The Medigap Plan Limitations That Cause Surprise Charges
Medigap plans help cover Medicare’s out-of-pocket costs—but they’re not all the same. Seniors often discover unexpected gaps involving excess charges, foreign travel limits, enrollment rules, and uncovered services.
Quick Take
Watch: The Medigap Plan Gaps That Cause Surprise Charges
1. No prescription drug coverage
Medigap plans do not include prescription drug coverage. Seniors must buy a separate Part D plan or pay full price for medications.
Why this matters
- High drug costs not covered
- Part D penalties for late enrollment
- Confusion between Medigap and Medicare Advantage benefits
2. Exposure to Part B excess charges
Some doctors can bill up to 15% above Medicare’s approved amount. Only Medigap Plans F and G cover these excess charges.
Common issues
- Unexpected bills from non-participating providers
- Higher costs in states that allow excess charges
- Confusion about which providers accept Medicare assignment
3. Limited foreign travel emergency coverage
Medigap covers only 80% of approved emergency costs abroad—and only up to a lifetime limit of $50,000.
Typical gaps
- No coverage for routine care overseas
- High upfront costs before reimbursement
- Lifetime cap reached quickly during major emergencies
4. No coverage for dental, vision, or hearing
Just like Original Medicare, Medigap does not cover routine dental, vision, or hearing services.
Examples of uncovered services
- Hearing aids
- Dental crowns and implants
- Eyeglasses and routine exams
5. Strict rules for switching Medigap plans
Outside the initial enrollment window, insurers can require medical underwriting. Seniors may be denied or charged more based on health conditions.
Common surprises
- Switching plans not guaranteed
- Higher premiums for pre-existing conditions
- Limited “trial rights” for Medicare Advantage switchers
6. No out-of-pocket maximum
Medigap helps pay Medicare costs, but Medicare itself has no out-of-pocket maximum. Seniors may still face large expenses for uncovered services.
Examples
- Long-term care
- Custodial care
- Non-medically necessary services
7. Limited coverage for skilled nursing facility (SNF) costs
Medigap covers Medicare’s SNF coinsurance—but only after Medicare approves the stay. If Medicare denies coverage, Medigap won’t pay.
Common issues
- Observation stays don’t qualify
- Coverage ends after 100 days
- High daily copays after day 20
8. No coverage for Medicare Advantage costs
Medigap cannot be used with Medicare Advantage. Seniors switching between the two often misunderstand this rule.
Why this matters
- Medigap won’t pay MA copays or deductibles
- MA networks and rules still apply
- Switching back to Medigap may require underwriting
Quick comparison: Medigap plan limitations
| Limitation | What It Means | How It Causes Surprise Charges |
|---|---|---|
| No drug coverage | Requires separate Part D plan | High medication costs |
| Excess charges | Only Plans F/G cover them | Unexpected provider bills |
| Foreign travel limits | 80% coverage with lifetime cap | Large overseas medical bills |
| No dental/vision/hearing | Not included in Medigap | High out-of-pocket costs |
| Switching restrictions | Underwriting required | Higher premiums or denial |
| No OOP maximum | Medicare has no spending cap | Large uncovered expenses |
| SNF limitations | Only covers Medicare-approved stays | Denied coverage surprises |
| Not usable with MA | Medigap doesn’t cover MA costs | Confusion and unexpected bills |
FAQ: Medigap plan limitations
Does Medigap cover prescription drugs?
No. You need a separate Part D plan.
Does Medigap cover excess charges?
Only Plans F and G cover them.
Can I switch Medigap plans anytime?
Not without underwriting, unless you qualify for special rights.
Does Medigap work with Medicare Advantage?
No. They cannot be used together.
Final thoughts
Medigap fills important Medicare gaps—but it’s not complete. Drug coverage, excess charges, foreign travel limits, and strict switching rules often lead to surprise bills. Understanding these limitations helps seniors choose the right plan and avoid unexpected costs.
Boss Block: Official Medigap & Medicare Resources
Trusted government and nonprofit organizations offering general information on Medigap, Medicare coverage, and consumer protections.
Medigap Plan Information
State Health Insurance Assistance Program (SHIP)
Free Medigap Counseling
National Council on Aging (NCOA)
Medicare & Senior Benefits
Consumer Financial Protection Bureau (CFPB)
Managing Medical Costs
Medicare Basics
MyCreditUnion.gov
Financial Planning Tools
National Institute on Aging (NIA)
Senior Health Resources
State Insurance Departments
State‑Specific Medigap Contacts
