Medicare Supplement (Medigap) Insurance in New York
Find the Right Medigap Plan for Your Needs
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New York Residents Have Unique Protections
Unlike most states, New York requires community-rated premiums for Medigap plans, meaning your age cannot affect your premium. New York also provides year-round open enrollment, so you can buy or switch Medigap plans at any time without medical underwriting. Learn more from NY DFS
What Is Medicare Supplement (Medigap) Insurance? (Medicare.gov overview)
Medicare Supplement insurance, commonly called Medigap, is private health insurance designed to help pay for out-of-pocket costs that Original Medicare (Part A and Part B) does not cover. These out-of-pocket costs include copayments, coinsurance, and deductibles that can add up significantly over the course of a year.
When you have a Medigap policy, Original Medicare pays its share of the Medicare-approved amount for covered health care costs, and then your Medigap policy may pay its share of remaining costs, such as coinsurance, copayments, and deductibles. This coordination can help reduce or eliminate your out-of-pocket expenses for covered services.
Medigap policies are sold by private insurance companies but are standardized by the federal government. This means that a Plan G from one company covers the same benefits as a Plan G from another company — the only differences may be the premium and the customer service experience of the insurer.
How Medigap Works
What Medigap May Cover vs. What It Doesn't
Typically Covered (varies by plan)
- ✓Part A Coinsurance & Hospital Costs
Up to 365 additional days of coverage after Medicare benefits are exhausted
- ✓Part B Coinsurance or Copayment
The 20% coinsurance you owe for most outpatient services
- ✓Blood (First 3 Pints)
Covers the cost of the first 3 pints of blood needed in a medical procedure
- ✓Skilled Nursing Facility Coinsurance
Coinsurance for days 21–100 in a skilled nursing facility
- ✓Part A Deductible
The deductible you pay for each hospital benefit period ($1,676 in 2025)
- ✓Foreign Travel Emergency
Emergency care during foreign travel (80% of costs, up to plan limits)
Not Covered by Medigap
- ✗Prescription Drugs
You need a separate Medicare Part D plan for drug coverage
- ✗Long-Term Care
Custodial care in a nursing home or assisted living facility
- ✗Vision, Dental, and Hearing
Routine eye exams, dental work, and hearing aids are not included
- ✗Private-Duty Nursing
One-on-one nursing care at home or in a facility
- ✗Services Medicare Doesn't Cover
Medigap only supplements what Original Medicare already covers
- ✗Medicare Advantage Compatibility
You cannot use a Medigap plan with a Medicare Advantage plan
Not Sure Which Plan Fits Your Needs?
We can help you compare Medigap plans and understand your coverage options. There is no obligation and no cost for our assistance.
Understanding Standardized Medigap Plan Types
The federal government standardizes Medigap plans so each plan type offers the same basic benefits regardless of which insurance company sells it. Plans are identified by letters. Here is a summary of what each plan type may cover:
| Benefit | A | B | D | G* | K | L | M | N* |
|---|---|---|---|---|---|---|---|---|
| Part A Coinsurance | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B Coinsurance | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes** |
| Blood (First 3 Pints) | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A Hospice Coinsurance | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled Nursing Facility Coinsurance | No | No | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A Deductible | No | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B Deductible | No | No | No | No | No | No | No | No |
| Part B Excess Charges | No | No | No | Yes | No | No | No | No |
| Foreign Travel Emergency | No | No | Yes | Yes | No | No | Yes | Yes |
| Out-of-Pocket Limit | N/A | N/A | N/A | N/A | Yes | Yes | N/A | N/A |
*Plan G is the most comprehensive plan available to people newly eligible for Medicare on or after January 1, 2020.
**Plan N covers Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don't result in an inpatient admission.
Note: Plans C and F are no longer available to people who became newly eligible for Medicare on or after January 1, 2020, per the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. If you were eligible for Medicare before that date, you may still be able to purchase Plans C or F.
Comparing the Most Popular Medigap Plans
While all standardized plans have their place, Plan G and Plan N are the most commonly chosen by people newly eligible for Medicare. Here is how they compare:
Medigap Plan G
- ✓Covers nearly all Medicare cost-sharing
- ✓You pay only the annual Part B deductible ($257 in 2025)
- ✓Covers Part B excess charges
- ✓Foreign travel emergency coverage included
- ✓No copays for doctor or ER visits
Typically suited for people who want maximum predictability and minimal out-of-pocket costs.
