How to Find Medigap for New Beneficiaries

Securing the right Medigap policy as a new Medicare beneficiary is a critical step towards comprehensive healthcare coverage. This guide cuts through the noise, providing practical, actionable steps to navigate the Medigap landscape and make an informed decision that protects your health and finances.

Understanding Your Golden Opportunity: The Medigap Open Enrollment Period

Your Medigap Open Enrollment Period is your absolute best chance to get a Medigap policy without hassle. This is a one-time, six-month window, unique to you, that starts the first day of the month you are 65 or older AND enrolled in Medicare Part B.

Why it’s golden: During this period, insurance companies cannot:

Deny you coverage: Regardless of any pre-existing health conditions.
Charge you more: Your health status won’t impact your premiums.
Impose waiting periods: For pre-existing conditions (if you had “creditable coverage” before your Medigap policy starts).

Concrete Example: If you turn 65 on August 15th and your Medicare Part B coverage begins on September 1st, your Medigap Open Enrollment Period begins on September 1st and lasts until February 28th of the following year. You can apply for any Medigap policy during this time, and the insurer must accept you, even if you have a serious medical condition like heart disease or diabetes.

Actionable Tip: Mark this 6-month window on your calendar immediately after you confirm your Part B effective date. Do not miss it. After this period, you may face medical underwriting, higher premiums, or even denial of coverage, unless specific “guaranteed issue” situations apply.

Deconstructing Medigap Plans: Standardized Benefits Are Your Friend

Medigap plans are standardized by the federal government. This means a Plan G from one insurance company offers the exact same benefits as a Plan G from any other insurance company, regardless of where you live (except in Massachusetts, Minnesota, and Wisconsin, which have different standardization). The only difference is the premium. This standardization simplifies your comparison process.

The most common plans for new beneficiaries include:

Plan G: This is often the most comprehensive plan available to new beneficiaries. It covers everything Original Medicare doesn’t, except for the Medicare Part B deductible.
- Example: If your Part B deductible for the year is $240 (hypothetical), Plan G will pay all your other Medicare-approved out-of-pocket costs after you pay that $240 deductible. This includes your 20% Part B coinsurance for doctor visits, specialists, and outpatient services, as well as hospital coinsurance.
Plan N: This plan offers lower premiums than Plan G but requires some cost-sharing. You’ll pay copayments for doctor’s office visits ($20) and emergency room visits ($50, waived if admitted). It also doesn’t cover Medicare Part B excess charges.
- Example: You visit your primary care physician. With Plan N, you’d pay a $20 copay. If you go to the ER for a non-emergency that doesn’t result in admission, you’d pay a $50 copay. If a doctor charges more than the Medicare-approved amount (an “excess charge”), Plan N wouldn’t cover that difference.
High-Deductible Plan G (HDG): This plan has a much lower monthly premium but a high annual deductible (e.g., $2,800 in 2025). You pay all Medicare-approved costs until you meet this deductible, then the plan pays 100% of covered services.
- Example: You have a HDG plan with a $2,800 deductible. You break your leg, and after Medicare pays its share, you owe $1,500. You pay that $1,500. Later in the year, you have surgery, and after Medicare, you owe another $1,500. You pay the remaining $1,300 of your deductible, and then the plan covers the rest of the $1,500. For the rest of the year, your plan covers 100% of your Medicare-approved costs.
Plan A: The most basic Medigap plan, covering only hospital coinsurance and costs for an additional 365 days after Medicare benefits are exhausted, and the Part B coinsurance (20% of the Medicare-approved amount). It doesn’t cover deductibles.
- Example: You have Plan A. You are hospitalized, and Medicare pays its share. Plan A covers your remaining hospital coinsurance. However, when you visit your doctor, you are still responsible for your Part B deductible and any Part B excess charges.

Plans C and F are NOT available to new Medicare beneficiaries (those eligible for Medicare on or after January 1, 2020). If you were eligible before this date but just enrolling now, you might be able to purchase them. However, for most new beneficiaries, Plan G effectively replaces Plan F as the most comprehensive option.

Actionable Tip: Don’t get fixated on a specific letter. Instead, focus on your anticipated healthcare needs and budget. Do you prefer predictable costs (Plan G) or lower premiums with some out-of-pocket exposure (Plan N or HDG)?

The Practical Steps to Finding Your Medigap Policy

This is where the rubber meets the road. Follow these steps to systematically find and enroll in the best Medigap policy for your situation.

Step 1: Understand Your Healthcare Needs and Preferences

Before you even look at a single plan, assess your healthcare situation.

