1. Higher Monthly Premiums
One of the biggest downsides of Medigap plans is their cost. Unlike Medicare Advantage, which often has low or even $0 monthly premiums, Medigap plans have a monthly premium that varies by state, age, and health history.
- Plan G: $150–$250 per month
- Plan N: $120–$180 per month
- Plan F (if eligible): $200–$300 per month
These premiums can be a significant financial burden for those on a fixed income, especially when combined with other healthcare expenses like Medicare Part B premiums and a separate Part D plan.
2. No Prescription Drug Coverage
Medigap plans do not cover prescription drugs, meaning beneficiaries must purchase a separate Medicare Part D plan for medications.
- Average Medicare Part D Cost: $30–$50 per month
- Risk: If you don’t enroll in Part D when first eligible, you may face a late enrollment penalty.
3. No Extra Benefits (Dental, Vision, or Hearing)
Unlike Medicare Advantage, which often includes dental, vision, hearing, and wellness benefits coverage, Medigap only covers Medicare-approved expenses.
If you need routine dental cleanings, eyeglasses, or hearing aids, purchase standalone insurance plans or pay out-of-pocket.
4. Restrictions on When You Can Enroll Without Underwriting
Medigap plans have strict enrollment periods.
- During your 6-month Medigap Open Enrollment Period, you get guaranteed issue rights (no health screening or higher rates).
- If you miss this window, insurers can deny coverage or charge higher premiums based on your health.
What Are the Disadvantages of Plan N?
Many people choose Medigap Plan N as a lower-cost alternative to Plan G. However, Plan N has some disadvantages that may lead to higher out-of-pocket expenses.
- Copays for Doctor Visits: Up to $20 per visit
- Emergency Room Copay: Up to $50 (waived if admitted)
- Does NOT Cover Medicare Part B Excess Charges (some doctors charge up to 15% more than Medicare’s approved rate)
How does Plan N compare to other Medigap plans? The chart below breaks it down:
Should You Choose Medicare Advantage Instead?
Since Medigap has disadvantages like higher premiums and no extra benefits, some people prefer Medicare Advantage. Here’s how they compare:
| Feature | Medicare Advantage | Medigap (Medicare Supplement) |
|---|---|---|
| Monthly Premium | Low or $0 (varies by plan) | Higher ($100–$300/month) |
| Doctor & Hospital Choice | Limited to HMO/PPO network | Any doctor that accepts Medicare |
| Out-of-Pocket Costs | Copays, deductibles, & max out-of-pocket limits | Minimal costs after premium (covers most gaps) |
| Prescription Drug Coverage | Usually included | Requires a separate Part D plan |
| Dental, Vision, & Hearing | Often included | Not covered |
Frequently Asked Questions (FAQs)
What is the downside to Medigap?
The biggest downsides are high monthly premiums, no prescription drug coverage, and lack of extra benefits like dental and vision.
What are the disadvantages of Plan N?
Plan N has copays for doctor and ER visits and does not cover Medicare Part B excess charges. If your doctor charges more than Medicare’s approved rate, you may owe up to 15% more in out-of-pocket costs.
Can I switch from Medicare Advantage to Medigap?
Yes, but if you switch outside your Medigap Open Enrollment Period, you may face medical underwriting and be denied coverage.
Is Medigap still worth it?
Medigap may be worth it if you want predictable costs and freedom to see any doctor. However, if you wish to lower premiums and extra benefits, Medicare Advantage could be a better fit.