Medicare Supplement

Medicare Supplement in Irvington: what Medigap letters cover

IRVINGTON, N.J. — If Original Medicare feels like it has holes in it, that's because it does. Medicare Part A and Part B cover a lot, but they leave you on the hook for deductibles, coinsurance, and copays that can add up quickly. Medicare Supplement insurance — often called Medigap — is designed to help pay some of those leftover costs. Here's a plain look at what Medigap does, what it doesn't do, and how those standardized letter plans (A, B, D, G, K, L, M, N) actually work.

What Medigap is — and what it isn't

Medigap is private insurance you can buy to work alongside Original Medicare (Parts A and B). After Medicare pays its share of a covered service, your Medigap policy picks up some or all of what's left, depending on the plan you chose.

A few things Medigap is not:

• It is not Medicare Advantage. Medicare Advantage (Part C) replaces the way you get your Original Medicare benefits. Medigap works with Original Medicare. You can't have both at the same time.
• It is not a drug plan. Medigap policies sold today do not include Part D prescription drug coverage. If you want drug coverage, you enroll in a stand-alone Part D plan.
• It is not the same as Medicaid, and it doesn't usually cover long-term care, dental, vision, hearing aids, or private-duty nursing.

How the standardized letter plans work

In most states, including New Jersey, Medigap plans are standardized by the federal government. That means Plan G from one insurance company covers exactly the same core benefits as Plan G from any other company. The letters — A, B, D, G, K, L, M, and N — identify the benefit package, not the carrier.

Here's what that standardization covers, in general terms:

• Part A coinsurance and hospital costs (all letter plans help with this).
• Part B coinsurance or copayment (all letter plans, though K and L pay a percentage).
• Blood (first 3 pints).
• Hospice care coinsurance or copayment.
• Skilled nursing facility coinsurance (most, but not all, letter plans).
• Part A deductible (most letter plans; K and M pay part of it).
• Part B deductible (only older Plan C and Plan F — and those are no longer sold to people who became eligible for Medicare on or after January 1, 2020).
• Part B excess charges (Plans F and G).
• Foreign travel emergency (most letter plans, up to plan limits).

Plans K and L have out-of-pocket yearly limits — once you hit the limit, the plan pays 100% of covered services for the rest of the year. Plan N has small copays for some office and emergency room visits.

Because benefits are standardized, the real differences between two companies selling the "same" Plan G usually come down to monthly premium, customer service, and how the company raises rates over time.

What Medigap does not cover

Even the most generous letter plan won't cover everything. Medigap generally does not pay for:

• Prescription drugs (that's Part D).
• Routine dental, vision, or hearing exams and hearing aids.
• Eyeglasses or dentures.
• Long-term care (like ongoing help in a nursing home).
• Private-duty nursing.
• Cosmetic procedures.

If those benefits matter to you, you'd need separate coverage or a different approach to how you get your Medicare.

When you can buy a Medigap policy

The best time to buy Medigap is during your Medigap Open Enrollment Period — the 6-month window that starts the month you're 65 or older and enrolled in Part B. During that window, you have a guaranteed issue right: insurers can't turn you down or charge you more because of health problems.

Outside that window, in most states, insurers can use medical underwriting. That means they can look at your health history and decide whether to sell you a policy and at what price. New Jersey has some of its own consumer protections, so it's worth checking with the state before you assume you're stuck.

Also worth knowing: the Medicare Annual Enrollment Period (Oct. 15 – Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) apply to Part D and Medicare Advantage — not directly to Medigap. Medigap has its own rules.

How Medigap fits with Part D and 2026 drug costs

Because Medigap doesn't cover prescriptions, most people who choose Original Medicare + Medigap also enroll in a stand-alone Part D plan. A few 2026 facts worth keeping in mind:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• The Part D maximum deductible is $615 for 2026.
• The old coverage gap ("donut hole") was eliminated in 2025, so Part D now works in three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments instead of paying all at once at the pharmacy.
• IRMAA surcharges — extra amounts higher-income enrollees pay for Part B and Part D — begin above $109,000 in income for a single filer in 2026.

What this looks like in Irvington

Irvington is in Essex County, and Medicare plan availability — including Medicare Advantage and Part D plan options — is set at the county level. Medigap, on the other hand, is regulated more at the state level, and the letter plans available in New Jersey follow the federal standardization rules described above.

If you're weighing Original Medicare + Medigap + a Part D plan against a Medicare Advantage plan, it helps to think about how often you travel, whether you want to see any doctor who accepts Medicare, and how predictable you need your out-of-pocket costs to be. There is no single right answer — only the right answer for your situation.