Do you anticipate frequent doctor visits or specialist care? If so, a plan with lower copayments, like Plan G, might be more suitable than Plan N.
Are you generally healthy and rarely visit the doctor? A high-deductible plan could save you significantly on premiums, as you’d only pay the deductible if a major health event occurs.
Do you travel frequently outside the U.S.? Some plans (like G and N) offer foreign travel emergency coverage, which Original Medicare does not.
What is your comfort level with out-of-pocket costs? Are you comfortable paying a deductible and some copays, or do you prefer minimal surprise bills?
Do you have specific doctors or hospitals you want to continue seeing? Medigap works with any doctor or hospital that accepts Original Medicare, giving you flexibility.

Concrete Example: Sarah, turning 65, has a chronic condition requiring regular specialist visits and prescription medications. She knows she’ll meet her Part B deductible quickly. She prioritizes predictability and comprehensive coverage over lower premiums, making Plan G a strong contender. Mark, also 65 and very healthy, rarely sees a doctor. He’s comfortable with a higher deductible if it means lower monthly premiums. High-Deductible Plan G becomes attractive to him.

Step 2: Compare Standardized Plan Benefits (Again, Critically)

Now that you’ve considered your needs, look at the standardized Medigap plan benefits chart. This will help you narrow down your choices to 2-3 plans. Focus on the benefits that align with your needs from Step 1.

Key benefits to consider:

Part A Coinsurance & Hospital Costs: All standardized plans cover this.
Part B Coinsurance (20%): Most popular plans (G, N) cover this, or cover it with copays (N).
Part A Deductible: Covered by most popular plans except Plan A.
Part B Deductible: Not covered by plans for new beneficiaries (G, N, etc.). This is a key differentiator.
Skilled Nursing Facility Care Coinsurance: Covered by most popular plans.
Part B Excess Charges: Covered by Plan G. Not covered by Plan N. This is a significant point for some beneficiaries. Excess charges are the amount a doctor can charge above Medicare’s approved amount (up to 15% more).
Foreign Travel Emergency: Covered by Plans C, D, F, G, M, N (80% up to plan limits, after a deductible).

Concrete Example: Sarah, from the previous example, looks at the benefits chart. She immediately rules out Plan A because it leaves too many gaps. She compares Plan G and Plan N. Since her specialists might charge excess charges, and she doesn’t want to deal with copays, Plan G remains her top choice for its comprehensive coverage of all gaps except the Part B deductible.

Step 3: Research Insurance Companies and Their Pricing

Once you’ve identified 1-2 target plans (e.g., Plan G or Plan N), it’s time to find out which insurance companies offer these plans in your state and what they charge. Remember, the benefits are the same, but premiums vary wildly between insurers for the exact same plan letter.

Methods for research:

State Health Insurance Assistance Programs (SHIPs): These are free, unbiased counseling services offered by every state. They can provide you with a list of Medigap policies sold in your area and comparative pricing. This is arguably the best resource.
- Actionable Tip: Search online for “[Your State] SHIP” or “State Health Insurance Assistance Program [Your State]”. Call them directly and request a Medigap comparison chart for your area.
Medicare.gov Plan Finder: While Medicare.gov primarily focuses on Medicare Advantage and Part D plans, it also has tools to help you find Medigap policies.
Independent Insurance Brokers: A reputable independent broker can provide quotes from multiple insurance companies in your area and help you compare them. They are paid by the insurance companies, so their services are typically free to you.
- Actionable Tip: Seek a broker who specializes in Medicare and represents multiple carriers, not just one. Ask about their experience and if they can provide quotes from at least 5-7 different companies.
Directly Contacting Insurance Companies: If you know which companies offer Medigap in your state, you can call them directly for quotes. However, this is more time-consuming as you’d have to contact each one individually.

Key pricing factors:

Attained-age rated: Premiums are based on your current age and increase as you get older.
Issue-age rated: Premiums are based on your age when you buy the policy and generally don’t increase due to age. They may still increase due to inflation or other factors.
Community-rated: Everyone pays the same premium, regardless of age. This is less common.

Concrete Example: Sarah contacts her state’s SHIP. They provide her with a comprehensive list of all insurance companies offering Plan G in her zip code, along with their current monthly premiums and rating methods (attained-age, issue-age, or community-rated). She sees Company A offers Plan G for $150/month (issue-age rated), while Company B offers it for $140/month (attained-age rated), starting at age 65. Company C is $160/month (issue-age rated). Sarah projects her costs over 10-20 years based on the rating method to determine the best long-term value.

Step 4: Consider Financial Stability and Customer Service

While premiums are a major factor, don’t overlook the financial strength and reputation of the insurance company.

