductibles and co-payments and other expenses that Medicare doesn’t cover. But you’ll have the most options and may save money if you choose a plan within six months of signing up for Part B.

If you sign up for Medicare at age 65, you can also sign up for Part D, which covers outpatient prescription drugs, or Medicare Advantage, which provides medical and drug coverage, during the seven-month initial enrollment period, which includes the month you turn 65 as well as the three months before and after. You may have to pay a penalty if you don’t have drug coverage by certain deadlines (see below). If you’re one of the lucky few who have retiree coverage from a former employer, that may fill in the gaps.

MEDIGAP. If you don’t sign up for medigap insurance within six months of signing up for Medicare, you generally have to go through medical underwriting, meaning the health plan checks to see if you’ve been hospitalized in the past two years or if you’ve had any chronic health issues, says Shaina Popkin, an independent Medicare broker in Long Beach, Calif. And insurers in most states can charge you more or reject you for coverage because of preexisting conditions.

You could still qualify for a medigap policy if you’re healthy, and your state may have special rules allowing you to get a policy at certain times regardless of any preexisting conditions. In California, for example, you can buy any medigap policy with lesser benefits than your current plan within a 30-day period starting on your birthday each year, regardless of your health. Find out more from your state insurance department or by contacting the State Health Insurance Assistance Program in your area. Also see Medicare.gov’s When Can I Buy Medigap? to learn about other special situations when you can buy a policy regardless of preexisting conditions. See How to Save on Medicare Supplement Insurance for information about shopping for a policy.

PART D AND MEDICARE ADVANTAGE. If you delayed signing up for drug coverage because you were covered by an employer or other source, you have two months after losing that insurance to sign up for Part D or a Medicare Advantage plan. If you miss that deadline, you generally have to wait until the next open-enrollment period to sign up. Open enrollment runs from October 15 to December 7 for coverage starting January 1.

You’ll also have to pay a penalty if you go more than 63 days without “creditable drug coverage,” which can include drug coverage from an employer, a retiree plan, Tricare or a few other sources considered to be as good as or better than Medicare’s drug insurance. Ask your plan if it is eligible. The penalty is 1% of the “national base premium” ($35.63 in 2017) for every month that you didn’t have Part D or creditable coverage. See How to Avoid the Medicare Part D Penalty for more information.

You can switch Part D or Medicare Advantage plans every year during open enrollment. It’s a good idea to check out all of your options annually to see if your plan still offers the best deal for your drugs, doctors and other care. Go to the Medicare Plan Finder to compare premiums, coverage and out-of-pocket costs for all of the Part D and Medicare Advantage plans in your area.

There are also some special circumstances in which you can switch Part D or Medicare Advantage plans outside of open enrollment, such as if you move to a new address not in your plan’s service area. For more information, see Medicare.gov’s Special Circumstances page or the Medicare Rights Center’s Special Enrollment Periods guide. You can also switch into a Medicare Advantage plan with a five-star quality rating anytime during the year if one is available in your area. However, there are only 17 five-star plans in the country in 2017. See How to Switch Out of a Medicare Advantage Plan for more information.

For more information about choosing a medigap, Part D or Medicare Advantage plan, see How to Fill in Medicare Coverage Gaps. Also see FAQs About Medicare for information about the rules for signing up, as well as how to fill the gaps and save money on coverage.

Question: I turned 65 a few years ago while living in Florida. My wife and I are about to move to Delaware, and the insurer says I can keep my policy. (My wife turns 65 next year.) Do the pricing rules for medigap policies vary by state? And will the premiums change for the policy I already have?

Answer: Yes to both questions. Medicare supplemental coverage fills in the gaps in Medicare, such as deductibles and co-payments, and comes in 10 standardized policies (A through F, and K through N). Each policy with the same letter designation provides the same coverage, but the premiums can vary a lot by insurer. In some states, insurers can choose from three pricing methods for medigap policies: issue-age policies, which base premiums on your age when you purchase the policy; attained-age policies, which can increase premiums each year because of your age; and community-rated policies, which are similar to issue-age policies but generally charge everyone the same rate regardless of age. “Premiums for attained-age policies are likely to go up a lot more than policies that are issue-age or community-rated,” says Bonnie Burns, a medigap expert and the training and policy specialist for California Health Advocates.

Since you already have an issue-age policy, you’ll be able to keep your policy with that pricing structure, even though you are moving, says Burns. Your premiums may change, however, because of differences in health care costs in your area. When your wife turns 65, she’ll have to choose from the options available in Delaware. Most insurers in that state offer attained-age policies, but she should be able to find a few that offer issue-age or community-rated policies.

Most state insurance departments have lists of medigap premiums and pricing structures for the policies sold in their state, such as the Delaware Medicare Supplement Insurance Shopper’s Guide. Go to the National Association of Insurance Commissioners’ map to find links to each state’s insurance department. You can get extra help with your medigap choices by ordering a customized Weiss Ratings Medigap Report ($49 for Kiplinger readers), which lists the premiums and pricing structure of the medigap plans available in your area, based on your age and location, and provides advice on choosing a policy.

