Which Medigap Plan Might Fit Which Retiree?
Medicare can feel complicated, especially when you are first getting started. One of the biggest decisions people make when choosing Original Medicare is whether to add a Medicare Supplement Insurance plan, also called Medigap.
Think of Medigap as extra insurance purchased from a private insurance company to help pay some of the out-of-pocket costs that Original Medicare leaves behind.
But then comes the alphabet soup: Should you choose Plan G, Plan N, Plan K, or Plan L?
The good news is that you don’t have to memorize a Medicare dictionary. These four Medigap plans share many benefits, but they differ in how much they pay toward certain medical expenses—and how much you may have to pay yourself.
For many retirees, the decision comes down to a simple question: Would you rather pay a higher monthly premium for more predictable health care costs, or pay a lower premium and accept more cost-sharing when you receive care?
There is no single right answer. Your health, budget, preferred doctors, where you live, travel plans, and comfort with unexpected medical bills all deserve a place in the decision.
This guide walks you through the differences in plain English, so you can compare your options with greater confidence.
One important distinction: Medigap works with Original Medicare. It is not the same as Medicare Advantage, which is a different way to receive your Medicare benefits. If you are enrolled in a Medicare Advantage plan, you do not need a Medigap policy and insurers cannot lawfully sell you one.
Quick Jump to Topics
- Quick Glance: How the Four Plans Divide Costs
- What All Four Plans Have in Common
- One Term to Know: Part B Excess Charges
- Plan G: Pay a Little More, Worry a Little Less
- Plan N: A Lower Premium with Some Pay-as-You-Go Costs
- Plan K: Lower Premiums, More Cost-Sharing, and an Annual Safety Net
- Plan L: A Middle Ground Between K and the More Comprehensive Plans
- Which Plan Might Fit You? A Quick Self-Check
- Shopping Tips: How to Compare Policies Wisely
- Can You Switch Plans Later? Understanding Your State’s Rules
- What is a Medicap Birthday Rule?
- The Bottom Line
Quick Glance: How the Four Plans Divide Costs
The chart below compares the standardized benefits of Plans G, N, K, and L. It shows the percentage of each listed benefit that the Medigap policy covers, subject to the policy’s terms and applicable Medicare rules.
The chart below compares the standardized benefits of Plans G, N, K, and L. It shows the percentage of each listed benefit that the Medigap policy covers, subject to the policy’s terms and applicable Medicare rules.
| Benefit | Plan G | Plan N | Plan K |
Plan L |
| Part A hospital coinsurance and hospital costs for up to 365 additional days after Medicare benefits are used | 100% | 100% | 100% | 100% |
| Part A deductible | 100% | 100% | 50% | 75% |
| Part B coinsurance or copayments | 100% | 100%* | 50% | 75% |
| Part B excess charges | 100% | Not covered | Not covered | Not covered |
| Skilled nursing facility coinsurance | 100% | 100% | 50% | 75% |
| Part A hospice coinsurance or copayments | 100% | 100% | 50% | 75% |
| First three pints of blood | 100% | 100% | 50% | 75% |
| Foreign-travel emergency care | 80%** | 80%** | Not covered | Not covered |
| Part B deductible | Not covered | Not covered | Not covered | Not covered |
| Annual out-of-pocket limit for 2027 | None | None | $8,360 | $4,180 |
* Plan N covers Part B coinsurance, except that you may owe a copayment of up to $20 for certain office visits and up to $50 for an emergency room visit that does not result in an inpatient admission.
** Plans G and N cover 80% of eligible foreign-travel emergency care after a $250 annual deductible, subject to a $50,000 lifetime maximum and the plan’s other requirements.
Plans K and L: Once you have met the applicable annual out-of-pocket limit and the Medicare Part B deductible, your plan pays 100% of covered services for the remainder of the calendar year. These limits are set annually. Be sure to check them to determine whether they are accurate when you read this article.
Something to Note:
Plans C and F are not included in this comparison. People who first became eligible for Medicare on or after January 1, 2020 generally cannot buy these plans. Those who already have an eligible Plan C or F policy may keep it, provided they continue to meet the policy’s requirements.
