What is Medicare Advantage?

Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. It usually combines Part A, Part B, and often Part D prescription drug coverage.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare is run by the federal government and lets you use any provider that accepts Medicare. Medicare Advantage is offered by private insurers and often uses provider networks.

What is Medicare Supplement or Medigap?

Medicare Supplement, also called Medigap, works with Original Medicare to help reduce out-of-pocket costs. It can help cover certain copays, coinsurance, and deductibles.

Does Medigap include prescription drug coverage?

Medigap plans sold today do not include prescription drug coverage. Most people need a separate Medicare Part D plan for medications.

What is Medicare Part D?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover medication costs based on the plan’s formulary.

When is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period usually runs from October 15 to December 7 each year. During this time, many people can review or change Medicare Advantage and Part D plans.

Can I switch Medicare Advantage plans later?

Yes, but timing matters. Most people can switch during Annual Enrollment, Medicare Advantage Open Enrollment, or a qualifying Special Enrollment Period.

What is the difference between HMO and PPO Medicare Advantage plans?

HMO plans usually require in-network care and may need referrals. PPO plans generally offer more provider flexibility but may cost more for out-of-network care.

Do Medicare Advantage plans require prior authorization?

Many Medicare Advantage plans require prior authorization for certain services. This can include imaging, surgeries, skilled nursing care, or other covered treatments.

Do Medicare Advantage plans have an out-of-pocket limit?

Yes, Medicare Advantage plans include an annual maximum out-of-pocket limit for covered medical services. Original Medicare does not include this protection by itself.

Why do Medicare plans change every year?

Plans may update premiums, copays, drug formularies, provider networks, and benefits each year. Reviewing your plan annually helps avoid unexpected changes.

How can I find a Medicare plan that includes my doctor?

You should check the plan’s provider network before enrolling. A local Medicare agent can help confirm whether your doctors and hospitals are included.

IRMAA is an income-related adjustment that can increase Medicare Part B and Part D premiums. It is based on your reported income from prior tax years.

What is a Special Enrollment Period?

A Special Enrollment Period allows certain Medicare changes outside normal enrollment windows. Qualifying events may include moving, losing coverage, or plan changes.

Why work with a local Medicare agent?

A local Medicare agent can help compare plan options, explain networks, and review coverage based on your area. This can make Medicare decisions easier to understand.

Medicare Supplement Plan G: The Complete 2026 Guide for New Enrollees

June 23, 2026

By Paul Barrett, Principal Agent, The Modern Medicare Agency | Updated June 2026

Quick Answer: Medicare Supplement Plan G is the most comprehensive Medigap plan available to new Medicare enrollees in 2026. It covers virtually everything Original Medicare doesn’t — with one exception: the annual Part B deductible ($283 in 2026). After you pay that, Plan G covers 100% of Medicare-approved costs for the rest of the year. No copays. No specialist bills. No hospital bills. See any doctor in the U.S. who accepts Medicare — no networks, no referrals.

Average cost: $180/month for a 65-year-old woman who doesn’t smoke. Ranges from ~$100/month in low-cost states to $372/month in New York.

Best for: Anyone who wants complete cost predictability, nationwide provider access, and no financial surprises — and is willing to pay a higher monthly premium for that peace of mind.

Why I Wrote This Guide — and Why It’s Different

Most Plan G guides online are written by websites that earn money when you click “Get a Quote.” Their content is shaped by what drives revenue, not what helps you make the right decision.

I’m Paul Barrett, founder of The Modern Medicare Agency. I’ve spent 18 years working exclusively in Medicare, representing 40+ carriers in 34 states, and serving more than 5,000 clients. I earn commissions on every plan I sell — Plan G, Plan N, Medicare Advantage, High Deductible Plan G. My commission structure doesn’t change based on which one I recommend.

What does change is whether I’ve actually served you well.

This guide gives you everything you need to understand Plan G from the ground up: what it covers, what it costs, what it doesn’t cover, how to choose a carrier, and when to buy. I’ll also give you my honest take on situations where Plan G is not the right answer — because that’s information you deserve.

What Is Medicare Supplement Plan G?

Medicare Supplement insurance — also called Medigap — is private insurance that works alongside Original Medicare (Parts A and B) to cover the gaps Medicare leaves behind. When Medicare approves a service, it pays its share. Your Medigap plan covers what’s left.

Plan G is the most comprehensive Medigap plan available to anyone who became eligible for Medicare on or after January 1, 2020. (Plan F, which was historically the most comprehensive, is no longer available to new enrollees as a result of federal legislation passed in 2015.)

Here is the single most important thing to understand about Plan G: it is standardized by federal law. That means every insurance company selling Plan G must offer identical benefits. A Plan G from UnitedHealthcare covers exactly the same services as a Plan G from Mutual of Omaha, Aetna, or any other carrier. The only difference between carriers is the monthly premium, the rate increase history, the financial strength rating, and the customer service experience.

Because the benefits are identical, shopping for Plan G is entirely about finding the right carrier for your situation — not about comparing different coverage packages.

Source: Medicare.gov: Compare Medigap Plan Benefits; CMS: Medigap Standardization

What Plan G Covers: Every Benefit in Plain English

Here is a complete breakdown of what Plan G pays for in 2026 — explained in plain language, not insurance jargon.

Part A: Hospital Coverage

Hospital deductible — When you’re admitted to a hospital, Medicare charges a $1,736 deductible per benefit period in 2026. Plan G pays this in full. You owe nothing.

Hospital stays, Days 1-60 — Medicare covers these after you pay the deductible. Since Plan G covers the deductible, you pay nothing.

Hospital stays, Days 61-90 — Medicare charges $434 per day. Plan G pays this in full.

Hospital stays, Days 91+ (lifetime reserve days) — Medicare charges $868 per day. Plan G pays this in full.

Hospital stays beyond lifetime reserve — After your 60 lifetime reserve days are exhausted, Medicare pays nothing. Plan G covers up to an additional 365 days of hospital costs after your lifetime reserve runs out.

