10 Questions to Ask When Deciding on a Medigap Plan

 

Posted on December 17th, 2025.

 

Choosing a Medigap (Medicare Supplement) plan can feel confusing at first, especially when you see all those letters (A–N) and different prices from multiple companies.

But underneath the jargon, you’re really trying to answer one practical question: “Which plan gives me the most peace of mind for the money I’m paying?”

Instead of starting with brochures or price charts, it helps to start with the right questions. The more focused your questions are, the easier it becomes to see which plan fits your health needs, budget, and future plans.

Below are 10 key questions to ask as you compare Medigap options. Use them when you talk with an agent, review quotes, or sit down with a family member to make your decision.

 

1. What gaps in Original Medicare do I most want my Medigap plan to cover?

Before you look at specific Medigap letters, get clear on what you’re trying to protect yourself from. Original Medicare (Parts A and B) leaves you responsible for costs like:

• Part A and Part B deductibles
• Coinsurance and copayments
• Excess charges (in some cases)
• Certain emergency care when traveling outside the U.S.

Ask yourself:

• Do I worry most about hospital costs from a long stay?
• Is the Part B 20% coinsurance my biggest concern?
• Am I more comfortable paying a higher monthly premium if it means lower out-of-pocket bills when I use care?

Once you know which “gaps” matter most, you can focus on the plans that protect you where you feel most vulnerable, instead of just chasing the lowest premium or the most coverage on paper.

 

2. Which Medigap plans are available in my state and ZIP code?

Not every Medigap plan is offered everywhere, and some states have unique rules or plan options. After you know what you want to protect against, ask:

• “Which standardized Medigap plans are actually available where I live?”
• “Are there any state-specific rules that affect my options?”

All Medigap plans with the same letter (for example, Plan G) offer the same basic benefits regardless of the insurance company. However, availability can vary. Narrowing your list down to the plans you can realistically buy is a big first step.

 

3. How do the benefits of each plan (like Plan G vs. Plan N) fit my health and budget?

Once you know which plans are available, it is time to compare what they actually cover. Two of the most popular options today are Plan G and Plan N, but your choices may include others as well. Ask:

• “Can you walk me through the benefits of each plan I’m considering?”
• “What does Plan G cover that Plan N doesn’t, and vice versa?”

For example:

• Plan G typically covers most gaps except the Medicare Part B deductible. After you pay that deductible each year, your Medicare-approved services are usually covered in full (for approved services).
• Plan N usually has a lower premium but includes some copayments (for example, some office and ER visits) and doesn’t cover certain excess charges.

Think about:

• How often you see doctors or specialists
• Whether you’re comfortable with some “pay as you go” costs in exchange for a lower monthly premium
• How much simplicity and predictability you want in your budget

You’re not just picking a letter; you’re matching a coverage style to your lifestyle and comfort level.

 

4. What will my total yearly costs look like with each plan?

It’s easy to focus only on the monthly premium, but that’s not the whole picture. Ask for a clear breakdown of:

• Monthly premium
• Deductibles you’re still responsible for
• Possible copayments or coinsurance
• Any out-of-pocket exposure that could add up

Then ask:

• “If my health stays about the same, what might my total yearly cost be with this plan?”
• “If I have a year with higher medical use, how might that change?”

Comparing premiums plus possible out-of-pocket costs gives you a better feel for which plan is truly more affordable for you, not just cheaper on paper.

 

5. How does the company set and increase premiums over time?

Two people can buy the same Medigap plan from different companies at different prices, and those prices may change differently over the years. You’ll want to ask:

• “Is this plan community-rated, issue-age-rated, or attained-age-rated?”
• “How often have your premiums increased in the last few years?”

In simple terms:

• Community-rated: Everyone pays the same premium, regardless of age (other factors may still affect cost).
• Issue-age-rated: Your premium is based on the age you are when you first buy the policy and doesn’t go up just because you get older (though it can increase for other reasons).
• Attained-age-rated: Your premium is based on your current age and typically increases as you get older.

Understanding how your premium may grow over time helps you avoid surprises and choose a plan that you can keep comfortably, not just afford this year.

