Medicare Supplement (Medigap) Insurance

A Medicare Supplement policy, also called Medigap, pays your share of the hospital and doctor bills that Original Medicare covers but does not pay in full. Part A charges you a deductible every time a new benefit period starts, then daily coinsurance if the stay runs long. Part B pays about eighty percent of approved charges and leaves you the other twenty percent, with no annual limit on what that twenty percent can become. A supplement puts a ceiling on both. What it does not do is pay for care Original Medicare will not cover, which is where most of the surprises come from.

What Original Medicare leaves you holding in 2026

On the hospital side, Part A charges a deductible of one thousand seven hundred thirty-six dollars per benefit period. Read that as per benefit period, not per year. A benefit period ends after you have been out of a hospital or skilled nursing facility for sixty days in a row, so two separate admissions far enough apart mean two deductibles in the same calendar year.

If the stay runs past sixty days, you owe four hundred thirty-four dollars a day for days sixty-one through ninety. Past that you owe eight hundred sixty-eight dollars a day for days ninety-one through one hundred fifty, drawn from a lifetime reserve of sixty days. You get sixty of those days for your entire life and they do not renew.

Skilled nursing runs two hundred seventeen dollars a day for days twenty-one through one hundred.

On the doctor side, Part B has an annual deductible of two hundred eighty-three dollars, and then you owe generally twenty percent of the Medicare-approved amount for the rest of the year. That twenty percent has no annual maximum. In a routine year it hardly registers. In the year of a cardiac event, a joint replacement, or a cancer diagnosis, it is the number that matters.

The day one hundred fifty-one cliff

Once your lifetime reserve days are gone, Original Medicare stops paying for that hospital stay entirely and you owe one hundred percent.

Every standardized Medicare Supplement plan adds three hundred sixty-five additional hospital days over your lifetime after Medicare’s days run out. During those days the insurance company pays what Medicare would have paid, and the hospital cannot come after you for the difference. Most people never need it. The ones who do would have been ruined without it.

What Plan G covers, and why Plan F is off the table for most people

Plan G picks up the Part A deductible, all of the Part A coinsurance, the additional three hundred sixty-five hospital days, skilled nursing coinsurance, blood, hospice coinsurance, your Part B twenty percent, and Part B excess charges.

It does not cover the annual Part B deductible. That two hundred eighty-three dollars is the one bill you keep, and it is the entire difference between Plan G and the old Plan F.

Plan F covered that deductible too, but it closed to anyone who became eligible for Medicare on or after January 1, 2020. If your Medicare eligibility started in 2020 or later, Plan F is not available to you at any price, which is why Plan G is the practical top of the market now.

The rest of this page uses Plan G as the reference point, because it is what most people are comparing. The standardized plans are not identical, though. Plans K and L cover only a portion of your Part B twenty percent, fifty percent and seventy-five percent respectively, in exchange for a lower premium and an annual cap on what you spend out of pocket. Plan N covers the coinsurance in full but applies small copays to some office visits and emergency room visits, and it does not cover Part B excess charges. Where this page says a supplement pays your twenty percent, that is true of Plan G and most of the other plans, and only partly true of K and L.

The rule almost nobody explains, and it costs people real money

A Medicare Supplement pays only on services Original Medicare approves. If Medicare does not cover something at all, your supplement does not cover it either. Not part of it. Not at a discount. Nothing.

There is one place a supplement pays for a kind of care Original Medicare does not cover at all, and that is foreign travel emergency care. Plans C, D, F, G, M, and N include it. That benefit pays eighty percent of billed charges for medically necessary emergency care, after a two hundred fifty dollar annual deductible, up to a fifty thousand dollar lifetime maximum, and only for care beginning in the first sixty days of a trip outside the country.

Everything else runs through Medicare first. That matters more than it does in most markets, because a lot of our clients use care Medicare was never built to pay for.

About that foreign travel benefit, and why we tell clients not to lean on it

We just told you it is the one thing your supplement covers that Medicare does not. Now here is the part the brochure does not put in bold.

Read the limits again. Eighty percent, so you still owe twenty percent of whatever a hospital abroad charges. Fifty thousand dollars is a lifetime maximum, not an annual one. The two hundred fifty dollar deductible resets every year, but the ceiling never resets at all. Use it once at sixty-seven for a bad fall in Italy and it is substantially gone for the rest of your life. And it only pays for care that begins in the first sixty days of a trip, which quietly fails anyone doing a long stay abroad or an extended cruise.

It was also never designed to get you home. Emergency medical treatment overseas is one bill. Getting you stabilized, transported, and repatriated to a hospital in the United States is a different and usually much larger one, and it is not what this benefit is built to do.

So we treat the foreign travel benefit as a small backstop rather than a plan. Before a real trip abroad, we point clients toward a standalone travel medical policy written for the actual exposure, with meaningful limits and evacuation and repatriation coverage included. It is inexpensive relative to the trip and to what it protects against.