Skilled Nursing Facility (SNF) coinsurance — After a qualifying hospital stay, Medicare covers SNF care. For days 1-20, you owe nothing. For days 21-100, Medicare charges $217 per day in 2026. Plan G pays this in full. After day 100, neither Medicare nor Plan G pays — you bear all costs.

Blood — Medicare doesn’t cover the first three pints of blood you need. Plan G covers them.

Hospice care — Medicare covers most hospice costs but requires a small copay for prescription drugs and respite care. Plan G covers those copays.

Part B: Medical Coverage

The Part B deductible — This is the one cost Plan G does NOT cover. In 2026 it’s $283 per year — the only out-of-pocket exposure you have for covered medical services under Plan G. You pay this once, at the start of the year when you first use a Part B service. After that, Plan G covers 100% of Medicare-approved Part B costs for the rest of the year.

Part B coinsurance — After your deductible is met, Medicare covers 80% of approved services and you owe the remaining 20%. Plan G pays that 20% in full. Every time.

Part B excess charges — If a doctor accepts Medicare but not Medicare’s “assignment” (meaning they want to charge more than Medicare’s approved rate), they can bill up to 15% above the Medicare rate. Plan G covers this 100%. You owe nothing.

Blood (Part B) — Same as above — Plan G covers the first three pints.

Clinical laboratory services — Medicare covers these at 100%. Plan G covers any residual.

Home health care — Medicare-approved home health care is covered. Plan G covers the 20% coinsurance.

Durable medical equipment — Wheelchairs, oxygen, walkers, and similar equipment are covered at 80% by Medicare. Plan G covers the remaining 20%.

Additional Benefits

Foreign travel emergency — Original Medicare does not cover emergency care abroad. Plan G covers 80% of the cost of medically necessary emergency care that begins during the first 60 days of a trip outside the United States, after a $250 deductible per calendar year, up to a lifetime maximum of $50,000.

Preventive care — Medicare covers preventive services at 100% when you see participating providers. Plan G has no copay for preventive care.

What Plan G Does NOT Cover

Medicare Part B deductible ($283 in 2026 — the one out-of-pocket cost)
Prescription drugs — No Medigap plan covers prescription medications. You need a separate Medicare Part D plan.
Routine dental care — Cleanings, fillings, crowns, dentures. Not covered by Medicare, not covered by Plan G.
Routine vision — Eye exams for glasses or contacts, eyewear. Not covered.
Routine hearing — Hearing exams, hearing aids. Not covered.
Long-term care — Custodial care in a nursing home or assisted living. Not covered by Medicare, not covered by Plan G.
Private-duty nursing
Cosmetic surgery
Medicare Advantage copays — Plan G only works with Original Medicare. If you have Medicare Advantage, Plan G provides no benefit.

Source: CMS 2026 Medicare Costs; Medicare.gov: What Medigap Covers

What Does Plan G Actually Cost in 2026?

The National Average

Medigap Plan G costs an average of $180 per month for a 65-year-old woman who doesn’t smoke in 2026 — up from $159 per month in 2025, a 13% increase. High-deductible Plan G options start at $61 a month for the same profile.

That $180 national average is a useful starting point. But it obscures enormous variation — and the variation is where the real story is.

The State-by-State Reality

Your state can shift your Medigap cost by more than $190 a month for the same coverage. New York is the most expensive at $354 a month, while South Carolina and New Mexico are the cheapest at $160 for 65-year-olds.

Here is a representative picture of Plan G pricing across key states in 2026 (65-year-old female nonsmoker, national carrier averages):

State	Approximate Monthly Range	Pricing Model	Notes
New York	$300 – $372/month	Community-rated	Guaranteed issue year-round; UHC typically lowest at ~$372
Florida	$190 – $449/month	Attained-age	Wide range; Florida Blue to Aetna; rises significantly with age
Texas	$95 – $225/month	Attained-age	Cigna often competitive at ~$167; Aetna ~$220
California	$140 – $280/month	Attained-age	Birthday rule provides annual switching window
Pennsylvania	$130 – $200/month	Attained-age	Excess charges banned in-state
Ohio	$110 – $175/month	Attained-age	Among lower-cost states; excess charges banned
Illinois	$130 – $200/month	Attained-age	Competitive market with multiple carriers
South Carolina	$100 – $160/month	Attained-age	Among the lowest-cost states nationally

Source: ValuePenguin: Medicare Supplement Plan G Costs 2026; MoneyGeek: Medicare Supplement Cost 2026; PolicyGuide: Plan G Costs 2026

Important: These are representative ranges, not quotes. Your specific premium depends on your exact ZIP code, age, gender, tobacco status, carrier choice, and available household discounts. Rates for the same Plan G from the same carrier can vary significantly by ZIP code within the same state. Always get actual quotes for your specific situation.

What Affects Your Premium — The Six Key Factors

Your age — This is the biggest factor in most states. Under attained-age pricing (the most common method), your premium increases every year on your birthday. A premium that’s $150/month at 65 might be $200/month at 72 just from age increases alone — before any general rate increases are added.
Your state and ZIP code — As shown above, location drives enormous premium variation. Someone in New York pays three times what someone in South Carolina pays for identical Plan G coverage.
Your gender — Men typically pay 5-15% more than women for the same plan. Not all states allow gender-based pricing.
Tobacco use — Smokers typically pay 10-50% more than nonsmokers, depending on the carrier and state.
Timing and household discounts — Many carriers offer discounts of 5-12% for household members. If two people in the same household both enroll with the same carrier, both may qualify for this discount. Always ask.
The carrier itself — For identical Plan G coverage, premiums can vary by 50% or more between carriers offering coverage in the same ZIP code. This is why comparison shopping from an independent broker isn’t optional — it’s the single most effective way to lower your premium without reducing coverage.

Source: Medicare.gov: Get Medigap Costs; MoneyGeek: Medicare Supplement Cost 2026

The Pricing Model Question: The Decision Most People Miss

This is the factor that determines not just what you pay today, but what you’ll pay in 10 years — and it’s the one most people never ask about.

Insurance companies use three different methods to price Medigap plans. Understanding which method a carrier uses in your state is as important as the starting premium.