What All Four Plans Have in Common
Before exploring the differences, let’s start with what these plans share.
You keep Original Medicare. Medicare pays its share of covered services, and your Medigap policy helps pay certain remaining costs according to the benefits it covers.
You generally have nationwide provider flexibility. You can see any doctor or hospital in the United States that accepts Medicare, subject to Medicare’s coverage rules. Medigap policies generally do not have the provider networks associated with many Medicare Advantage plans.
Prescription drugs are separate. These Medigap plans do not cover outpatient prescription drugs. If you want Medicare prescription drug coverage, you generally need to enroll in a separate Part D plan.
You still pay your Medicare Part B premium. A Medigap policy does not replace your monthly Part B premium. You are also responsible for any costs the policy does not cover.
Benefits are standardized in most states. A Plan G policy generally provides the same standardized benefits as another Plan G policy, regardless of the insurance company selling it. Premiums, pricing methods, and customer service can differ.
One Term to Know: Part B Excess Charges
A provider who does not accept Medicare assignment may, in certain circumstances, legally charge more than the Medicare-approved amount for a service. The difference is called a Part B excess charge.
Among the four plans in this article, only Plan G covers these excess charges. Plans N, K, and L do not.
Some states prohibit or limit excess charges. And providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment for covered services, apart from applicable deductibles and coinsurance.
With those basics in mind, let’s look at each plan individually.
Plan G: Pay a Little More, Worry a Little Less
Plan G is often attractive to people who want broad protection against Medicare-covered out-of-pocket expenses.
It covers the Medicare Part A deductible, Part A and Part B coinsurance covered by the plan, skilled nursing facility coinsurance, and several other benefits. It also covers Part B excess charges and includes limited foreign-travel emergency coverage.
The main exception is the Medicare Part B deductible, which you pay yourself each year.
The pluses:
- More predictable costs. After you meet your annual Part B deductible, Plan G generally covers the remaining Medicare-approved Part A and Part B cost-sharing included in the plan.
- Broad coverage. The plan covers the Part A deductible, skilled nursing facility coinsurance, and other covered expenses that can otherwise add up.
- Protection against Part B excess charges. Plan G is the only plan of the four that covers them.
- Potentially attractive for frequent users of health care. If you regularly see doctors or specialists, paying a higher premium may be worthwhile in exchange for less cost-sharing when you receive covered care.
The minuses:
- The premium may be higher. You pay for more comprehensive cost-sharing protection.
- You still have expenses. You must pay your Part B premium and annual Part B deductible, along with any costs outside the plan’s coverage.
- Premiums vary. Prices can differ substantially by insurance company, location, age, and pricing method.
Plan N: A Lower Premium with Some Pay-as-You-Go Costs
Plan N is similar to Plan G in many important ways, but you take on more responsibility for certain costs when you receive care.
Plan N generally covers the Part A deductible, Part B coinsurance subject to its copayment rules, skilled nursing facility coinsurance, and limited foreign-travel emergency expenses.
The two major differences from Plan G are that Plan N does not cover Part B excess charges and may require copayments for certain office and emergency room visits.
The pluses:
- Potentially lower premiums. You may pay less each month in exchange for accepting some additional out-of-pocket costs.
- Strong basic protection. Plan N covers many of the same major cost-sharing categories as Plan G.
- Foreign-travel emergency coverage. Like Plan G, Plan N provides limited coverage for eligible emergency care outside the United States.
The minuses:
- Office visit copayments. You may owe up to $20 for certain office visits.
- Emergency room copayments. You may owe up to $50 for an emergency room visit that does not result in an inpatient admission.
- No Part B excess-charge coverage. If a doctor doesn’t accept Medicare assignment, you may owe the difference.
Plan K: Lower Premiums, More Cost-Sharing, and an Annual Safety Net
Plan K takes a different approach.
Instead of covering 100% of several cost-sharing benefits, it generally pays 50% of them. These include the Part A deductible, Part B coinsurance or copayments, skilled nursing facility coinsurance, hospice cost-sharing, and the first three pints of blood. Plan K also covers the Part A hospital coinsurance and hospital costs for up to 365 additional days after Medicare benefits are used.