 

6. When is my Medigap Open Enrollment Period, and what happens if I miss it?

Timing is a big deal with Medigap. During your Medigap Open Enrollment Period (a six-month window that starts when you’re 65 or older and enrolled in Part B), you generally:

• Can buy any Medigap plan offered in your state
• Cannot be charged more or turned down because of health conditions

Ask:

• “When does my Medigap Open Enrollment Period start and end?”
• “If I apply after that, will I have to go through medical underwriting?”
• “Are there any guaranteed-issue rights I might qualify for later if my situation changes?”

If you wait until after this window, the insurance company may review your health history. That can mean higher premiums or even a denial in some cases. Knowing your timing options helps you plan ahead instead of feeling rushed or missing important rights.

 

7. Can I keep my doctors, and are there any networks I need to worry about?

One of the advantages of Medigap is flexibility, but you’ll still want to confirm how it works in real life. Ask:

• “As long as a provider accepts Medicare, will this Medigap plan be accepted too?”
• “Are there any networks or restrictions I should know about?”

With Medigap and Original Medicare, you typically:

• Can see any doctor or hospital in the U.S. that accepts Medicare
• Don’t need referrals for specialists (as long as they also accept Medicare)

If keeping your current doctors is important to you, mention them by name and ask if there are any issues expected with claims or billing. Knowing this up front helps you avoid surprises or the stress of switching providers if you don’t want to.

 

8. How does this plan work with prescription drugs and other coverage I might need?

Medigap plans do not include prescription drug coverage. You’ll usually need a separate Medicare Part D plan for that. Ask:

• “How do I coordinate this Medigap plan with a Part D drug plan?”
• “Does anything in this plan affect my ability to get drug coverage?”

If you travel often or spend time out of the country, also ask:

• “Does this plan include any coverage for emergency care when I travel outside the U.S.?”
• “Are there limits or lifetime caps on foreign travel emergency coverage?”

You may also want to ask about other services you care about, such as skilled nursing facility coinsurance or hospice cost-sharing. This is your chance to check how well the plan fits your whole health picture, not just doctor visits.

 

9. What is the company’s reputation for customer service and claims handling?

Two companies can sell the exact same standardized plan (for example, Plan G), but your experience with them can be very different. Ask:

• “How long has this company been offering Medigap plans?”
• “What kind of customer service support will I have if I have questions about claims?”
• “Are there online tools or local support if I need help?”

You can also ask your agent:

• “Do you have feedback from other clients about this company?”

Since the benefits are standardized by law, service and reliability become major deciding factors. A company that handles claims smoothly and picks up the phone when you have questions can save you stress when you’re already dealing with health issues.

 

10. Who will help me review my plan as my needs and budget change?

Your health, finances, and lifestyle may look very different in 2026, 2028, or beyond than they do today. It’s smart to know up front how you’ll keep your coverage aligned with your life. Ask:

• “Will someone check in with me each year (or when I ask) to review whether this plan still fits?”
• “If I want to explore changing plans later, what will that process look like?”

While you may not be able to switch Medigap plans freely without underwriting after your open enrollment, you can still:

• Revisit your Part D drug coverage annually
• Explore other options if your situation changes or certain guaranteed-issue rights apply

Having a trusted professional who understands Medicare and Medigap makes it easier to adjust rather than staying in a plan simply because it feels too hard to change.

Related: Is Final Expense Life Insurance Right for You? Key Considerations

 

Moving Forward with Confidence

Deciding on a Medigap plan doesn’t have to feel overwhelming when you have the right questions in hand. By asking about coverage gaps, availability, costs, timing, provider access, extra benefits, company reputation, and long-term support, you’re doing exactly what a smart healthcare consumer should do.

You deserve a plan that fits your health needs, respects your budget, and gives you the peace of mind that an unexpected medical bill won’t derail your retirement plans.

At New Look Insurance LLC, we help you walk through these 10 questions step by step, compare real-world options, and understand how each choice might affect you today and down the road. You don’t have to figure it out on your own.

Ready to find the perfect Medigap plan for you? Explore our offerings to secure tailored coverage that fills those gaps, protecting your finances and providing unwavering peace of mind. 

Should questions arise, don’t hesitate to reach out—drop us a line at [email protected] or just give us a call at (505) 588-2759.