Attained-Age Pricing (Most States, Most Carriers)

Your premium is based on your current age. It increases every year on your birthday, in addition to any general rate increases the carrier files. This is the most common pricing model — and the most dangerous for long-term budgets.

A plan that looks cheap at 65 ($130/month) can become expensive by 75 ($200/month) from age increases alone, before adding any general rate inflation. When you’re comparing plans in an attained-age state, always ask what the rate will be at age 70, 75, and 80 — not just today.

Issue-Age Pricing

Your premium is locked to the age you were when you first enrolled. It doesn’t increase just because you get older — only from general rate increases the carrier files. This model starts higher than attained-age but tends to be more cost-effective over time. UnitedHealthcare uses issue-age pricing in Arizona, Florida, Georgia, Missouri, and New Hampshire.

Community-Rated Pricing

Everyone in the same plan pays the same premium regardless of age. A 65-year-old and an 80-year-old pay the same rate. Premiums increase from general rate filings, not from aging. This model starts highest but offers the flattest long-term trajectory.

States with community-rated Medigap include New York, Connecticut, Massachusetts (limited), and Vermont. UnitedHealthcare also uses community pricing in 43 states.

What this means for New York specifically: New York’s community-rated requirement means premiums don’t rise with age — but they start significantly higher than attained-age states and are subject to general rate increases from carriers. The 2026 Plan G premium in NY (~$372/month for UHC) is the market price for everyone, regardless of whether you’re 65 or 82. The year-round guaranteed issue rules mean you can switch carriers without underwriting at any time — but as we’ve discussed in detail in our Rate Increase article, UHC is currently the lowest-priced Plan G option in NY, so switching carriers often doesn’t produce meaningful savings.

Source: MedicareSupplement.com: Pricing Models; MoneyGeek: Medigap Costs by State

High Deductible Plan G: The Option Most Agents Don’t Mention

I want to spend extra time here because this plan is genuinely underused, genuinely underexplained, and — for the right person — genuinely the smartest financial choice.

High Deductible Plan G (HD Plan G) provides identical medical benefits to standard Plan G. The same nationwide access, the same 100% coverage of Medicare-approved costs, the same excess charge protection. The only difference: you pay a $2,950 annual deductible before the plan’s coverage activates.

In exchange for that higher deductible, the monthly premium drops dramatically.

A high-deductible Plan G costs only $52 per month, on average, for a 65-year-old woman who doesn’t smoke — compared to $180/month for standard Plan G. That’s a difference of $128/month — $1,536/year in premium savings.

The Math That Makes HD Plan G Compelling

Let’s use real 2026 numbers. Standard Plan G at $180/month vs. HD Plan G at $52/month:

Annual premium savings with HD Plan G: $1,536/year

Worst-case scenario (you hit the full $2,950 deductible):

HD Plan G total annual cost: $624 premiums + $2,950 deductible = $3,574
Standard Plan G total annual cost: $2,160 premiums + $283 Part B deductible = $2,443
Standard Plan G wins by $1,131

Average healthy year (you use $600 in medical costs):

HD Plan G total: $624 premiums + $600 out-of-pocket = $1,224
Standard Plan G total: $2,160 premiums + $283 Part B deductible = $2,443
HD Plan G saves $1,219 this year

5-year cumulative (4 healthy years + 1 worst-case year):

HD Plan G: ($1,224 × 4) + $3,574 = $8,470
Standard Plan G: $2,443 × 5 = $12,215
HD Plan G saves $3,745 over 5 years — even including a worst-case year

The math clearly favors HD Plan G for healthy enrollees. The premium savings accumulate rapidly, and even factoring in an occasional high-use year, HD Plan G frequently wins over a 5-10 year horizon.

Source: CMS: HD Plan G Deductible Announcement 2026; ValuePenguin: Medigap Plan G Costs 2026

Why I Recommend HD Plan G More Often Than Most Agents Do

I’ll be direct about something: HD Plan G pays a lower commission than standard Plan G. Most agents don’t recommend it — not because it’s the wrong choice for the client, but because it’s the less profitable sale.

I recommend it when it fits. Here’s who HD Plan G is genuinely right for:

HD Plan G is a strong fit if:

You are in good to excellent health with no chronic conditions requiring frequent care
You have at least $2,950 in accessible savings to cover a high-use year without financial stress
You rarely see specialists and your annual healthcare costs are modest
You want maximum premium savings while maintaining the same underlying coverage
You understand and are comfortable with the “pay as you go, then full coverage” structure

HD Plan G is not right if:

You see multiple specialists regularly or manage a chronic condition with frequent care
A $2,950 bill in a single year would cause real financial hardship
You want complete cost predictability above all other considerations
Your state has very few HD Plan G carrier options

One important note on HD Plan G: The annual deductible for High Deductible Plan G is $2,950 in 2026, up from $2,870 in 2025. The deductible rises annually based on the CPI. It has gone from $2,370 in 2021 to $2,950 in 2026 — a 24% increase in five years. This trajectory continues. Factor it into your long-term planning, not just the 2026 figure.

Source: CMS: F, G & J Deductible Announcements; Boomer Benefits: High Deductible Plan G

Plan G vs. Plan F: Why Plan F Almost Never Makes Sense for New Enrollees

This is a straightforward one.

Plan F is the most comprehensive Medigap plan that has ever existed — it covers everything, including the Part B deductible. But as of January 1, 2020, Plan F is no longer available to anyone who became newly eligible for Medicare. If you turned 65 in 2020 or later, Plan F is not an option for you.

If you were eligible for Medicare before 2020, you can still purchase Plan F — but you almost certainly shouldn’t. Here’s why.

Medigap Plan F costs $227 per month on average in 2026 — compared to $180/month for Plan G. That’s $47/month more, or $564/year in additional premiums.

What does Plan F cover that Plan G doesn’t? The Part B deductible: $283 in 2026.

The math is simple: you’re paying $564/year in extra premiums to avoid a $283 annual deductible. You pay the difference. Every year. For the rest of your life.

Plan G is almost always the better financial choice for anyone who can still select between the two.

