Tuesday, July 7, 2026Vol. XII · No. 47

The Health Almanac

Field Reports · Enrollment Wires · Beneficiary Tools

Primer · Medigap

Medigap: The Predictability Policy — When You Can Still Get One

Medicare Supplement plans pay Original Medicare's cost-sharing. Plan G and Plan N dominate new enrollment. The catch: outside your open enrollment window, carriers can decline you for health history in most states.

Coverage Desk · Updated this quarter · 9 min read

A Medigap policy is private insurance that pays the deductibles, coinsurance and copayments Original Medicare leaves behind. Plans are federally standardized: Plan G from one carrier covers the same benefits as Plan G from any other carrier. The only meaningful shopping variables are premium, rate history and financial strength.

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The plans that matter today

  • Plan G — pays everything Original Medicare doesn't, except the Part B deductible ($257 in 2025). The default for anyone eligible on or after Jan 1, 2020.
  • Plan N — pays most Part B coinsurance, but you owe up to $20 per office visit and $50 per ER visit that doesn't result in admission. Excess charges are also not covered.
  • High-Deductible Plan G — pays Plan G benefits after you meet an annual deductible ($2,870 in 2025). Lower premium, real risk.
  • Plan F — pays the Part B deductible too. Closed to newly eligible beneficiaries after Jan 1, 2020; still available if you were eligible before that date.

Underwriting: the window that closes

During your 6-month Medigap Open Enrollment Period — starting the month you're 65 and enrolled in Part B — no carrier can decline you or surcharge you for health history. After that window closes, most states allow full medical underwriting: a carrier can decline you outright, or rate you up, based on your health.

A handful of states (Connecticut, Massachusetts, New York, and — with rules — Maine, Vermont, Washington) require guaranteed issue or continuous open enrollment. Rules vary; check your state's Department of Insurance before assuming portability.

Premium structures

  • Community-rated: All enrollees pay the same premium regardless of age.
  • Issue-age-rated: Premium is fixed based on your age at issue and doesn't rise with age.
  • Attained-age-rated: Premium rises annually as you age. Cheap early, expensive late — the most common structure and often the most expensive over a lifetime.

Guaranteed-issue rights outside the window

Federal law provides limited guaranteed-issue rights — for example, losing employer coverage, moving out of a Medicare Advantage service area, or trial-right disenrollment from a Medicare Advantage plan within the first 12 months. These rights have short deadlines (usually 63 days). Miss them and you're back under state underwriting rules.

When Medigap is worth the premium

  • You value predictable, near-zero cost-sharing over a lower premium.
  • You want nationwide access to any provider that accepts Medicare.
  • You anticipate significant medical utilization or have a chronic condition.
  • You want to avoid prior-authorization gatekeeping.