People who are enrolling in traditional Medicare should buy a supplemental insurance policy to cover the substantial gaps left by deductibles and co-payments, according to consumer advocates. But choosing a private Medigap plan can be daunting.

That's what Joyce Katen discovered when she turned 65 in May. "I got so confused," says Katen, a clothing manufacturing consultant in New York City. She turned to the Medicare Rights Center (www.medicarerights.org), a consumer group that helped her choose an insurance policy among numerous offerings.

Like others approaching 65, Katen first needed to decide how she would protect herself against Medicare's large coverage gaps. Most beneficiaries have two options. They can go with a private Advantage plan, which covers all Medicare benefits, provides drug coverage and limits out-of-pocket costs. Or they can opt for traditional Medicare and buy a separate Medigap policy as well as a Part D prescription-drug plan.

For Katen, that decision was easy. Advantage plans restrict your selection of providers, and Katen says she wants to be able to use any doctor she chooses, as traditional Medicare allows.

Then came the hard part for Katen: choosing a supplemental insurance policy. Medigap policies are sold by private insurers in ten standardized benefit designs, named A through N. With some exceptions, coverage and price generally increase as you move up the alphabet.

Plans C and F are held by a majority of the nine million Medigap beneficiaries. Both plans pay the deductible for Part A, which covers hospital costs, and for Part B, which covers outpatient costs. The deductible for Part A will be $1,260 for each benefit period in 2015, and the annual Part B deductible will be $147. (Plans E, H, I and J are no longer sold, but if you hold one, you can continue to keep it in most cases.)

To figure out which policy is best for you, consider your "health status, family medical history and risk tolerance," says Casey Schwarz, policy and client services counsel for the Medicare Rights Center. Healthier beneficiaries who rarely need medical care may be best suited for high-deductible plans.

Plans K and L are high-deductible policies that have lower premiums but impose higher out-of-pocket costs. Plan F also offers a high-deductible version.

But new beneficiaries should not choose a plan based solely on their health today. As long as you buy a Medigap policy within six months of enrolling in Part B, an insurer cannot reject you or charge you more because of medical issues. If you become ill and want to switch to a plan with better coverage, an insurer can boost the cost or turn you down.

Katen decided to go with the fully loaded Plan F. Katen, who is healthy, would rather pay more for comprehensive coverage and not worry about footing the bill if she gets sick. "I can't imagine not having the coverage," she says. She pays UnitedHealthcare, which sells policies under the AARP name, a monthly premium of $261, in addition to the monthly $104.90 Part B premium she pays to Medicare.

Find a Plan That Fits Your Needs

Depending on the plans offered in your area, Plan N could be a middle ground for many healthy beneficiaries. "Plan N provides very good coverage and is more affordable than Plan F," says Ross Blair, senior vice-president of eHealthMedicare.com, a division of online broker eHealth Inc. Plan N provides much of the same coverage as Plan F, but it doesn't cover the $147 Part B deductible. It also charges a $20 co-payment for doctor visits and a $50 co-payment for emergency room visits that don't result in hospital admissions.

In New York City, UnitedHealthcare offers a Part N plan for $178 a month, compared with Katen's $261 premium for Plan F. Katen could still come out ahead with Plan N if she had two emergency room visits and 40 visits to the doctor.

Once you choose your plan category, it usually makes sense to go with the cheapest plan. Under federal law, all plans offered under the same letter must offer the same benefits. Prices for the same policy can vary widely. For example, annual Plan F premiums range from $1,752 to $3,768 in Rockville, Md., and from $2,472 to $6,552 in Miami.

Besides checking the initial premium, ask the insurer which of the three pricing methods it uses for the plan you are considering. Attained-age pricing bases the premium on your age when you buy the policy, with rates rising as you grow older. Premiums can also increase because of inflation.

With issue-age pricing, the premium is based on the age at which you buy the policy (the younger you buy, the less expensive), and it will not change as you age, except for inflation. Community-rated policies charge the same price to everyone regardless of age, and your annual premium can only increase for inflation. "We would encourage going with a community-rated plan, with an issue-age plan being the next best thing," Blair says. He compares attained-age policies to variable-rate mortgages, which start off at a low price but can escalate considerably.

To understand how your costs may change over time, ask for a three- to five-year rate history for each policy you are considering. Also ask for quotes as if you were age 70, 75 and 80. Some insurers will offer discounts -- for nonsmokers, for women and for those who hold several policies with the company, such as homeowners and auto insurance.

While companies in most states can conduct medical underwriting if you apply for a plan after the initial six months are over, there are some exceptions. You can buy Medigap coverage without underwriting if you're in a Medicare Advantage plan and you move out of its service area, or if your insurer stops selling the Medigap plan you currently have. Another exception is if your retiree health coverage from a former employer ends. And some states, such as New York, prohibit underwriting after the six-month period.

To compare policies in your area, visit www.medicare.gov/find-a-plan/questions/medigap-home.aspx. To get additional help, get in touch with your local State Health Insurance Assistance Program at www.shiptalk.org. You'll find rules in your state by visiting the Web site of the National Association of Insurance Commissioners (www.naic.org). Note that Massachusetts, Minnesota and Wisconsin have their own standardized benefits.