In exchange for taking on more of these expenses, you receive an annual out-of-pocket limit.
For 2027, the Plan K limit is $8,360. After you have met that limit and the annual Part B deductible, Plan K pays 100% of covered services for the rest of the calendar year.
The pluses:
- Potentially lower premiums. Plan K provides less cost-sharing protection up front, which can mean a lower monthly premium.
- An annual financial safety net. The out-of-pocket limit places a ceiling on your responsibility for the covered Medicare cost-sharing counted toward that limit.
- You retain Original Medicare. As with other Medigap plans, Plan K supplements Original Medicare rather than replacing it.
The minuses:
- You pay a larger share when you receive care. Plan K covers only 50% of several benefits until you reach the applicable annual limit.
- The annual limit is higher than Plan L’s. In 2027, Plan K’s limit is $8,360, compared with $4,180 for Plan L.
- No foreign-travel emergency benefit. Unlike Plans G and N, Plan K does not include this benefit.
- No Part B excess-charge coverage. You may be responsible for eligible excess charges that a provider bills.
Remember, the annual limit does not mean every health care expense is capped. Your premium, Part B deductible, and costs for services not covered by Medicare or the policy may remain your responsibility.
Plan L: A Middle Ground Between K and the More Comprehensive Plans
Plan L follows the same general approach as Plan K, but it pays a larger share of several covered expenses.
Plan L generally pays 75% of the Part A deductible, Part B coinsurance or copayments, skilled nursing facility coinsurance, hospice cost-sharing, and the first three pints of blood. It also covers the Part A hospital coinsurance and hospital costs for up to 365 additional days after Medicare benefits are used.
For 2027, Plan L’s annual out-of-pocket limit is $4,180. After you have met that limit and the annual Part B deductible, Plan L pays 100% of covered services for the remainder of the calendar year.
The pluses:
- More cost-sharing protection than Plan K. Plan L pays 75% of several benefits, compared with Plan K’s 50%.
- A lower annual out-of-pocket limit. Plan L’s 2027 limit of $4,180 is half Plan K’s $8,360 limit.
- A possible compromise. If you want more protection than Plan K provides but prefer not to pay the premium associated with a more comprehensive plan, Plan L is worth comparing.
The minuses:
- You still pay part of certain medical costs. Until you reach the annual limit, Plan L pays only 75% of several covered benefits.
- No Part B excess-charge coverage. You may be responsible for eligible excess charges.
- No foreign-travel emergency benefit. Plan L does not include the limited foreign-travel emergency benefit available under Plans G and N.
Which Plan Might Fit You? A Quick Self-Check
The easiest approach is to create an account at Medicare.gov, then you can begin your Medigap research there. It lists the options available in your area.
Work through these questions. Your answers will point you toward one or two plan letters.
- Do I see doctors often, or want predictable costs? Look closely at Plan G. The premium is higher, but after the Part B deductible, you’ll have little cost-sharing for covered services.
- Do I want strong coverage with a lower premium, and can I handle small copays? Compare Plan N with Plan G. Weigh the $20 office and $50 emergency room copayments and ask your regular doctors whether they accept Medicare assignment.
- Is keeping my monthly premium down the top priority? Compare Plans K and L. You’ll pay more when you get care, but both cap your annual out-of-pocket costs. Plan L’s 2027 cap ($4,180) is half of Plan K’s ($8,360).
- Do I travel outside the United States? Only Plans G and N include limited foreign-travel emergency coverage.
- Could I manage a large medical bill in a difficult year? Don’t choose solely on how often you see a doctor today, because your health needs can change. Choose a premium you can afford every month and a worst-case year you could handle.
- Have I planned for what Medigap doesn’t cover? Prescription drugs require a separate Part D plan. Medigap also generally doesn’t cover routine dental care, routine vision care, hearing aids, or long-term custodial care.
Shopping Tips: How to Compare Policies Wisely
Once you have narrowed your choices to one or two plan letters, the next step is comparing insurance companies.
- Choose the plan letter first, then compare insurers.