One more thing worth knowing before you book. Original Medicare generally pays for medically necessary care aboard a cruise ship only when the ship is in United States territorial waters, which means within six hours of a United States port. Once you are farther out than that, Medicare does not pay, and neither does your supplement outside of the foreign travel benefit and its limits. If you sail out of Jacksonville, New Orleans, or Tampa, that is worth a phone call before you go.

Concierge doctors, and doctors who have left Medicare

There are three situations here and they are not the same.

If your doctor participates in Medicare and charges a separate membership fee for extras like same-day access or a longer annual visit, Medicare and your supplement still pay their normal share of the covered medical care. The membership fee itself is not covered by Medicare, and standardized Medicare Supplement plans do not pay it either.

If your doctor does not participate but still accepts Medicare, they can bill you above the Medicare-approved amount. That is an excess charge and it has its own section below.

If your doctor has formally opted out of Medicare, you are in a different world. Opted-out physicians see Medicare patients under a private written contract. Medicare pays nothing. You are not permitted to submit the claim yourself. And because your supplement only pays a share of what Medicare approves, your supplement pays nothing either. You owe the entire bill, with no limiting charge protecting you.

That is the most expensive surprise in this whole subject and it is completely avoidable. Medicare publishes a list of physicians who have opted out, updated monthly, and those elections renew automatically every two years. Ask the question before your first appointment, not after the bill arrives.

Acupuncture

Medicare covers acupuncture for exactly one condition: chronic low back pain. The pain has to have lasted twelve weeks or longer, have no identifiable systemic cause, and not be tied to surgery or pregnancy. You get up to twelve visits in ninety days, eight more if you are improving, and no more than twenty in a year. Treatment stops if you are not getting better.

Acupuncture for migraine, neuropathy, arthritis, fibromyalgia, nausea, or anything else is not covered by Original Medicare, and your supplement pays nothing toward it. Some Medicare Advantage plans offer acupuncture as a supplemental benefit, which varies by plan and by county.

There is a second catch that surprises people here: Medicare does not recognize licensed acupuncturists as billing providers. Covered treatment has to be furnished by a physician, physician assistant, nurse practitioner, or clinical nurse specialist, or by someone working under that provider’s direct supervision and billed under their number. Many acupuncturists practice independently, which means even covered low back treatment often cannot be billed to Medicare at all.

Chiropractic

Part B covers one chiropractic service: manual manipulation of the spine to correct a subluxation. That is the whole benefit.

Not covered when a chiropractor performs or orders it: X-rays, the office visit or exam itself, massage, acupuncture, ultrasound, electrical stimulation, traction, therapeutic exercise, nutritional supplements, and orthotics. Manipulation of anything outside the spine is also not covered.

Maintenance care is not covered either. Once treatment is holding you steady rather than actively correcting something, Medicare stops paying for it. Your chiropractor should hand you an Advance Beneficiary Notice before performing anything in that category so you know in advance that the bill is yours.

Your supplement pays its share of the twenty percent on the covered adjustment. On everything else in that list it pays nothing.

Functional and integrative medicine

Medicare covers a functional medicine visit only when a Medicare-enrolled physician bills a medically necessary service tied to a covered diagnosis. The approach itself is not a benefit category.

The testing is where the bills land. Comprehensive stool analysis, food sensitivity panels, organic acids testing, heavy metal provocation, saliva and dried urine hormone panels, micronutrient testing, and expanded thyroid panels are generally treated as investigational or not medically necessary and are denied. Nutritional supplements, IV vitamin therapy, and chelation outside of diagnosed heavy metal poisoning are not covered.

When the claim is denied, your supplement pays nothing, because Medicare’s approved amount was zero and a share of zero is zero.

Compounded prescriptions and bioidentical hormones

A supplement does not include prescription drug coverage, so a compounded prescription filled at a pharmacy runs through Part D, and Part D has a rule that catches a lot of people.

For Part D to pay, every ingredient in a compounded prescription has to itself qualify as a Part D drug. Bulk chemical powder, which is what most compounding pharmacies start from, does not qualify. That means compounded bioidentical hormone pellets are generally not covered, and neither are most custom compounds built from bulk ingredients.

Where you get a medication changes who pays for it

This is one of the most useful things to understand about Medicare and almost nobody explains it.

Medications you pick up at a pharmacy are generally Part D. Medications a doctor gives you in the office, in an infusion suite, or in a hospital outpatient setting are generally Part B. If you are formally admitted as an inpatient, your medications are usually bundled into what Part A pays for the stay. Same person, same year, three different sets of rules.

Part B drugs include infusions and injections you cannot administer yourself, chemotherapy given in the office, the eye injections used for macular degeneration, drugs delivered through durable medical equipment such as a nebulizer or an insulin pump, certain oral cancer and anti-nausea drugs, immunosuppressants after a Medicare-covered transplant, and injectable osteoporosis drugs for homebound patients who meet the requirements.

Here is why it matters. Part B drugs carry the same twenty percent coinsurance as everything else under Part B, with no annual cap. A biologic infusion or a course of chemotherapy can run into the thousands per treatment, and twenty percent of that is yours every single time.

