What it is
Original Medicare is the federal health program with Part A (hospital) and Part B (medical). It covers many services. But it was not designed to pay for every cost.
There are two kinds of gaps. The first is cost-sharing. Original Medicare generally has deductibles, coinsurance and copayments, and it has no annual limit on what you could owe out of pocket. The second is services it generally does not cover.
Services that original Medicare generally does not cover include routine dental care, routine vision care such as eyeglasses, hearing aids, and most long-term custodial care. Original Medicare also does not include outpatient prescription drug coverage. That comes from a separate Part D plan. Coverage can also be limited when you travel outside the U.S. For exact details, check Medicare.gov.
How it’s traditionally been approached
Many people handle the cost-sharing gaps with a Medigap plan, also called Medicare Supplement Insurance. These plans are sold by private insurance companies. They are designed to help pay some of the costs original Medicare leaves behind.
Medigap plans come in standardized letters. Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
Other people choose Medicare Advantage instead. These plans are often built with lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans. They also use networks and may require prior authorization or copays. Medigap offers any provider nationwide that accepts Medicare, no network or referrals, and predictable cost-sharing. Its trade-offs are generally higher monthly premiums, possible medical underwriting outside open enrollment or guaranteed issue, a separate Part D plan for drugs, and no routine dental, vision or hearing. Both approaches are valid. The better fit depends on the person.
How the right licensed agent may help
A Medigap agent is a licensed professional who can explain how these plans work. A good conversation may help you see which gaps matter most to you. It may also help you compare options such as Medigap Plan G and Medigap Plan N. Call 1-800-MEDIGAP for more information.
A visit or call is usually a relaxed conversation. The agent may ask about your doctors, how often you use care, your prescriptions, whether you travel, and your budget comfort. If you are turning 65, the agent may also talk about first-time enrollment timing. These details help shape the discussion. They are not a promise of any outcome.
Good questions to ask include: Which gaps would a Medigap plan leave open? How would I cover drugs, dental, vision and hearing? Will I face medical underwriting? What are the enrollment rules in my state? Rules vary by state and change over time. Confirm current details with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
The bigger picture
Health costs can weigh on the mind. Not knowing what Medicare leaves out can create worry, and worry can affect sleep, stress and even how willing you are to seek care. Understanding the gaps ahead of time may bring some calm and help you plan.
Peace of mind looks different for everyone. Some people value predictability. Others value lower premiums or extra benefits. No approach is wrong. If you are also looking for care providers, Providers.plus may be one place to explore.
Keep in mind
- 1-800-MEDIGAP is an independent educational directory. It is not Medicare.gov, not the government and not a professional advisor.
- This page is insurance education only. It is not insurance, legal, tax or medical advice.
- Enrollment rules, open enrollment, guaranteed issue and under-65 access vary by state and can change. Confirm them with Medicare.gov, your SHIP or a licensed agent.
- A Medigap agent may help you compare options, but no plan is guaranteed to be available, affordable or the best fit for everyone.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
What does original Medicare not cover?
Original Medicare generally does not cover routine dental, routine vision, hearing aids, most long-term custodial care, or outpatient prescription drugs. It also leaves you with deductibles, coinsurance and copayments, and it has no annual out-of-pocket limit. Check Medicare.gov for current details.
Does original Medicare cover prescription drugs?
Original Medicare does not include outpatient prescription drug coverage. People usually add a separate Part D plan, or choose a Medicare Advantage plan that includes drug coverage. A Medigap plan does not include drug coverage either.
Does Medigap cover what original Medicare does not?
Medigap helps with some cost-sharing gaps, such as certain deductibles, coinsurance and copayments, depending on the plan letter. It generally does not add routine dental, vision or hearing coverage, or drug coverage. It only works alongside original Medicare.
Do Medigap Plan G and Plan N cover the same gaps?
No, they differ. Both are sold to people newly eligible for Medicare, and both help with several cost-sharing gaps. Plan N generally has some copays and does not cover everything Plan G does. A Medigap agent can walk you through the differences.
What should I know about gaps when turning 65?
Turning 65 is often when people first compare ways to handle these gaps. Your first enrollment window can matter, because medical underwriting may apply to Medigap later in some situations. Rules vary by state, so confirm them with Medicare.gov, your SHIP or a licensed agent.
Is 1-800-MEDIGAP part of Medicare?
No. 1-800-MEDIGAP is an independent, privately run educational directory. It is not Medicare.gov, CMS, Social Security or any government agency, and it is not endorsed by the federal Medicare program. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.