Understanding Medigap: Your Guide to Medicare Supplement Insurance (2025)
Medicare doesn't cover everything. Learn how Medigap supplement insurance fills the gaps with comprehensive coverage, which plans are right for you, and when to enroll for guaranteed acceptance.
Medicare covers a lot, but it doesn't cover everything. Those gaps in coverage—deductibles, copayments, and coinsurance—can add up quickly, especially if you're managing chronic conditions or facing unexpected health challenges. That's where Medigap comes in.
If you've heard the term "Medigap" or "Medicare Supplement Insurance" and wondered whether it's right for you or a loved one, this guide will help you understand what these policies offer, how they work, and when they make sense. Whether you're in Ocean County, Monmouth County, or anywhere across New Jersey and beyond, these fundamentals apply to your Medicare planning.
What Is Medigap?
Medigap is private, standardized insurance that helps pay for out-of-pocket costs left behind by Original Medicare (Parts A and B). Think of it as filling in the "gaps" left by Medicare—hence the name.
These policies are sold by private insurance companies but are standardized by the federal government. This means that a Plan G from one company offers the exact same medical benefits as a Plan G from any other company—only the premiums differ.
What Medigap Typically Covers
- Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted)
- Part B coinsurance or copayment
- First 3 pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility coinsurance
- Part A deductible
- Part B deductible (only Plans C & F, available only to those eligible for Medicare before January 1, 2020)
- Part B excess charges (some plans)
- Foreign travel emergency care (only Plans C, D, F, G, M, and N include this benefit)
What Medigap Does NOT Cover
- Prescription drugs (you'll need Part D for that)
- Vision care
- Dental care
- Hearing aids
- Long-term care (nursing home care)
- Custodial care
- Cost-sharing from Medicare Advantage plans (Medigap cannot be used with Medicare Advantage)
The Different Medigap Plans
Medigap policies are labeled with letters: A, B, C, D, F, G, K, L, M, and N. Each letter represents a different standardized package of benefits. Plans C and F are no longer available to people who became eligible for Medicare on or after January 1, 2020.
Most Popular Plans
Plan G is currently the most popular choice for new enrollees. It covers nearly everything except the Part B deductible (projected around $257 for 2025, with the final CMS number pending). Many people find this provides comprehensive coverage with predictable out-of-pocket costs.
Plan N costs less than Plan G but requires small copayments for doctor visits (up to $20) and emergency room visits (up to $50, waived if admitted). It also doesn't cover Part B excess charges.
High-Deductible Plan G offers lower monthly premiums but requires you to pay a deductible expected to be around $3,000 in 2025 (exact CMS number pending) before coverage kicks in. This can be a good option if you're relatively healthy and want protection against catastrophic costs.
Plan G vs. Plan N: Quick Comparison
Plan G:
- Monthly Premium: Higher ($150-$250+ depending on age/area)
- Part B Deductible: You pay (≈$257/year)
- Doctor Visit Copay: $0
- ER Visit Copay: $0
- Part B Excess Charges: Covered
- Foreign Travel Emergency: Covered (80% after $250 deductible, up to $50,000 lifetime)
- Best For: Maximum predictability, frequent medical visits
Plan N:
- Monthly Premium: Lower ($100-$180+ depending on age/area)
- Part B Deductible: You pay (≈$257/year)
- Doctor Visit Copay: Up to $20
- ER Visit Copay: Up to $50 (waived if admitted)
- Part B Excess Charges: Not covered
- Foreign Travel Emergency: Covered (80% after $250 deductible, up to $50,000 lifetime)
- Best For: Lower premiums, generally healthy, okay with small copays
When Can You Enroll?
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This is the six-month period that begins the first day of the month you're both 65 or older and enrolled in Medicare Part B.
Why This Timing Matters
During this period, insurance companies cannot refuse to sell you any Medigap policy they offer, regardless of your health conditions. They also cannot charge you more because of pre-existing conditions. This is your guaranteed-issue right.
Outside this window: If you miss this enrollment period, you may face medical underwriting, which means insurance companies can deny coverage, charge higher premiums, or impose waiting periods for pre-existing conditions. Some states offer additional protections, but the federal guarantee is strongest during this initial enrollment period.
For those in New Jersey and across the country, this six-month window is critical—don't let it pass without making an informed decision about your coverage.
Medigap vs. Medicare Advantage: Understanding Your Options
One of the most important healthcare decisions you'll make is choosing between Original Medicare with a Medigap policy or a Medicare Advantage plan (Part C). These are fundamentally different approaches to Medicare coverage.