There’s also a structural concern specific to Plan F: because it’s closed to new enrollees, the Plan F risk pool is permanently aging. As younger, healthier beneficiaries can no longer join, the pool becomes progressively older and sicker — which drives up claims and fuels accelerating rate increases. Plan F prices increased the most in 2026, at an average of 14%, while Plan G increased around 13%. This trend is likely to continue as the Plan F pool ages further.

Source: ValuePenguin: Medigap Plans 2026; Medicare.gov: Medigap Plan Benefits

How to Choose the Right Plan G Carrier

Since all Plan G policies cover identical benefits, choosing a carrier comes down to four factors — and the order matters.

Factor 1: Rate Increase History (Most Important)

The premium you pay today is not the premium you’ll pay in 10 years. What a carrier has done with rates over the past 5 years is the single best predictor of what they’ll do in the next 5.

Ask any broker you work with: “Can you show me the rate increase history for this carrier over the past 5 years?” A good independent broker will provide this without hesitation. If they can’t or won’t, that tells you something important.

As documented in our Medigap Rate Increase Guide, rate increases across the industry have accelerated significantly — with major carriers filing increases of 12-26% in early 2026, according to Telos Actuarial data reported by CBS News/KFF Health News. Some outlier carriers imposed increases of 45% or more. Rate history is not a guarantee of future behavior — but a carrier with a 3-5% average annual increase history is a very different risk profile from one with a 15% average.

Factor 2: Financial Strength Rating (AM Best)

Medigap is a long-term commitment. The plan you buy at 65 may still be paying your claims at 85. That’s 20 years during which a lot can happen to an insurance company.

AM Best is the gold standard rating agency for insurance companies specifically. Look for an AM Best rating of A- or higher before enrolling with any carrier.

Key 2026 ratings update: AM Best downgraded UnitedHealthcare’s insurance subsidiaries — including the entity that underwrites AARP Medicare Supplement plans — from A+ (Superior) to A (Excellent) in 2026. They remain a financially sound company with a stable outlook, but this is a real-world reminder that ratings are not permanent. Always verify current ratings rather than relying on what you heard or read previously.

You can check any carrier’s current AM Best rating at ambest.com — search by company name. This takes two minutes and is worth doing for any carrier you’re seriously considering.

Factor 3: NAIC Complaint Index

The National Association of Insurance Commissioners (NAIC) publishes complaint index scores for every Medicare Supplement insurer. A score below 1.0 is better than the market average. A score significantly above 1.0 is a warning sign about how the company treats policyholders when problems arise.

You can look up any carrier’s NAIC complaint index at naic.org. State Farm and USAA consistently receive some of the lowest complaint scores among major Medigap carriers.

Factor 4: Current Premium Competitiveness

Because Plan G benefits are identical across carriers, the premium difference between carriers for the same coverage is pure cost difference. If Carrier A charges $175/month and Carrier B charges $210/month for the same Plan G in your ZIP code, you’re paying $420/year more with Carrier B for no additional benefit.

However — and this is important — the lowest premium today isn’t always the lowest premium over 10 years. A carrier offering a teaser rate with aggressive future rate increases can become more expensive than a carrier that started slightly higher but has a stable rate history. This is why rate increase history comes first.

A specific warning about UHC/AARP enrollment discounts that most agents never explain: UHC builds a significant enrollment discount into their starting premium. For policyholders who enrolled several years ago, that discount started at approximately 39% at age 65 and phases out by roughly three percentage points per year between ages 69 and 81 — at which point the discount is gone entirely and you pay the full undiscounted base rate. For newer enrollees, UHC has updated the structure with a higher starting discount (reportedly around 45%) but a slower phase-out of approximately two percentage points per year.

What this means practically: the UHC premium you’re quoted at 65 is not the premium you’ll pay at 73 or 79. You’re seeing a discounted entry price, not the long-term rate. This discount phase-out creates premium growth above and beyond any general rate increases — particularly in your late 60s and 70s. When comparing UHC quotes to competitors, always ask for the projected premium at age 70, 75, and 80 — not just today’s rate. A starting premium that looks competitive can look very different once the discount disappears.

Source: paulbinsurance.com: How to Check a Medicare Supplement Company’s Financial Strength; NerdWallet: Best Plan G Companies 2026; ValuePenguin: AARP Medicare Supplement Review 2026

The Enrollment Window: When to Buy and What Happens If You Wait

This is the most important section in this entire guide for anyone approaching 65. Please read it carefully.

Your One-Time Open Enrollment Period

When you turn 65 and enroll in Medicare Part B, you enter a 6-month Medigap Open Enrollment Period during which every insurance carrier selling Medigap in your state must accept you for any plan they offer — at standard rates, with no health questions, no medical underwriting, and no ability to deny you coverage based on pre-existing conditions.

This window is one-time. It starts the first month you are both 65 or older AND enrolled in Part B. Medicare.gov confirms explicitly: “Your Medigap Open Enrollment Period is a one-time enrollment period. It doesn’t repeat every year.”

During this window, you have complete freedom — any plan, any carrier, guaranteed acceptance at standard rates. The most expensive insurance mistake most Medicare enrollees make is not using this window wisely.

What Happens After the Window Closes

In most states, once your 6-month open enrollment period ends, switching to a Medigap plan requires medical underwriting. The carrier can:

Ask detailed health questions
Review your medical history
Charge you a higher premium based on health status
Decline your application if you have certain conditions

The people who most want to switch to Plan G later are often the ones least able to do so — because they’ve developed health conditions that make underwriting difficult or impossible.

State exceptions: New York, Connecticut, and Vermont offer year-round guaranteed issue — you can apply for any Medigap plan at any time without underwriting. Sixteen other states have “birthday rules” that give you an annual window to switch plans without underwriting. See our complete guide: When Is the Best Time to Switch Medicare Supplement Plans?

The 30-Day Free Look Period

When you enroll in any Medigap plan, federal law gives you a 30-day free look period during which you can cancel and receive a full premium refund if you’re not satisfied. Critical rule: do not cancel your existing coverage until you’ve decided to keep the new plan.