Financial Ratings: Look for ratings from independent agencies like A.M. Best, Standard & Poor’s, or Moody’s. Higher ratings indicate greater financial stability.
Customer Service and Reviews: Check online reviews and consumer complaint data for the insurance companies you’re considering. A company with good customer service can make a big difference when you have questions or claims.
- Actionable Tip: Call the insurance company’s customer service line with a few questions before you buy. See how long you’re on hold and how helpful their representatives are.

Concrete Example: Sarah narrows down her choice to Company A and Company C, both offering issue-age rated Plan G. Company A has an A+ rating from A.M. Best and generally positive customer reviews, while Company C has an A rating and a few more complaints about claims processing. Sarah opts for Company A, prioritizing peace of mind and better customer service, even if it means a slightly higher premium.

Step 5: Understand the Application Process and Effective Date

Once you’ve chosen a plan and company, you’ll need to apply.

Application Form: Complete the application accurately. During your Medigap Open Enrollment Period, you typically won’t have to answer health questions.
Effective Date: You can choose your Medigap policy to become effective the first day of the month after you apply, or a later date if you prefer. Coordinate this with your Medicare Part B effective date.
- Actionable Tip: Aim for your Medigap coverage to start the same month your Part B coverage begins to avoid any gaps in coverage.
Payment: Be prepared to set up premium payments, usually monthly or quarterly.

Concrete Example: Sarah fills out the application for Plan G with Company A. She indicates she wants her policy to become effective on September 1st, aligning with her Medicare Part B start date. She sets up automatic monthly premium payments from her bank account.

Navigating Specific Situations for New Beneficiaries

While the Open Enrollment Period is ideal, some new beneficiaries might have unique circumstances.

If You’re Under 65 and on Medicare Due to Disability or ESRD

Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. However, many states have enacted laws to ensure access.

Actionable Tip: Immediately contact your State Insurance Department or SHIP to understand your specific rights and options for Medigap coverage if you’re under 65. Some states offer their own open enrollment periods or guaranteed issue rights for this population.

If You’re Delaying Part B Due to Employer Coverage

If you’re still working at 65 and have creditable employer health coverage, you might delay enrolling in Medicare Part B. Your Medigap Open Enrollment Period will be delayed until you enroll in Part B.

Actionable Tip: When your employer coverage ends, you’ll get an 8-month Special Enrollment Period for Part B. Your 6-month Medigap Open Enrollment Period begins the month you enroll in Part B. Plan your transition carefully to avoid gaps.

If You’re Switching from a Medicare Advantage Plan

If you were in a Medicare Advantage (MA) plan and decide to switch to Original Medicare, you may have “guaranteed issue rights” to buy a Medigap policy under certain circumstances. These rights allow you to get a Medigap policy without medical underwriting.

Common Scenarios for Guaranteed Issue Rights:
- You joined an MA plan when you were first eligible for Medicare at 65, and you want to switch back to Original Medicare within the first 12 months (trial right).
- You dropped a Medigap policy to join an MA plan for the first time, and you’ve been on the MA plan for less than a year and want to switch back to Medigap.
- Your MA plan leaves your area or stops operating.
- You move out of your MA plan’s service area.
Actionable Tip: If you’re switching from MA, carefully document the reason for your switch. You’ll likely need proof for the Medigap insurer. Understand that guaranteed issue rights typically apply to a limited set of Medigap plans (A, B, C, D, F, G, K, L – though C and F aren’t for new beneficiaries). These rights usually last for 63 days from the date your prior coverage ends.

Avoiding Common Pitfalls

Don’t confuse Medigap with Medicare Advantage (Part C): They are completely different. Medigap supplements Original Medicare. Medicare Advantage replaces Original Medicare. You cannot have both.
Don’t enroll in a Medigap plan if you have Medicaid: Medicaid already covers most of your out-of-pocket costs, so a Medigap policy would be redundant and unnecessary.
Don’t forget Part D (Prescription Drug Coverage): Medigap policies sold after 2006 do not include prescription drug coverage. You’ll need to enroll in a separate Medicare Part D plan.
Beware of high-pressure sales tactics: Take your time, do your research, and don’t feel pressured into a decision.

Conclusion

Finding the right Medigap policy as a new Medicare beneficiary is a strategic decision that significantly impacts your healthcare costs and access. By understanding your unique six-month Medigap Open Enrollment Period, critically comparing the standardized plans (especially Plan G and N for new beneficiaries), meticulously researching insurance companies and their pricing, and being aware of specific situations like guaranteed issue rights, you can confidently navigate this crucial period. Proactive planning and thorough research will ensure you secure the most effective and affordable coverage for your healthcare journey.