Plan G is Plan G. In most states, the standardized benefits of a Plan G policy are the same regardless of which insurer sells it, and the same is true for Plans N, K, and L. What differs is the premium, pricing method, rate-increase history, and customer service.
So get quotes from several insurers offering the same plan letter. And don’t compare a $180 Plan G with a $150 Plan N and automatically conclude that Plan N is the better deal. First decide which benefits you want. Then weigh each plan’s premium against the additional costs you might reasonably expect to pay.
- Ask how the company prices its policies, and how its premiums have changed.
Insurance companies generally use one of three pricing methods:
- Community-rated: People insured under the same policy form generally pay the same base premium regardless of age, although other permitted factors may affect the price.
- Issue-age-rated: Your base premium is tied to your age when you first buy the policy.
Premiums can also rise because of inflation, rising health care costs, claims experience, or other factors permitted by state law and the policy. Ask how the insurer’s premiums have changed over the past several years for the plan you are considering, ideally for people in your age group and area.
Be cautious about choosing a policy solely because it has the lowest introductory premium. A low starting price doesn’t mean the policy will stay the least expensive, and a high one doesn’t guarantee smaller future increases. Past rates offer useful context, but they are not a prediction.
- Check the insurer’s financial strength and reputation.
You want an insurer that can meet its obligations over time. Consider an independent financial-strength rating from a service such as AM Best, where available. An A- or higher rating may be a useful benchmark, but it is not a guarantee of future performance or a substitute for other research.
Also check your state insurance department for consumer complaints and regulatory information. A company’s customer service, claims support, and history of treating policyholders fairly matter, too.
- Use free, unbiased help.
Medicare offers an official guide to choosing Medigap coverage. You can also contact your State Health Insurance Assistance Program (SHIP) – an independent government program with trained counselors in every state– for free, personalized Medicare counseling. Both are excellent resources if you want help comparing policies without relying solely on an insurance salesperson.
Can You Switch Plans Later? Understanding Your State’s Rules
One of the most common worries retirees have is, “What if I choose Plan G today, but the premiums become too expensive a few years from now? Am I trapped?”
The answer depends on your circumstances and where you live.
Under federal rules, your initial six-month Medigap Open Enrollment Period begins when you are both 65 or older and enrolled in Medicare Part B. During that period, you generally have important protections when buying a Medigap policy, including protection against medical underwriting (which is a big deal).
After that period, federal law generally does not guarantee that you can switch to another Medigap policy whenever you wish. In many circumstances, an insurer may consider your medical history when you apply and may charge significantly more or flat-out deny coverage.
Some states provide additional opportunities to change policies without medical underwriting.
What Is a Medigap Birthday Rule?
In certain states, a birthday rule gives eligible policyholders an annual window around their birthday to switch Medigap coverage without medical underwriting, subject to the state’s specific requirements.
Depending on the state, the rule may allow you to change insurers while keeping the same plan benefits, or to move to a plan with equal or lesser benefits.
Other states have different protections, such as anniversary windows, and some do not have a comparable annual switching opportunity.
Why does this matter? Suppose your Plan G premium rises substantially. If your state offers a qualifying switching window, you may be able to move to a more affordable policy without answering medical questions. Depending on your state’s rules, you may also be able to switch to a different plan letter with less coverage.
But these protections are not universal. Don’t assume that a birthday rule applies to you simply because you have heard about it.
Before changing plans, verify the current rules with your state insurance department or SHIP counselor. And do not cancel your existing policy until you have confirmed that your new coverage is approved and will begin when you need it.
For more information, see Medicare’s guidance on changing Medigap policies.
The Bottom Line
There isn’t one best Medigap plan, only the one whose premium, cost-sharing, and protection best fit your health and your budget. Choose your plan letter first. Then compare several insurers selling that same letter, paying close attention to how each one prices its policies. Switching later isn’t guaranteed in every state, so choose with both today’s needs and tomorrow’s in mind.
If you’re unsure about any part of the decision, you don’t have to figure it out alone. Medicare and your local SHIP counselor can help you review your options.
A little research now can help you feel confident about one of retirement’s important health care decisions.
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