Source: Medicare.gov: When Can I Buy a Medigap Policy?

The Biggest Mistake New Enrollees Make

After 18 years and thousands of client conversations, I can tell you with certainty: the single biggest mistake new Medicare enrollees make is waiting.

Waiting to learn about their options until after they need care. Waiting to compare plans until the open enrollment window is closing. Waiting to decide because the topic feels overwhelming. Waiting because a friend said Medicare Advantage looked fine.

Here’s the cost of waiting:

Your open enrollment period starts on a specific date. It ends 6 months later. During that window, you can get any Medigap plan from any carrier at standard rates. Outside that window, in most states, carriers can say no.

I talk to people every year who let that window close, stayed on Medicare Advantage for a few years, developed a health condition, and then tried to get Plan G. In most states, they can’t. Or they can, but only at rates that are significantly higher than what they would have paid at 65.

The two decisions that drive this outcome are always the same:

They didn’t understand what the enrollment window was
Nobody sat down with them before that window opened

That’s a solvable problem. That’s exactly what an independent Medicare broker does — and it costs you nothing. The carrier pays the broker’s commission. Your premium is the same whether you work with a broker or not.

Plan G vs. Medicare Advantage: A Honest Note

Plan G is not right for everyone. I want to be clear about that because an article that tells you Plan G is always the answer isn’t giving you honest advice.

Medicare Advantage plans — which replace Original Medicare with a private plan — can offer lower monthly premiums, bundled prescription drug coverage, and extras like dental, vision, and hearing benefits. For a healthy senior on a tight budget who lives locally and sees doctors infrequently, Medicare Advantage may genuinely be the better choice.

Plan G wins when:

You see specialists regularly or have chronic health needs
You travel frequently or live part of the year in another state
You want complete cost predictability
Provider choice and network-free access matter to you

For a detailed side-by-side comparison, see our full guide: Medicare Supplement vs. Medicare Advantage: The Honest Side-by-Side

Plan G at a Glance: The Numbers You Need (2026)

Item	Amount	Source
Your only out-of-pocket cost	$283/year (Part B deductible)	CMS
Average monthly premium (65F nonsmoker)	$180/month	ValuePenguin
HD Plan G average premium	$52/month	ValuePenguin
HD Plan G annual deductible	$2,950	CMS
Most expensive state (NY)	~$354/month	MoneyGeek
Least expensive states (SC, NM)	~$160/month	MoneyGeek
Part A deductible Plan G covers	$1,736/per benefit period	CMS
SNF coinsurance Plan G covers	$217/day, days 21-100	CMS
Foreign travel emergency	80% up to $50,000 lifetime	Medicare.gov
Enrollment window	6 months from Part B enrollment at 65	Medicare.gov

Paul’s Honest Bottom Line

Plan G is the plan I recommend most often — but not because it’s always the right answer. I recommend it most often because most of my clients have health needs that make Plan G’s comprehensive, predictable coverage genuinely the best fit. And because the freedom to see any Medicare provider, anywhere in the country, without prior authorization or network restrictions is something people don’t fully appreciate until they need it.

For clients who are healthy, cost-conscious, and comfortable with modest financial risk, I recommend High Deductible Plan G — and I’ll keep recommending it even though it pays me less, because that’s the right answer for them.

For clients who are genuinely on tight fixed incomes and can’t sustain the Plan G premium, I explore Plan N and sometimes Medicare Advantage — because the best plan is always the one you can actually maintain.

What I don’t do is sell you a plan based on what earns me the most commission. That’s not the kind of broker I am, and after 18 years, it’s not the kind of reputation I’ve built.

If you’re approaching 65 — or if you already have Plan G and want to know whether you’re with the right carrier at the right price — I’m happy to look at your specific situation.

Ready to Get a Real Quote From Someone Who Will Tell You the Truth?

Getting a Medigap quote through an independent broker costs you nothing. The carrier pays the commission — your premium is identical whether you work with a broker or go directly to the carrier. The difference is that an independent broker with 40+ carrier appointments can show you the full market instead of one company’s options.

I’ll compare rates from every carrier available in your ZIP code, walk you through the rate increase histories, and give you my honest take on what makes sense for your health, your budget, and your state’s rules.

Paul Barrett | The Modern Medicare Agency 📞 (631) 358-5793 ✉️ medicare@paulbinsurance.com 🌐 paulbinsurance.com

Additional Resources in This Series

This article is part of Paul Barrett’s Medicare Supplement content cluster. Each article links to the others:

Sources and Further Reading

Paul Barrett is the founder and Principal Agent of The Modern Medicare Agency. He has worked exclusively in Medicare for 18+ years, holds licenses in 34 states, and represents 40+ carriers. He is the author of Medicare Mastery Unlocked and hosts the Insurance Wise Guys Podcast. This article is for educational purposes only. Premium data represents national averages for a 65-year-old female nonsmoker — your actual premium will vary based on state, ZIP code, age, gender, tobacco use, carrier, and applicable discounts. All 2026 cost figures are sourced from CMS official publications. Contact a licensed independent Medicare broker for guidance specific to your situation.

What Is Medicare Part B and What Does It Actually Cover?

The complete guide to Medicare’s medical insurance — every service it covers, exactly what it costs in 2026, how it works with group insurance and VA benefits, and the excess charges most people have never heard of until they get a surprise bill.

The Short Answer

Medicare Part B is medical insurance — it covers doctor visits, outpatient care, preventive services, durable medical equipment, and more. Unlike Part A, Part B is not premium-free for anyone: everyone pays a monthly premium (202.90in2026formostpeople),anannualdeductible(283), and 20% coinsurance on most covered services, with no yearly cap on that 20% under Original Medicare alone. Whether you need to enroll at 65, and whether delaying is safe, depends heavily on your employment status and your employer’s size — getting this wrong is one of the most consequential and permanent mistakes in all of Medicare.

