What is the downside to Medigap?


Editorial team Published on

The primary disadvantages of Medigap plans are high monthly premiums, a lack of prescription drug and extra wellness benefits, and strict rules that make it difficult to switch plans later.

Key Disadvantages of Medigap Plans

  • High Monthly Premiums: Medigap policies generally cost more each month than Medicare Advantage plans, and these rates tend to increase as you age or as healthcare costs rise.
  • No Prescription Drug Coverage: Medigap plans do not cover outpatient prescription drugs. You must buy a separate Medicare Part D plan, meaning an extra monthly premium and another card to manage.
  • No Extra Benefits: These policies do not cover routine extras like dental cleanings, vision exams, hearing aids, or gym memberships.
  • Underwriting Restrictions on Switching: While you have a guaranteed right to buy any Medigap plan during your initial 6-month open enrollment window, trying to change plans later often requires medical underwriting. Insurance companies can look at your health history, charge you more, or deny coverage entirely if you have pre-existing conditions.
  • Does Not Cover All Costs: Standard Medigap plans do not pay for the annual Medicare Part B deductible, and newer plans do not cover Part B excess charges (extra amounts some doctors charge above the Medicare-approved limit).