Medigap, also called Medicare Supplement Insurance, is a private health insurance policy that helps pay your share of costs in Original Medicare, such as deductibles, coinsurance and copayments. It only works with Original Medicare (Parts A and B), not with a Medicare Advantage plan. New York has stronger rules than most states: you can apply at any time of year, and premiums depend on where you live, not on your age or health.
What is Medigap, and what does it pay?
Original Medicare pays a large share of hospital and doctor bills, but not all of it. Medicare.gov describes Medigap as extra insurance from a private company to help with copayments, coinsurance and deductibles. A Medigap policy covers one person only, so spouses each need their own.
When you get care, Medicare pays its share first. Then, in most policies, the Medigap company pays what your policy says you owe, and you are responsible for anything left. Here are the main gaps, using the 2026 amounts listed on Medicare.gov.
| Original Medicare cost in 2026 | What you owe without extra coverage |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Hospital days 61 to 90 | $434 per day |
| Hospital days 91 to 150 (lifetime reserve days) | $868 per day |
| Skilled nursing facility, days 21 to 100 | $217 per day |
| Part B yearly deductible | $283 |
| Part B coinsurance for most doctor services | Usually 20% of the Medicare-approved amount, with no yearly limit |
Medigap does not pay your monthly Part B premium ($202.90 in 2026, or more depending on income). For how Medicare differs from Medicaid in general, see our guide to Medicare versus Medicaid in New York.
Which Medigap plans can you buy in New York?
Medigap policies are standardized. According to Medicare.gov, policies with the same letter offer the same basic benefits no matter where you live or which company sells them, and price is the only difference. Most states have 10 lettered plans: A, B, C, D, F, G, K, L, M and N. Massachusetts, Minnesota and Wisconsin standardize differently.
Two New York details matter. Plans C and F (and high-deductible F) can be bought only by people who first became eligible for Medicare before 1 January 2020, according to the New York State Department of Financial Services (DFS). DFS also says no insurer currently offers Medicare Select, a type that limits you to certain hospitals, in New York.
| Plan | What it adds beyond the basic benefits |
|---|---|
| A | Basic benefits only: hospital coinsurance, 365 extra hospital days, Part B coinsurance, first 3 pints of blood, hospice coinsurance |
| B | Basic benefits plus the Part A deductible |
| C | Part A deductible, skilled nursing coinsurance, Part B deductible, foreign travel emergency care (not for people newly eligible since 2020) |
| D | Part A deductible, skilled nursing coinsurance, foreign travel emergency care |
| F | Everything in C plus Part B excess charges (not for people newly eligible since 2020); a high-deductible version exists |
| G | Like F except it does not pay the Part B deductible; a high-deductible version exists |
| K and L | Pay 50% (K) or 75% (L) of several costs, then 100% after a yearly out-of-pocket limit ($8,000 for K and $4,000 for L in 2026) |
| M | 50% of the Part A deductible, skilled nursing coinsurance, foreign travel emergency care |
| N | Part A deductible, skilled nursing coinsurance, foreign travel; up to $20 copay for some office visits and up to $50 for some emergency room visits |
Sources: the Medicare.gov plan comparison and the benefit chart in the 2026 HIICAP training notebook from the NYS Office for the Aging. Not every letter is sold by every insurer. DFS’s October 2026 premium tables, for example, show pages for A, B, C, D, F, G, K, L, M and N plus high-deductible F and G. This page does not recommend a plan.
What does Medigap not cover?
Medicare.gov says Medigap plans generally do not cover long-term care (like nursing home care), vision or dental care, hearing aids, glasses or private-duty nursing. Policies sold after 2005 also do not include prescription drug coverage, so people who want it join a separate Medicare drug plan (Part D).
For families planning care at home, this is the key limit. Medigap follows Medicare: it helps with Medicare-covered services, and it does not turn custodial care (help with bathing, dressing, supervision) into a covered benefit. Medicare’s own home health benefit costs $0 for covered services, but only for the skilled, part-time care described in our guide to what Medicare covers at home. Medicare covers 80% of durable medical equipment, and Medigap policies that cover Part B coinsurance can help with the other 20%.