Key Takeaways

Part B is never premium-free — everyone pays a monthly premium, and higher earners pay significantly more through IRMAA.
The 20% coinsurance under Original Medicare alone has no yearly cap — this is the single biggest financial risk in Medicare, and it’s the reason Medigap and Medicare Advantage exist.
Whether you can safely delay Part B without a penalty depends on your employer’s size: 20+ employees generally allows delay; fewer than 20 generally does not.
Missing your enrollment window triggers a permanent 10% penalty for every 12-month period you went without coverage.
Veterans can and generally should enroll in Part B even with VA benefits, since Medicare and VA coverage don’t coordinate — each only pays for care received within its own system.
“Excess charges” from non-participating providers can add up to 15% on top of what Medicare approves, and only some Medigap plans protect you from them.

What Part B Actually Covers

While Part A handles hospital room and board, Part B is the half of Original Medicare that covers medical care and most services delivered outside a hospital admission — doctor visits, outpatient procedures, and ongoing medical needs.

What’s covered

Doctor visits — primary care and specialists
Outpatient surgeries and procedures
Diagnostic lab work, X-rays, and MRIs
Emergency room visits
Ambulance services
Outpatient mental health care
Physical, occupational, and speech therapy
Chemotherapy and radiation received in an outpatient clinic
Durable Medical Equipment (DME) — wheelchairs, oxygen equipment, blood sugar monitors, walkers, and similar equipment
Ambulatory surgical center services

Preventive services: the part Medicare gets genuinely right

Most preventive services are covered at 100%, with no deductible and no copay, as long as your provider accepts Medicare assignment. This includes:

Your one-time “Welcome to Medicare” wellness visit, available within your first 12 months on Part B
Annual wellness visits after that
Flu shots and most other recommended vaccines
Mammograms
Colonoscopies and other cancer screenings
Diabetes and cardiovascular screenings
Many other screenings recommended by the U.S. Preventive Services Task Force

Paul’s Honest Take: This is one of the most underused parts of Medicare, full stop. I’ve had clients who paid for a private physical every year out of habit and never realized their annual wellness visit through Medicare was completely free. If you haven’t used your Welcome to Medicare visit or your annual wellness visit, that’s real value sitting on the table.

What’s NOT covered

Routine dental care — cleanings, fillings, dentures, extractions
Routine vision exams and eyeglasses
Hearing aids (though diagnostic hearing tests ordered by a doctor may be covered)
Long-term custodial nursing home care — help with daily living activities, as opposed to short-term skilled or medical care
Routine prescription drugs you pick up at a retail pharmacy — that’s Part D’s job, not Part B’s
Cosmetic surgery, unless medically necessary (such as reconstruction after an accident or mastectomy)
Most care received outside the United States, with very limited exceptions
Routine foot care, such as nail trimming, in the absence of a qualifying medical condition
Acupuncture, except for a narrow, specific chronic low back pain benefit
Concierge medicine fees and membership-style charges some practices add on top of standard care
Long-term care insurance-style services, including most home-based personal care that isn’t tied to a skilled medical need

Paul’s Honest Take: The dental and vision exclusions are the ones that surprise people most, especially since they’re such routine parts of healthcare for most adults. This is exactly why so many Medicare Advantage plans build dental, vision, and hearing benefits into their coverage — Original Medicare was simply never designed to include them, and that gap doesn’t go away on its own.

What Part B Costs in 2026

Part B has three separate cost components, and understanding all three matters:

Cost Component	2026 Amount
Standard monthly premium	$202.90
Annual deductible	$283
Coinsurance on most covered services	20%

The premium is deducted automatically from your Social Security check if you’re already collecting benefits. If you’re not yet collecting Social Security, you’ll receive a bill, typically every three months.

The deductible works differently than Part A’s — it’s a straightforward annual figure. You pay the first $283 of Medicare-approved outpatient costs each calendar year, and then Medicare’s cost-sharing kicks in.

The coinsurance is where the real risk lives. After your deductible is met, Medicare pays 80% of the Medicare-approved amount for most covered services, and you’re responsible for the remaining 20%. There is no yearly cap on this 20% under Original Medicare alone. If you have a $100,000 course of cancer treatment, your 20% share is $20,000 — unless you have a Medigap policy or Medicare Advantage plan absorbing that cost.

Paul’s Honest Take: I put this in bold because it’s genuinely the single most important number in this entire guide. That uncapped 20% is the whole reason Medigap and Medicare Advantage exist as products in the first place. Original Medicare by itself was never designed to protect you from a truly expensive year — it was designed to cover 80% of it and leave the rest to you.

IRMAA: What Higher Earners Actually Pay

If your income is above certain thresholds, you’ll pay more for Part B through the Income-Related Monthly Adjustment Amount (IRMAA) — based on your tax return from two years prior. For 2026, that means your 2024 income determines your premium tier.

2024 Income (Individual)	2024 Income (Married, Joint)	Total Part B / Month
$109,000 or less	$218,000 or less	$202.90
$109,001 – $137,000	$218,001 – $274,000	$284.10
$137,001 – $171,000	$274,001 – $342,000	$405.80
$171,001 – $205,000	$342,001 – $410,000	$527.50
$205,001 – $499,999	$410,001 – $749,999	$649.20
$500,000 and above	$750,000 and above	$689.90

At the top tier, you’re paying more than three times the standard premium. If your income has recently dropped — retirement, the loss of a spouse, or certain other life-changing events — you can appeal your IRMAA determination using Form SSA-44.

Do You Have to Enroll? And What Happens If You Don’t?

Technically, Part B is optional — Medicare won’t force you into it. But opting out without a valid alternative is genuinely risky, because of how the penalty structure works.

If you don’t sign up during your Initial Enrollment Period (the 7-month window around your 65th birthday) and you don’t have qualifying employer coverage, you’ll face a permanent 10% penalty added to your premium for every full 12-month period you went without Part B. That penalty doesn’t expire — you pay it for as long as you have Part B, which for most people means for the rest of your life.

Example: If you delayed enrollment by 24 full months without a valid exception, you’d pay an extra 20% on top of the standard $202.90 premium in 2026 — roughly $40.58 more, every month, permanently.

How Part B Works with Group Insurance

Just like Part A, whether you can safely delay Part B without penalty comes down to one specific number: how many employees your company has.