Medigap Plan N
- ✓Generally lower monthly premium than Plan G
- ✓Covers most Medicare cost-sharing
- ~Copays of up to $20 for some office visits
- ~Copay of up to $50 for ER visits not resulting in admission
- ✗Does not cover Part B excess charges
May be suited for people comfortable with small copays in exchange for a lower monthly premium.
When Can You Enroll in a Medigap Plan?
Medigap Open Enrollment Period (Federal)
Your federal Medigap Open Enrollment Period is a 6-month window that begins the month you turn 65 and are enrolled in Medicare Part B. During this period:
- Insurance companies cannot deny you a Medigap policy
- They cannot charge you more due to past or present health conditions
- They cannot impose waiting periods for pre-existing conditions
Guaranteed Issue Rights
Even outside open enrollment, federal law provides guaranteed issue rights in certain situations, such as:
- Your Medicare Advantage plan leaves the Medicare program or stops providing care in your area
- You move out of your Medicare Advantage plan's service area
- You had a Medigap policy before joining a Medicare Advantage plan for the first time and want to switch back within 12 months
- Your Medigap insurance company goes bankrupt
New York's Special Enrollment Protections
New York provides some of the strongest Medigap consumer protections in the country:
- ✓Continuous Open Enrollment: New York residents can apply for a Medigap policy at any time, not just during the initial 6-month window. Insurers cannot deny you coverage based on health status.
- ✓Community Rating Required: All Medigap policyholders pay the same premium regardless of age. A 65-year-old and an 80-year-old on the same plan with the same company pay the same rate.
- ✓No Pre-Existing Condition Exclusions: Insurers in New York cannot impose waiting periods for pre-existing conditions on Medigap policies.
- ✓Ability to Switch Plans: You can switch from one Medigap plan to another at any time, giving you flexibility as your needs change.
Source: New York Department of Financial Services — Medicare Supplement Insurance
Medigap vs. Medicare Advantage: Key Differences
One of the most common decisions Medicare beneficiaries face is choosing between a Medigap policy with Original Medicare or a Medicare Advantage plan. Here is a comparison of the key differences:
| Feature | Medigap + Original Medicare | Medicare Advantage (Part C) |
|---|---|---|
| Provider Network | Any doctor/hospital that accepts Medicare nationwide | Typically requires use of plan's network |
| Referrals | No referrals needed for specialists | May require referrals depending on plan type |
| Prescription Drugs | Requires separate Part D plan | Often included in the plan |
| Extra Benefits | Not typically included (vision, dental, hearing) | May include vision, dental, hearing, fitness |
| Monthly Premium | Medigap premium + Part B premium (+ Part D if enrolled) | Plan premium (may be $0) + Part B premium |
| Out-of-Pocket Costs | Generally lower and more predictable | Copays and coinsurance for services; annual out-of-pocket maximum |
| Travel Coverage | Nationwide coverage; some plans include foreign travel emergency | Typically limited to plan's service area |
For more about Medicare Advantage, visit our Medicare Advantage page.
How Medigap Claims Work
One of the conveniences of Medigap is the streamlined billing process. In most cases, you don't need to file separate claims with your Medigap insurer.
You Receive a Medicare-Covered Service
Visit any doctor or hospital that accepts Medicare. There is no need to check a network directory or get referrals.
Your Provider Bills Medicare
The healthcare provider submits the claim to Medicare first. Medicare pays its share of the approved amount.
Automatic Crossover to Medigap
Medicare automatically sends the remaining claim information to your Medigap insurer through what's called a "crossover claim." This happens electronically in most cases.
Medigap Pays Its Share
Your Medigap insurer reviews the claim and pays the provider for the covered cost-sharing amounts according to your plan type. In many cases, you may owe little or nothing.
Good to Know: Medicare Assignment
Medigap plans work when your provider accepts Medicare assignment (agrees to accept the Medicare-approved amount). In New York, providers who accept Medicare must accept assignment, which means they cannot charge more than the Medicare-approved amount. This protects you from excess charges in most situations.
Important Considerations When Choosing a Medigap Plan
Medigap Covers Only One Person
Each Medigap policy covers one individual. If both you and your spouse want Medigap coverage, you each need your own separate policy.
You Must Have Original Medicare
To purchase a Medigap policy, you must be enrolled in Original Medicare (Part A and Part B). You cannot use a Medigap policy with a Medicare Advantage plan. If you currently have a Medicare Advantage plan and want to switch to Medigap, you would need to disenroll from the Advantage plan first.