Where Medigap does matter after a hospital stay is the skilled nursing facility coinsurance. Plans C, D, F, G, M and N pay it, and Plans K and L pay part of it, as the table above shows. Our guide to Medicare skilled nursing facility days explains the 100-day rules. For long-term costs, see long-term care insurance in New York and what home care costs.
Can you have Medigap and Medicare Advantage?
No. Medicare.gov states that when you are getting started with Medicare you can either buy Medigap or enroll in a Medicare Advantage plan (Part C), but you cannot have both. You cannot buy Medigap while in a Medicare Advantage plan unless you are switching back to Original Medicare, and Medigap cannot be used to pay Advantage copayments, deductibles or premiums.
| Original Medicare + Medigap | Medicare Advantage (Part C) | |
|---|---|---|
| What it is | Original Medicare, plus a private policy that fills cost-sharing gaps | A private plan that replaces Original Medicare |
| Who regulates it in New York | DFS regulates Medigap policies | The federal CMS, according to DFS |
| Monthly costs | Part B premium plus the Medigap premium | Part B premium plus the plan’s own premium, if any |
| Yearly out-of-pocket limit | None in Original Medicare itself; Plans K and L have their own limit | Varies by plan; once reached, the plan pays 100% of covered services for the rest of the year |
| Prescription drugs | Not included in Medigap; a separate Part D plan is needed | Check each plan’s details |
| Can you have both? | No | |
Switching can be hard to undo. Medicare.gov explains that if you drop Medigap to join Medicare Advantage for the first time, you have a single 12-month trial right to get a Medigap policy back, and only if the same company still sells it. Most Medigap policies do not cancel automatically when you join a Medicare Advantage plan, so contact your insurance company to cancel.
When can you buy Medigap in New York?
Federal law gives everyone a one-time, 6-month Medigap Open Enrollment Period that starts the first month you have Part B and are 65 or older. During it, a company cannot refuse to sell you any policy it offers or charge more because of health problems. Medicare.gov says that after this period you may not be able to buy a policy, or it may cost more.
New York adds protections. The NYS Office for the Aging’s HIICAP notebook says a person enrolled in Parts A and B may buy a Medigap policy at any time, and insurers may not consider health status, claims experience or age.
There is one catch to know about. Insurers may impose a waiting period of up to six months before paying for a pre-existing condition, meaning one for which you were advised or treated in the six months before coverage starts. The state requires insurers to reduce that wait by the time you had other creditable coverage, provided there was no gap of more than 63 days. Credit for time on Medicare alone is accepted only if you apply within the six-month window that begins when you are 65 or older and enrolled in Part B.
How much does Medigap cost in New York City?
New York Medigap premiums are community rated. The HIICAP notebook explains that this means premiums vary by where you live but are unaffected by age or health, so the premium is the same for everyone in a given area for a specific policy. It also says prices differ from company to company and area to area.
DFS publishes the actual numbers. The table below is taken from the DFS community-rated comparison, premiums in effect as of 1 October 2026, column “NYC Proper” (ZIP codes starting 100 to 104 and 111 to 114, which covers Brooklyn and most of Queens). We show only the lowest and highest monthly figures and no company names.
| Plan | Lowest monthly premium listed | Highest monthly premium listed |
|---|---|---|
| Plan A | $223.00 | $413.53 |
| Plan G | $372.50 | $840.28 |
| Plan N | $299.00 | $523.54 |
The same letter can cost almost twice as much from one company as from another, which is the point of comparing. DFS notes that a premium shown in a region may be offered only in part of it, and points to its premium comparison tables and a rate look-up tool by ZIP code. Far Rockaway and some other Queens ZIP codes start with 116 and fall under DFS’s Long Island column instead.
How do you compare and buy a Medigap policy?
Medicare.gov’s buying steps and the HIICAP notebook suggest this order:
- Decide which benefits matter to you. Compare the lettered plans and think about the care you expect to need. Remember you might not be able to switch later.