Companies with 20 or more employees: If you or your spouse are actively working and covered by a genuine group health plan, your workplace insurance is primary, and you can legally delay Part B without any penalty. When that employment or coverage eventually ends, you get an 8-month Special Enrollment Period to enroll in Part B penalty-free.

Companies with fewer than 20 employees: Medicare automatically becomes your primary insurer at 65, regardless of your employment status. You need to enroll in Part B right on schedule. If you don’t, your small employer’s plan can legally refuse to pay claims that Medicare should have covered first — potentially leaving you responsible for the full cost.

Paul’s Honest Take: I say this in nearly every guide I write, because it’s genuinely one of the costliest misunderstandings I encounter: “I have good coverage at work” and “I’m protected from Medicare’s enrollment deadlines” are two completely different statements, and whether the second one is true depends entirely on your employer’s size — not how generous the coverage feels. Confirm the actual employee count before you decide to delay anything.

Retiree Coverage Is Not the Same as Active Employer Coverage

This is a distinction that catches a genuinely large number of people off guard: the “20 or more employees” exception only applies to active employment. If you retire and your former employer offers you retiree health benefits — sometimes a genuinely good, comprehensive plan — that coverage does not create a Special Enrollment Period the way active group coverage does, and it does not exempt you from enrolling in Part B on time.

Paul’s Honest Take: I’ve seen this mistake more than once, and it’s an especially painful one because it happens to people who did everything right during their working years. Someone retires with a strong retiree health plan from a large employer, assumes it works the same way their active coverage did, and delays Part B — only to find out later that retiree coverage was never a valid reason to delay in the first place. The moment you stop actively working, that clock starts, regardless of how good your retiree plan looks on paper. If you’re retiring and keeping employer retiree benefits, treat enrolling in Part B as something to handle right on schedule, not something retiree coverage lets you postpone.

Why You Need Both Part A and Part B for Medigap or Medicare Advantage

Here’s a foundational requirement worth understanding clearly, since it shapes every other coverage decision in Medicare: you must be enrolled in both Part A and Part B before you can buy a Medigap policy or enroll in a Medicare Advantage plan. Neither product exists as a standalone substitute for Original Medicare — both are built specifically to work alongside it.

Medigap fills the cost-sharing gaps left by Original Medicare (Parts A and B) — it has nothing to fill in if you’re not enrolled in both parts to begin with.
Medicare Advantage legally must provide at least the same coverage as Parts A and B combined, which is only possible because you’re required to be enrolled in both before a Medicare Advantage carrier can enroll you.

Paul’s Honest Take: This surprises people who assume they can somehow “skip” Part B and go straight into a Medicare Advantage plan to avoid the extra premium. It doesn’t work that way — Part B enrollment, and its premium, is a prerequisite either way, whether you end up on Original Medicare with Medigap or on a Medicare Advantage plan. There’s no path through Medicare that avoids the Part B premium once you’re actually using the system.

Does Medicare Work If You’re a Veteran?

Yes — and if you have VA health benefits, understanding how the two systems relate is genuinely important, because they work differently than most people assume.

Medicare and VA benefits do not coordinate. These are two entirely separate systems that each pay only for care received within their own network. Medicare doesn’t pay for care you receive at a VA facility, and VA benefits don’t pay for care you receive from a non-VA doctor or hospital. You, the veteran, choose which system to use each time you seek care.

Here’s the critical point: having VA benefits does not exempt you from Medicare’s enrollment deadlines. VA coverage is not considered a qualifying reason to delay Part B without penalty. If you don’t enroll in Part B during your Initial Enrollment Period and you’re relying solely on VA benefits, you can still trigger the permanent late enrollment penalty.

Why the VA itself recommends enrolling in Medicare anyway:

It gives you access to civilian doctors and hospitals outside the VA system
VA healthcare funding depends on annual Congressional appropriations, which isn’t guaranteed to remain stable
If VA authorizes only part of your needed care at a non-VA facility, Medicare can help cover the rest
Having both gives you meaningfully more flexibility and security than relying on either system alone

Paul’s Honest Take: This is one of the most common misconceptions I run into with veterans specifically, and it’s an expensive one to get wrong. Good VA coverage feels like it should be enough, and it might genuinely handle most of your care — but it doesn’t protect you from the Part B enrollment clock the way employer coverage from a large company can. The VA itself actively encourages enrolling in Medicare Parts A and B for exactly this reason. If you have VA benefits and are approaching 65, this is worth a direct conversation before you assume you’re covered.

Veterans who enroll in Part B can also purchase a Medigap policy, which can be particularly valuable if you use non-VA providers regularly — though if you primarily rely on VA facilities for most of your care, the value of an added Medigap policy may be more limited, and worth weighing carefully.

How Long Does It Actually Take to Get Part B Approved?

This is one of the most practical, and most overlooked, pieces of planning — especially if you’re leaving a job after 65 and coordinating your Part B start date around the end of your employer coverage. Applying isn’t instant, and the timeline depends heavily on which enrollment window you’re using.

Enrollment Situation	Typical Processing Time	When Coverage Actually Starts
Initial Enrollment Period (around 65)	2–4 weeks, sometimes up to 6	1st of your birthday month (if applied in the 3 months before) or 1st of the month after you apply (if applied during or after your birthday month)
Special Enrollment Period (leaving employer coverage)	4–8 weeks, sometimes longer	1st of the month after your application is submitted
General Enrollment Period (Jan 1–Mar 31, missed window)	4–6 weeks	1st of the month after you apply

Why the Special Enrollment Period takes longer: applying after leaving employer coverage requires two forms, not one — Form CMS-40B (the actual Part B application) and Form CMS-L564 (Request for Employment Information), which your employer needs to complete to verify you had qualifying coverage. Social Security has to manually review both, which is exactly why this route consistently takes longer than a standard Initial Enrollment Period application.