With Medigap (Original Medicare + Supplement)
- You have Original Medicare (Parts A and B) plus a Medigap policy
- Freedom to see any doctor who accepts Medicare, anywhere in the country—no network restrictions
- No need for referrals to see specialists
- Separate Part D plan needed for prescription drug coverage
- Higher monthly premiums (Medicare Part B premium + Medigap premium + Part D premium)
- Lower out-of-pocket costs when you receive care
- Coverage stays the same year after year
With Medicare Advantage (Part C)
- Replaces Original Medicare with a private plan
- Usually includes prescription drug coverage
- Often has lower monthly premiums (sometimes $0)
- Network restrictions (HMO, PPO) that may limit your choice of doctors and hospitals
- May need referrals for specialists
- Higher out-of-pocket costs when receiving care (copays, coinsurance)
- Coverage can change annually
- Annual out-of-pocket maximum provides catastrophic protection
Neither option is universally "better"—it depends on your health needs, budget, travel patterns, and preferences for flexibility versus cost predictability.
How Much Does Medigap Cost?
Medigap premiums vary based on several factors:
Your Location
Premiums differ significantly by state and even by ZIP code. For example, rates in Ocean County and Monmouth County may differ from rates in other parts of New Jersey, and New Jersey rates differ from neighboring states. Urban areas often have higher premiums than rural areas.
The Plan You Choose
More comprehensive plans like Plan G typically cost more than plans with more cost-sharing like Plan N.
The Insurance Company
Different companies charge different premiums for the same plan, which is why shopping around is essential. Since the benefits are identical, comparing prices is straightforward.
Your Age and How It's Priced
- Community-rated (no age surcharge): Everyone pays the same premium regardless of age
- Issue-age rated: Premium based on your age when you buy the policy
- Attained-age rated: Premium increases as you get older (most common pricing method)
Typical ranges for Plan G in New Jersey: $120 to $250+ per month, depending on age, location, and insurer. Remember, you'll also pay your Medicare Part B premium (projected at $185/month for 2025 for most people) and potentially a Part D premium.
Is Medigap Right for You?
Consider a Medigap Policy If:
You value predictability: With comprehensive Medigap coverage, you know your monthly costs upfront and face minimal surprise bills when you need healthcare.
You want provider flexibility: If seeing any Medicare-accepting doctor without referrals or network restrictions matters to you—whether you're seeing specialists at Jersey Shore University Medical Center, visiting family out of state, or seeking care anywhere in the country—Medigap preserves this freedom.
You travel frequently: Medigap plans offer coverage anywhere in the United States, and many include foreign travel emergency coverage. This matters whether you're traveling to visit grandchildren or spending winters in warmer climates.
You have chronic conditions: If you anticipate needing regular healthcare services, the lower out-of-pocket costs with Medigap can provide significant savings and peace of mind.
You prefer comprehensive coverage: If the idea of copays, coinsurance, and deductibles for every service causes stress, Medigap's comprehensive coverage may suit you better.
A Medicare Advantage Plan Might Be Better If:
You prefer lower monthly premiums: If keeping monthly costs low is your priority and you're comfortable with higher costs when you need care.
You want all-in-one coverage: Medicare Advantage plans typically include prescription drug coverage, eliminating the need for a separate Part D plan.
You're comfortable with networks: If you're willing to use network providers and can obtain referrals when needed, and your preferred doctors and hospitals participate in the plan's network.
You rarely travel: If you primarily stay in one area and don't need coverage outside your plan's service area.
Your Action Plan
If you're considering Medigap:
1. Start during your enrollment window. Don't miss your six-month Medigap Open Enrollment Period when you're guaranteed coverage regardless of health conditions.
2. Compare multiple companies. Since plans are standardized, shop based on price, customer service reputation, and financial stability. Get quotes from at least three companies operating in your area.
3. Understand the pricing method. Ask whether premiums are community-rated, issue-age rated, or attained-age rated, as this affects long-term costs significantly.
4. Don't forget Part D. Medigap doesn't include prescription drug coverage, so you'll need a separate Part D plan unless you have creditable coverage elsewhere.
5. Review annually. While you can't easily switch Medigap plans later without underwriting, you can always switch insurance companies offering the same plan letter if you find better rates. Many people don't realize this money-saving opportunity.
6. Get personalized guidance. Medicare decisions are complex and deeply personal. Consider working with someone who can review your specific health needs, medications, doctors, and budget to help you make the right choice for your situation.
You Don't Have to Navigate This Alone
Understanding Medicare options—including whether Medigap is right for you—can feel overwhelming. The stakes are high, the terminology is confusing, and the wrong choice can affect both your health and your finances for years to come.
At SageAlly, we specialize in helping seniors and their families throughout Central New Jersey—including Ocean County, Monmouth County, and beyond—navigate exactly these kinds of healthcare decisions. We can review your Medicare options, compare Medigap plans available in your area, explain how different choices affect your specific situation, and ensure you're making informed decisions that align with your needs and budget.
Whether you're approaching your initial enrollment period, recently moved to the area, or reconsidering your current coverage, we're here to provide the clarity and support you need. Our services extend beyond local borders—we work with families nationwide who need expert Medicare navigation and care coordination.
You deserve healthcare that works for you. Let's make sure you have it.
Disclaimer: This content is for educational purposes only and does not constitute medical, legal, or financial advice. Information about Medicare, Medicaid, Social Security, VA benefits, and other programs is subject to change—verify current details with official sources. Every situation is unique; consult qualified professionals for guidance specific to your circumstances.