Medicare Supplement

Medigap Plan Letters Explained for Stevens Point Residents

STEVENS POINT, Wis. — If you have Original Medicare and you've ever opened a hospital bill and thought, "Wait, I still owe how much?" — that gap is exactly what Medicare Supplement insurance is built to fill.

Medigap, explained for Stevens Point readers

Medicare Supplement plans, better known as Medigap, are private policies that help pay some of the out-of-pocket costs Original Medicare leaves behind: deductibles, coinsurance, and copayments. They don't replace Medicare. They sit alongside it. Medicare pays first, then your Medigap policy picks up its share of what's left.

Here in Stevens Point, where a lot of folks stick with Original Medicare so they can see providers at Aspirus, Marshfield Clinic, or travel south to specialists in Madison without network worries, Medigap is often part of the conversation. Let's walk through how it actually works.

What Medigap does — and what it doesn't

Medigap helps with cost-sharing under Part A (hospital) and Part B (doctor/outpatient). Depending on the plan letter you choose, it can cover things like:

• The Part A hospital coinsurance and an extra 365 days of hospital coverage after Medicare's benefits run out
• Part B coinsurance or copayments
• The first three pints of blood
• Hospice coinsurance
• Skilled nursing facility coinsurance (on most letters)
• The Part A deductible (on most letters)
• Foreign travel emergency care (on some letters)

Here's what Medigap does not cover: prescription drugs, dental, vision, hearing aids, long-term custodial care, or private-duty nursing. For prescriptions, you'd add a stand-alone Part D drug plan. And you cannot have a Medigap policy and a Medicare Advantage plan at the same time — Medigap only works with Original Medicare.

How the standardized letters work

This is the part that trips people up. Medigap plans are sold by private insurance companies, but the benefits inside each "letter" plan are set by federal law. That means Plan G from one carrier covers the same core benefits as Plan G from another carrier. The price and customer service can differ. The benefits inside the letter cannot.

In most states, the letters currently sold are A, B, D, G, K, L, M, and N. Plans C and F are still held by many longtime enrollees, but they're no longer sold to people who became eligible for Medicare on or after January 1, 2020, because those plans covered the Part B deductible.

A few quick notes on the popular ones:

• Plan G is often the most comprehensive letter available to newly eligible enrollees. It covers nearly everything except the Part B deductible.
• Plan N has lower premiums but asks you to pay some office-visit and ER copays.
• Plans K and L have lower premiums with cost-sharing percentages and an annual out-of-pocket limit.

Wisconsin is one of three states (along with Massachusetts and Minnesota) that standardizes Medigap a little differently — plans here are built around a base policy with optional riders rather than the letter system used elsewhere. If you're shopping in Stevens Point, ask specifically about the Wisconsin Medigap structure so you're comparing apples to apples.

When you can buy a Medigap policy

Timing matters more with Medigap than with almost any other Medicare choice. Your Medigap Open Enrollment Period is a one-time, six-month window that starts the month you're 65 or older and enrolled in Part B. During that window, insurance companies must sell you any Medigap policy they offer at their best available rate, regardless of your health history.

Outside that window, in most cases, carriers can use medical underwriting — meaning they can charge more or turn you down based on your health. There are limited "guaranteed issue" situations (for example, if your employer coverage ends or a plan leaves your area), but the safest time to enroll is that initial six-month window.

Stevens Point is in Portage County, and while Medicare Advantage plan availability is set at the county level, Medigap policies are regulated and sold at the state level through the Wisconsin Office of the Commissioner of Insurance.

How Medigap fits with the rest of your Medicare

If you go the Original Medicare + Medigap route, most people also add a Part D prescription drug plan. A few 2026 figures worth knowing:

• The Part D out-of-pocket cap is $2,100 in 2026. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The Part D maximum deductible is $615.
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments instead of paying big amounts at the pharmacy counter.
• IRMAA income-based surcharges on Part B and Part D start above $109,000 for a single filer in 2026.

Key dates: the Annual Enrollment Period runs October 15 – December 7, and the Medicare Advantage Open Enrollment Period runs January 1 – March 31. Medigap has its own rules and isn't tied to these windows — but if you're switching from Medicare Advantage back to Original Medicare, those periods matter.