Paul’s Honest Take: This timeline question comes up constantly with clients who are retiring or leaving a job after 65, and it deserves real attention — not just because of the penalty risk we’ve already covered, but because a slow approval can leave you with an actual gap in coverage if you time it too tightly. My standard advice: start this process at least 2 to 3 months before you need Part B to actually begin, not the week your employer coverage ends. If your former employer is slow to complete their portion of Form CMS-L564, that alone can hold up the entire application — so it’s worth following up with your HR or benefits department directly rather than assuming it’s been submitted.

Practical tips to avoid delays

Apply online through SSA.gov whenever possible. It’s consistently the fastest method — mailed or faxed forms are more prone to getting lost or delayed.
If you’re on a Special Enrollment Period, submit Form CMS-L564 alongside Form CMS-40B, not separately. They need to arrive together, and one incomplete form can stall the whole application.
Expect a short intake lag even with online applications. It can take several business days for an online submission to actually appear on a local Social Security agent’s screen — don’t panic if you call shortly after applying and they say they don’t see it yet.
Once approved, you don’t have to wait for your physical card. Your Medicare Beneficiary Identifier typically appears in your online Social Security or Medicare.gov account within a day or two of approval, and you can print a temporary card from there — the physical card generally arrives by mail within about 30 days.

Excess Charges: The Cost Almost Nobody Knows to Ask About

Here’s a detail that surprises even people who’ve been on Medicare for years: not every doctor who accepts Medicare agrees to accept Medicare’s approved amount as full payment.

Providers fall into three categories:

Participating providers accept Medicare assignment, meaning they agree to accept the Medicare-approved amount as payment in full. This covers the vast majority of providers — roughly 98% of doctors nationally.
Non-participating providers still accept Medicare patients but haven’t agreed to accept the standard rate. They can charge an excess charge of up to 15% above the Medicare-approved amount.
Opted-out providers have left the Medicare system entirely and can charge whatever they want under a private contract — Medicare pays nothing at all for care from these providers, except in emergencies.

How excess charges actually work: if the Medicare-approved amount for a service is $300 and you see a non-participating provider, they can legally charge up to an additional $45 (15%) on top, for a total bill of $345 — and that excess amount doesn’t count toward your Part B deductible.

Eight states currently prohibit or limit excess charges entirely: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one of these states, you’re generally shielded from excess charges from providers within your state — though you could still face them if you receive care from a non-participating provider elsewhere.

Paul’s Honest Take: This is exactly why Medigap Plan G matters so much for people who want maximum flexibility. Plan G covers excess charges in full — Plan N does not. If you’re the kind of person who wants the freedom to see any doctor without worrying about billing surprises, that distinction is worth understanding clearly before you pick between the two. And regardless of which plan you choose, it’s always worth asking a new provider directly whether they accept Medicare assignment before your first appointment.

The HSA Rule: Part B Closes the Door Too

If you’re hoping to keep contributing to a Health Savings Account, know this clearly: enrolling in Part B — or any part of Medicare — ends your ability to make new HSA contributions. This isn’t unique to Part B; it applies the moment you enroll in Medicare in any form, including premium-free Part A.

If keeping your HSA active matters to you, the only way to legally delay both Part A and Part B is through qualifying employer coverage — which, as covered above, generally requires an employer with 20 or more employees. And because Part A enrollment can be backdated up to 6 months once you do enroll, it’s smart to stop HSA contributions 6 months before you plan to sign up for Medicare or file for Social Security, whichever comes first.

Frequently Asked Questions

Is there a cap on what I’ll pay for Part B services in a year? Not under Original Medicare alone — the 20% coinsurance has no yearly limit. A Medigap policy or Medicare Advantage plan is what actually caps your exposure.

What happens if I don’t sign up for Part B on time? You’ll generally face a permanent 10% penalty on your premium for every 12-month period you went without coverage, unless you qualify for a Special Enrollment Period through active employer coverage.

Do I need Part B if I have good coverage through a small employer? Almost certainly yes. If your employer has fewer than 20 employees, Medicare becomes your primary insurer at 65 regardless of your job coverage, and not enrolling can leave you exposed to unpaid claims and a lifelong penalty.

Do veterans need Medicare Part B if they have VA benefits? Generally, yes. Medicare and VA benefits don’t coordinate — each only pays for care within its own system — and VA coverage doesn’t exempt you from Medicare’s enrollment deadlines or penalties.

What is a Part B excess charge? An additional charge, up to 15% above the Medicare-approved amount, that a non-participating provider can legally bill you. It doesn’t count toward your deductible, and only Medigap Plan G (among current plans) covers it in full.

Can I keep contributing to my HSA if I enroll in Part B? No. Enrolling in any part of Medicare, including Part B, ends your HSA contribution eligibility going forward.

How long does it take to get approved for Part B? It depends on the enrollment window. Initial Enrollment Period applications typically process in 2–4 weeks. Special Enrollment Period applications, used when leaving employer coverage, generally take 4–8 weeks since Social Security must manually verify your prior coverage using Form CMS-L564. Start the process at least 2–3 months before you need coverage to begin, especially when coordinating around a job ending.

The Bottom Line

Part B is the half of Medicare that covers your everyday medical care — and it’s also where the real financial exposure of Original Medicare lives, thanks to that uncapped 20% coinsurance. Whether you should enroll at 65, whether you can safely delay, and how much of that exposure you’re carrying all depend on details specific to your situation: your employer’s size, your income, your VA status, and which doctors you actually see.

If you want help sorting out exactly how Part B applies to your specific circumstances — or want to understand how Medigap or Medicare Advantage could close that uncapped coinsurance gap — that’s exactly the conversation I have with clients every day, at no cost to you.

Call 631-358-5793 or visit paulbinsurance.com to set up a time to talk it through.

Paul Barrett, CMIP, is the founder of The Modern Medicare Agency, based in Melville, NY, and has spent 18+ years exclusively helping people navigate Medicare — never life insurance, never annuities, just Medicare. He’s licensed in 37 states, represents more than 40 carriers, and has personally helped over 5,000 clients choose coverage that actually fits their lives.

Figures current as of 2026 and sourced from CMS, Medicare.gov, and the Social Security Administration. Individual circumstances vary, especially around employer coverage, VA benefits, and income-based premiums — always verify your specific situation before making enrollment decisions.