- Compare the same letter across companies. Benefits are identical, so price, service and financial strength are what differ. The HIICAP notebook suggests comparing at least three companies.
- Check the company and agent. They should be registered and licensed with DFS. DFS’s consumer line is 1-800-342-3736.
- Get an official quote and read the outline of coverage. Answer application questions carefully, because wrong information can lead to denied claims.
- Use the free look. New York gives you 30 days from receiving the policy to return it for a full refund. Pay by check or money order to the insurer, not to the agent.
Standardized policies are guaranteed renewable: the company can only end yours if you stop paying, gave untrue information, or goes out of business.
Do you need Medigap if you have Medicaid or retiree coverage?
Not necessarily. The HIICAP notebook says not everyone on Medicare needs Medigap. People who qualify for Medicaid or the Qualified Medicare Beneficiary (QMB) program generally do not, because those programs fill many of Medicare’s gaps, unless their doctors do not accept Medicaid. Federal law also generally prohibits selling Medigap to people with Medicaid, with exceptions such as when Medicaid pays the premium. Someone who gets Medicaid after buying a policy may be able to suspend it, and if Medicaid ends within two years, reactivate it without a new waiting period.
The notebook adds that Medigap would in most cases duplicate retiree coverage from a former employer. Our guides on Medicaid home care coverage and the Medicare home health benefit explain what each program pays for at home.
Where can you get free help choosing in New York?
New York’s counseling program is HIICAP (Health Insurance Information, Counseling and Assistance Program), the state’s State Health Insurance Assistance Program. Counseling is free and one-on-one. The statewide HIICAP hotline is 1-800-701-0501.
The HIICAP notebook also lists 1-800-MEDICARE (1-800-633-4227) for Medicare coverage questions and the Department of Financial Services at 1-800-342-3736 for insurance questions and complaints. DFS also publishes the list of insurers offering Medigap in New York.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We are not an insurance agency and cannot advise on Medigap, but if a family is working out what care at home will cost beyond what Medicare pays, we can talk it through. Call (718) 232-2777 or use our contact page.
Medicare and insurance rules and premiums change. Everything above was checked on 14 October 2026 against medicare.gov, dfs.ny.gov, aging.ny.gov (HIICAP Notebook 2026, Module 7) and shiphelp.org. Confirm your own situation with a HIICAP counselor, DFS, 1-800-MEDICARE or a licensed insurance agent. This page is general information, not insurance, legal or medical advice.
Frequently asked questions
What is Medigap in simple terms?
It is extra insurance you buy from a private company to pay part of what Original Medicare does not, such as deductibles, coinsurance and copayments. You pay a monthly premium to the insurer in addition to your Part B premium.
Can I buy Medigap at any time in New York?
Yes. According to the NYS Office for the Aging’s HIICAP notebook, New York lets a person with Medicare Parts A and B buy a Medigap policy at any time, and insurers may not consider health status or age. A waiting period of up to six months for pre-existing conditions can apply.
Can I have Medigap and a Medicare Advantage plan?
No. Medicare.gov says you can have one or the other, not both, and Medigap cannot pay Medicare Advantage copayments, deductibles or premiums.
Does Medigap cover prescription drugs?
No. Medigap plans sold after 2005 do not include drug coverage. People who want it can join a separate Medicare drug plan (Part D).
Does Medigap pay for home care or a nursing home?
Not for long-term custodial care. Medicare.gov lists long-term care, such as care in a nursing home, among the things Medigap generally does not cover. Medigap can help with Medicare-covered costs such as skilled nursing facility coinsurance in most lettered plans.
Why do Medigap prices differ if every Plan G is the same?
Each insurer sets its own premium, and the benefits of a lettered plan are identical across companies. In New York the price also varies by region but not by age or health, which is why DFS publishes comparison tables by area.
Do I need Medigap if I have Medicaid?
Often not. The HIICAP notebook says people who qualify for Medicaid or QMB generally do not need a Medigap policy, and federal law restricts selling Medigap to people with Medicaid. Ask HIICAP at 1-800-701-0501 or your Medicaid agency about your case.