A Medicare Supplement pays your share of it. How much depends on the plan: Plan G covers the full twenty percent, Plans K and L cover a portion, and Plan N covers it in full apart from its copays. So while a supplement includes no pharmacy drug coverage at all, it does cover your share of drugs administered in a clinical setting, and for someone with a serious diagnosis that can be among the largest things the policy ever pays.

Your Part D plan handles the pharmacy side and works differently. It carries a maximum deductible of six hundred fifteen dollars and an annual out-of-pocket cap of two thousand one hundred dollars. Once you reach that cap, your covered medications cost you nothing for the rest of the year.

Excess charges, and why they matter more in Florida

A doctor who accepts Medicare but has not signed a participation agreement can bill you up to fifteen percent above the Medicare-approved amount for that service. That is an excess charge and you owe it.

Eight states prohibit this outright. Florida is not one of them. That makes excess charge coverage worth more here than it would be in Connecticut or New York, and it is one of the real practical differences between Plan G, which covers excess charges, and Plan N, which does not.

Snowbirds, sunbirds, and the six-month rule

Two different people, same problem.

Snowbirds come down to 30A for the winter and head home in the spring. Sunbirds are our actual neighbors, people who live in Santa Rosa Beach or Watersound or Inlet Beach year-round on paper and leave for the northern states or the mountains from June through September.

Most Medicare Supplement plans do not care where you are. There is no network and no service area. Any provider in the country that accepts Medicare works with your plan and you do not need a referral to see a specialist. The one exception is a variant called Medicare SELECT, which does require you to use network hospitals for non-emergency care, so if you have one of those, check how it handles care away from home.

Medicare Advantage is built differently. Networks and service areas apply, and out-of-area coverage is generally limited to emergency and urgent care. There is also a rule most people never hear until it affects them. An Advantage plan is required to disenroll a member who has been outside the plan’s service area for more than six months, unless the plan carries a specific visitor or traveler benefit that extends that window. A sunbird gone June through September is fine. One who leaves in May and drifts back at Christmas is not.

The geography here reinforces the point. Walton County has two hospitals, Ascension Sacred Heart Emerald Coast in Miramar Beach and North Walton Doctors Hospital in DeFuniak Springs, with more options west into Okaloosa County and east into Bay County. Even so, a lot of specialized and complex care still happens somewhere else entirely: Pensacola, Birmingham, Jacksonville, Nashville, Atlanta, Houston. We work with clients from Grayton Beach and Seaside to Destin, Freeport, and Panama City Beach, and the farther you are from a major medical center the more a plan with no network is worth. It has no opinion about where you go.

How Florida law affects your premium

Florida does not permit a Medicare Supplement premium to be increased because of your attained age. It is one of a small number of states that regulates supplement rating this way, so a supplement sold in Florida cannot raise your rate simply because you have gotten a year older.

Premiums can still change. Carriers can adjust rates for an entire class of policyholders based on medical cost trend, and when that happens it applies to everyone in the class at the same time. What Florida law prevents is an increase triggered by your birthday alone.

What a supplement does not do

No pharmacy prescription drug coverage. You pair a supplement with a standalone Part D plan.

No routine dental, vision, or hearing.

No meaningful international coverage, for the reasons above.

Medicare Advantage bundles the dental, vision, and hearing extras and is required to cap what you spend in network each year, though the amount of that cap varies by plan. It is a genuinely different structure with different tradeoffs, and for some people it is the better answer. What it comes down to is which doctors you want to keep, how many months a year you are actually here, and whether you would rather pay a steadier premium or a lower one with more cost when you use care.

Your six-month window, and why Florida makes it count

Your Medicare Supplement Open Enrollment Period is the six months beginning the first month you are both sixty-five or older and enrolled in Part B. Inside that window you can buy any supplement the carriers we represent offer in your area, and your health cannot be used to turn you down or raise your price.

Some states give people a second chance every year. Florida does not. There is no birthday rule here and no annual window to switch supplements without answering health questions. Once your six months close, applying later means medical underwriting and acceptance is not guaranteed.

A handful of federal guaranteed issue situations reopen the door: losing employer retiree coverage, trying Medicare Advantage for the first time and leaving within twelve months, your plan pulling out of the area, or a carrier becoming insolvent. Those generally run on a sixty-three day clock.

If you are under sixty-five and on Medicare through disability, Florida law requires carriers that sell Medicare Supplement policies in this state to make coverage available to you, with a six-month window of your own.

That is the entire reason this decision deserves an hour with somebody licensed instead of fifteen minutes on a comparison site.

Talk to someone licensed and local

Garrett Fuller, Chris Jayne, and Trista Cordell are licensed for Medicare Supplement and Part D and work out of the office on Highway 98 in Santa Rosa Beach. Call 850-622-5283.

All dollar figures shown are 2026 Medicare amounts and change annually. Coverage varies by policy and carrier, and your own policy controls. All terms are subject to underwriting.

Written by Garrett Fuller, Principal Agent, Fuller Insurance. Florida insurance license A091162, National Producer Number 600180.