What is
Medigap
A plain-English guide for Americans on Medicare  ·  Updated April 2026
"For about 5 bucks a day — less than a cup of coffee — you could avoid going broke because of surgery or getting sick."
The whole idea behind Medigap, explained simply
"Medicare is not health insurance. It's a head start. Medigap is what finishes the job."
The Three Things You Need To Know
In Plain English
Medicare pays most of your bills. Not all of them.

Original Medicare covers about 80% of your medical costs. The other 20% — deductibles, copays, hospital stays — comes out of your pocket. No cap. No ceiling. Just bills that keep arriving until they don't.

Here's what nobody explains clearly: Medigap means you can walk into virtually any doctor's office in America. About 93% of non-pediatric physicians accept Medicare — which means they accept you. No network. No referral. No asking a plan administrator for permission before seeing a specialist. You pick up the phone. You make the appointment. You go.

80¢ covered.
You pay the rest.
Medigap fixes that.

Around 14 million Americans have already figured this out. Plans are standardized by the federal government — Plan G in California is identical to Plan G in Florida. You're choosing the price, not the coverage. The only variable is which company collects your check.

What It Costs
Usually between $150 and $450 a month — depending on where you live.

Plan G — the most popular — runs about $130–$200/month at age 65 in most states. Florida and New York run higher. By 70 expect $160–$240. By 75, around $190–$280. Premiums rise as you age. That's the deal, and it's still a good one.

That's $5 to $15 a day. In exchange: no surprise bills. No 20% due at discharge. No annual ceiling on how much care you can receive.

$130–$200/mo.
No surprise bills.
Ever.

Here's what the Medicare Advantage ads skip: those plans can hit you with up to $9,350 out-of-pocket in a single bad year — in-network. Go out of network and there's often no cap at all. About one in eight prior authorization requests gets initially denied. Charlie Munger had a phrase for this: show me the incentive and I'll show you the outcome. A broker costs you nothing — they're paid by the insurer, not you.

What To Do
Three steps. Takes about 20 minutes.

The best time to enroll is during your 6-month Medigap Open Enrollment Period — it starts the month you turn 65 and enroll in Medicare Part B. During this window, no company can deny you or charge more because of health conditions. It's the one moment the rules are entirely in your favor.

After that window closes, 47 states allow full medical underwriting. Pre-existing conditions. Higher premiums. Outright denial. Only Connecticut, Massachusetts, New York, and Maine offer meaningful year-round protections. Miss the window and you may be negotiating from a much weaker position. Don't wait.

Official Medigap Definition — Medicare.govwhat it is, how it works Medicare Plan Findercompare plans in your area AARP Medicare Resourcesguides & advisors Medicare.govofficial enrollment Medicaid.govlower-income assistance

Not sure where to start? Call 1-800-MEDICARE. Free. Real people. Available 24/7.

The Real Cost of Getting Sick
"The difference between Medigap and Medicare Advantage isn't coverage. It's the bill you get when something goes wrong."

What You'd Actually Pay

Out-of-pocket costs for common procedures — with Medigap Plan G vs. Medicare Advantage vs. no supplement. Based on 2026 Medicare rates.

Procedure Medicare-Approved Cost No Supplement
You pay 20%
Medicare Advantage
Varies — up to $9,250 max
Medigap Plan G
$283 deductible, then $0
Knee Replacement ~$20,000 $2,100 – $4,000 $500 – $3,500 $283
Shoulder Replacement ~$22,000 $2,500 – $4,400 $500 – $4,000 $283
Hernia Surgery ~$8,000 $1,000 – $1,600 $300 – $1,500 $283
Heart Surgery (bypass) ~$100,000+ $10,000 – $20,000+ Up to $9,350 $283
Hip Replacement ~$23,000 $2,800 – $4,600 $500 – $4,200 $283
Cancer — Chemotherapy (per cycle) ~$10,000 – $30,000 $2,000 – $6,000+ Copays per visit, no cap on cycles $283 then $0
Stroke — Inpatient + Rehab (60 days) ~$40,000 – $80,000 $8,000 – $16,000+ Up to $9,350 $283
Emergency Room Visit + Observation ~$3,000 – $8,000 $600 – $1,600 $90 – $500 copay + coinsurance $0 – $283
Important — You Cannot Have Both Medigap and Medicare Advantage are mutually exclusive. You can choose one or the other, but not both. If you're currently in a Medicare Advantage plan and want to switch to Medigap, you'll need to return to Original Medicare first. Learn more at Medicare.gov →

Sources: Medicare.gov, GoodRx, NCOA 2026. Estimates vary by location, provider, and plan. Medigap Plan G requires meeting the annual Part B deductible of $283 before coverage begins.

A public service for America, by MartinsWay.org  ·  "A Good Life for All"