Prescription Drug Coverage Is Separate
Medigap policies sold since 2006 do not include prescription drug coverage. If you want drug coverage, you should also enroll in a Medicare Part D Prescription Drug Plan. It's generally recommended to enroll in Part D when you first become eligible, even if you don't currently take many medications, to avoid a late enrollment penalty.
Premium Pricing Methods
Outside of New York, Medigap premiums can be priced in three ways:
- Community-Rated (No Age Rating): Everyone pays the same premium regardless of age. This is the only method allowed in New York State.
- Issue-Age-Rated: Premium is based on your age when you first buy the policy. (Not used in NY.)
- Attained-Age-Rated: Premium is based on your current age and increases as you get older. (Not used in NY.)
Source: Medicare.gov — Medigap Costs
Under 65 and on Medicare?
Some people qualify for Medicare before age 65 due to disability or certain medical conditions. In many states, Medigap availability for under-65 beneficiaries is limited. However, New York requires insurers to offer Medigap plans to Medicare beneficiaries under 65, providing important protection for this group.
Frequently Asked Questions About Medicare Supplement Insurance
What is Medicare Supplement (Medigap) insurance?
Medicare Supplement, also called Medigap, is private insurance that helps pay for out-of-pocket costs not covered by Original Medicare (Part A and Part B), such as copayments, coinsurance, and deductibles. Medigap plans are standardized by the federal government and labeled with letters A through N.
When can I enroll in a Medigap plan?
Your federal Medigap Open Enrollment Period is a 6-month window that starts the month you turn 65 and are enrolled in Medicare Part B. During this period, insurance companies cannot deny you coverage or charge more due to health conditions. In New York State, residents have additional protections including continuous open enrollment rights, meaning you can enroll at any time.
What is the difference between Medigap and Medicare Advantage?
Medigap supplements Original Medicare by helping pay your share of costs, allowing you to see any provider that accepts Medicare. Medicare Advantage (Part C) replaces Original Medicare with a private plan that may include extra benefits but typically requires using network providers. You cannot have both a Medigap policy and a Medicare Advantage plan at the same time.
Does Medigap cover prescription drugs?
No. Medigap plans sold after 2006 do not include prescription drug coverage. If you want drug coverage with a Medigap plan, you need to enroll in a separate Medicare Part D Prescription Drug Plan.
Which Medigap plan is most popular?
Plan G has become the most popular Medigap plan for people newly eligible for Medicare. It covers all the same benefits as the previously popular Plan F except the Part B deductible ($257 in 2025). Plan N is also popular due to its lower premiums, though it requires small copays for some office and emergency room visits.
Does New York have special Medigap rules?
Yes. New York is one of the most consumer-friendly states for Medigap. State law requires community rating, meaning your premium cannot be based on your age. New York also provides continuous open enrollment protections, allowing residents to purchase or switch Medigap plans at any time without medical underwriting, regardless of health status.
Can I switch Medigap plans in New York?
Yes. Under New York Insurance Law, Medigap insurers must use community rating and offer plans on an open enrollment basis year-round. This means you can switch between Medigap plans at any time without being denied coverage or charged more due to pre-existing health conditions.
Related Medicare Coverage Options
Medigap is one part of a complete Medicare coverage strategy. Consider these related coverage options:
Medicare Advantage (Part C)
An alternative to Original Medicare that may include additional benefits like dental, vision, and prescription drug coverage.
Part D Prescription Drug Plans
Separate coverage for prescription medications, recommended alongside Medigap for comprehensive protection.
Medicare Overview
A general overview of Medicare, including Parts A, B, C, and D, and how the different parts work together.
Dental Insurance
Standalone dental coverage to complement your Medicare and Medigap benefits, since Medigap does not cover dental services.
Important Information
This information is provided for general educational purposes only and does not constitute insurance advice or policy recommendations. Coverage features described are examples and may not be available in all policies or from all carriers. Actual coverage is subject to the terms, conditions, and exclusions of the policy as issued. Plan benefits, premiums, and availability may change annually. Please consult with a licensed insurance professional to discuss your specific coverage needs and options. Stan Steele Agency is licensed in New York State.
Let Us Help You Compare Medigap Plans
Navigating Medicare Supplement options can feel complicated. We can help you compare standardized plans from multiple carriers and understand which coverage options may fit your situation.
What We Can Help With:
- ✓ Comparing plan types and coverage levels
- ✓ Reviewing multiple carrier options
- ✓ Understanding enrollment timing and your rights
- ✓ Coordinating Medigap with Part D drug coverage
- ✓ Answering your Medicare Supplement questions
Serving New York State • No-cost consultation • Multiple carrier options
