|Medigap Coverage Gaps
Coverage Gaps

What Medigap Does NOT Cover

Medigap (Medicare Supplement) plans are designed to fill the cost-sharing gaps in Original Medicare — deductibles, coinsurance, and copays. But they do not expand what Medicare covers. If Medicare doesn't cover a service, Medigap won't either.

This page covers 55 specific items and services across 12 categories that are excluded from both Medicare and Medigap coverage, along with typical costs and alternatives.

The Core Rule

Medigap pays your share of Medicare-covered services — it does not add new covered services. If Original Medicare (Part A or Part B) doesn't cover something, no Medigap plan will cover it either. The only exception is foreign travel emergency coverage, which some Medigap plans add as an extra benefit.

Quick Reference: Major Coverage Gaps at a Glance

CategoryMedicare Covers?Medigap Covers?Alternative
Long-term / custodial careNoNoLong-term care insurance, Medicaid
Dental (routine)NoNoDental insurance, discount plans
Vision (routine exams & glasses)NoNoVision insurance, discount retailers
Hearing aidsNoNoOTC hearing aids, Medicare Advantage
Outpatient prescription drugsNoNoMedicare Part D
Cosmetic surgery (elective)NoNoSelf-pay, medical financing
Massage therapyNoNoPhysical therapy (if covered)
Foreign travel emergency careNoPlans C/D/F/G/M/N: Yes (80%, $50K limit)Travel insurance
Private room in hospitalOnly if medically necessaryOnly if Medicare covers itPay out-of-pocket or document necessity
Routine foot careOnly with diabetes/neuropathyOnly if Medicare covers itPodiatry discount programs
Incontinence padsNoNoMedicaid, Medicare Advantage OTC benefit
Concierge medicine feesNoNoSelf-pay

The Biggest Financial Risk: Long-Term Care

The average nursing home costs $90,000–$110,000 per year for a semi-private room. Medicare covers skilled nursing care for up to 100 days per benefit period — but only when skilled care is needed. Once you only need help with daily activities (bathing, dressing, eating), Medicare stops paying. Medigap does not fill this gap. This is the most common reason Medicare patients exhaust their savings.

Detailed Coverage Gaps by Category

Click any category to expand. Each item shows typical out-of-pocket costs and what you can do instead.

What Medigap DOES Cover (Reminder)

Medigap plans (especially Plan G and Plan N) are excellent at covering the cost-sharing gaps within Original Medicare:

Part A hospital deductible ($1,736 in 2026)
Part A daily coinsurance (Days 61–90: $434/day)
Part B 20% coinsurance for covered services
Skilled nursing facility coinsurance (Days 21–100)
Part A hospice care coinsurance
Foreign travel emergency (80%, up to $50,000 lifetime)

Note: Plan G does not cover the Part B deductible ($257 in 2026). Plan N has copays up to $20 for office visits and $50 for ER visits.

Disclaimer: This page is for educational purposes only and reflects 2025–2026 Medicare policies. Coverage rules can change and individual circumstances vary. Always verify coverage with Medicare (1-800-MEDICARE) or a licensed insurance counselor before making financial decisions. Sources: CMS MLN906765, Medicare.gov, AARP, Medicare Interactive (2025).