Medigap Coverage Gap Calculator: What Original Medicare Still Leaves You Paying
Medigap Coverage Gap Calculator: What Original Medicare Still Leaves You Paying
Even with Medigap insurance, Medicare doesn’t cover everything. Understanding your remaining out-of-pocket costs is essential for realistic healthcare budgeting.
Quick Answer
Medigap Covers:
- Part A deductible, coinsurance, hospital costs
- Part B coinsurance (20%)
- Skilled nursing facility coinsurance
- First 3 pints of blood
- Foreign travel emergency (80%)
- Excess charges (Plans F and G only)
Medigap Does NOT Cover:
- Part B deductible ($240 in 2026) - Plans A, B, C*, D, K, L, M, N
- Part B excess charges - Plans A, B, C*, D, K, L, M, N
- Prescription drugs (need Part D)
- Dental, vision, hearing
- Long-term care
- Private-duty nursing
Use our Medicare Supplement Penalty Calculator to estimate your total costs.
Detailed Guidance
What Original Medicare Covers (and Doesn’t)
Part A (Hospital Insurance) Covers:
- Inpatient hospital care (days 1-60: $0 after deductible)
- Skilled nursing facility care (days 1-20: $0, days 21-100: $209.50/day in 2026)
- Home health care (limited)
- Hospice care
Part A DOESN’T Cover:
- Private-duty nursing
- Television/telephone in hospital
- Extra charge for private room (unless medically necessary)
Part B (Medical Insurance) Covers:
- Doctor services (after $240 deductible)
- Outpatient care
- Preventive services
- Durable medical equipment
- Mental health care
Part B DOESN’T Cover:
- Prescription drugs (most)
- Routine dental care
- Routine eye exams for glasses
- Hearing aids
- Cosmetic surgery
What Each Medigap Plan Covers
Coverage Gaps by Plan Type:
| Plan | Part B Deductible | Excess Charges | Copays | OOP Max |
|---|---|---|---|---|
| A | ✗ You pay | ✗ You pay | None | None |
| B | ✓ Covered | ✗ You pay | None | None |
| C* | ✓ Covered | ✗ You pay | None | None |
| D | ✗ You pay | ✗ You pay | None | None |
| F* | ✓ Covered | ✓ Covered | None | None |
| G | ✗ You pay | ✓ Covered | None | None |
| K | ✗ You pay | ✗ You pay | 50% | $7,220 |
| L | ✗ You pay | ✗ You pay | 30% | $3,610 |
| M | ✗ You pay | ✗ You pay | $50 | None |
| N | ✗ You pay | ✗ You pay | $20/$50 | None |
*C and F only available if eligible before Jan 1, 2020
Calculating Your Remaining Costs
Formula:
Total Annual Cost = Medigap Premium + Part B Premium + Part B Deductible + Plan Copays + Non-Covered ServicesExample: Plan G, Age 65, Non-Tobacco:
| Cost Component | Monthly | Annual |
|---|---|---|
| Medigap Plan G Premium | $145 | $1,740 |
| Part B Premium | $185 | $2,220 |
| Part B Deductible | - | $240 |
| Subtotal | $330 | $4,200 |
Additional Non-Covered Costs (estimate):
- Part D drug premium: $30/month = $360/year
- Dental/vision/hearing: $50/month = $600/year
- Total Estimated Annual Cost: $5,160
Hidden Gaps to Consider
1. Prescription Drugs
- Not covered by Original Medicare
- Not covered by Medigap
- Need separate Part D plan ($15-100/month)
- Or Medicare Advantage (includes drugs)
2. Dental, Vision, Hearing
- Not covered by Medicare or Medigap
- Dental exams/cleanings: $100-300/year
- Glasses/contacts: $200-500/year
- Hearing aids: $1,000-5,000 every 3-5 years
3. Long-Term Care
- Not covered by Medicare (custodial care)
- Not covered by Medigap
- Nursing home average: $7,000-10,000/month
- Need separate long-term care insurance
4. Overseas Medical Care
- Medicare doesn’t cover care outside US
- Medigap covers 80% up to $50,000 lifetime
- Travel insurance recommended for extended stays
Budgeting for Healthcare in Retirement
Typical Annual Healthcare Costs for Age 65:
| Category | Cost Range |
|---|---|
| Medicare Part B premium | $2,220 |
| Medigap premium | $1,500-2,500 |
| Part D drug premium | $300-600 |
| Drug copays | $200-1,000 |
| Dental/vision/hearing | $500-1,500 |
| Out-of-pocket medical | $200-800 |
| Total Range | $4,920-8,620 |
By Age 75: Expect 50-75% higher costs due to premium increases and more healthcare usage.
Coverage Gap Checklist
- Identify which Medigap plan you have/want
- Calculate your annual Medigap premium
- Add Part B premium ($185/month in 2026)
- Factor in Part B deductible ($240) if not covered
- Estimate doctor visits × copays (if Plan N/K/L/M)
- Add Part D drug premium and copays
- Budget for dental, vision, hearing care
- Consider long-term care insurance
- Build emergency fund for unexpected costs
- Use our calculator for projections
Frequently Asked Questions
Does Medigap cover prescription drugs?
No. Medigap plans don’t cover prescription drugs. You need a separate Medicare Part D prescription drug plan, or a Medicare Advantage plan that includes drug coverage.
What if I need dental work?
Original Medicare and Medigap don’t cover dental care. You’ll pay out-of-pocket or buy separate dental insurance. Some Medicare Advantage plans include dental coverage.
Are hearing aids covered?
No. Medicare doesn’t cover hearing aids or exams for fitting hearing aids. Medigap doesn’t either. Budget $1,000-5,000 for hearing aids every 3-5 years.
Does Medigap cover long-term care?
No. Medicare only covers skilled nursing care for up to 100 days after a hospital stay. Custodial long-term care (help with daily activities) is never covered by Medicare or Medigap.
What does Plan G NOT cover?
Plan G doesn’t cover:
- Part B deductible ($240)
- Prescription drugs
- Dental, vision, hearing
- Long-term care
- Private-duty nursing
- Care outside the US (only 80% up to $50,000 lifetime)