Medigap Plans G/F: Pay $217/Day SNF Coinsurance

Understanding Medigap’s Role in SNF Coverage

When Medicare covers your skilled nursing facility stay, you face significant out-of-pocket costs: the $1,736 Part A deductible (if not already paid) and $217 per day coinsurance for days 21-100. Over an 80-day coinsurance period, you would owe $17,360 without supplemental coverage. Medigap insurance is specifically designed to fill these gaps.

Medigap (Medicare Supplement insurance) is private insurance that works alongside Original Medicare (Parts A and B) to cover cost-sharing—deductibles, coinsurance, and copayments that Medicare doesn’t pay. For skilled nursing facility care, Medigap Plans G and F provide the most comprehensive coverage by paying 100% of the daily coinsurance from days 21-100.

What Medigap Does and Doesn’t Cover for SNF

It’s crucial to understand Medigap’s limitations:

• Covers: The $217/day coinsurance Medicare charges for days 21-100
• Covers: The $1,736 Part A deductible (Plans G covers after you meet it; Plan F covers it entirely)
• Extends: Part A hospital coverage by 365 additional lifetime reserve days
• Does NOT cover: SNF care beyond Medicare’s 100-day limit
• Does NOT cover: Custodial care that doesn’t meet Medicare’s skilled care requirements
• Does NOT cover: SNF stays that Medicare denies as not medically necessary

In other words, Medigap pays your share of Medicare-approved SNF costs, but it cannot extend coverage beyond Medicare’s 100-day benefit period or pay for care Medicare doesn’t cover at all. Once Medicare coverage exhausts, you need other solutions like Medicaid, long-term care insurance, or alternative care arrangements.

Plan G vs. Plan F: The Two Comprehensive Options

Of the 10 standardized Medigap plans, only Plans G and F provide complete SNF coinsurance coverage. Understanding the differences helps you choose wisely.

Plan F: The Most Comprehensive (But Limited Availability)

Plan F is the only Medigap plan that covers 100% of all Medicare cost-sharing, including:

• Part A deductible ($1,736 in 2026)
• Part B deductible ($262 in 2026)
• Part A coinsurance (including SNF daily coinsurance $217)
• Part B coinsurance (typically 20% of approved amounts)
• Part B excess charges (when doctors charge above Medicare rates)
• First three pints of blood
• Foreign travel emergency coverage (80% up to plan limits)

Plan F means you have virtually zero out-of-pocket costs when using Medicare-covered services. However, Plan F is only available if you qualified for Medicare before January 1, 2020. If you became eligible for Medicare in 2020 or later, you cannot purchase Plan F.

Plan G: The New Gold Standard

Plan G covers everything Plan F covers except the Part B deductible ($262 in 2026). For SNF coverage, Plan G is identical to Plan F:

• Part A deductible ($1,736)
• Part A coinsurance (including $217/day SNF coinsurance for days 21-100)
• Part B coinsurance (20%)
• Part B excess charges
• First three pints of blood
• Foreign travel emergency

Since Plan G premiums are typically $15-40/month lower than Plan F, and you only forego $262 annual coverage, Plan G offers better value for most beneficiaries. Once you pay the $262 Part B deductible early in the year, your Plan G coverage functions identically to Plan F.

Note: Plan N also covers SNF coinsurance fully, making it a budget-friendly option if you’re willing to accept small copays for doctor visits.

Real Cost Examples: Medigap Value for SNF Stays

Understanding the financial protection Medigap provides makes the premium investment clear.

Example 1: 80-Day SNF Stay (30 Days in Coinsurance Period)

You’re hospitalized for hip replacement, then transferred to SNF for rehabilitation:

• Days 1-20: $0 (Medicare pays 100% after Part A deductible)
• Days 21-50: 30 days × $217 = $6,510 coinsurance

Without Medigap: You pay $6,510 out of pocket

With Plan G or F: You pay $0; Medigap pays the full $6,510

If your Plan G premium is $175/month ($2,100 annually), this single 50-day stay saves you $4,410 more than the annual premium cost. Even a moderate SNF stay can justify years of premiums.

Example 2: Full 100-Day Medicare SNF Stay

You suffer a severe stroke requiring extensive rehabilitation:

• Days 1-20: $0 coinsurance
• Days 21-100: 80 days × $217 = $17,360 coinsurance

Without Medigap: You pay $17,360 out of pocket

With Plan G or F: You pay $0; Medigap pays the full $17,360

At $175/month premium ($2,100/year), a single full SNF stay saves you $15,260 more than one year’s premiums—or covers 8.3 years of premiums. This protection is particularly valuable for those at higher risk of needing rehabilitation: older seniors, those with chronic conditions, or anyone facing major surgery.

Example 3: Multiple Benefit Periods

Remember that Medicare’s 100-day limit applies per benefit period, not per calendar year. A benefit period ends after you’ve been out of hospital and SNF care for 60 consecutive days. If you need multiple SNF stays in one year, Medigap coverage becomes even more valuable:

• First stay: 60 days, 40 in coinsurance period = $8,680 Medigap pays
• Second stay (new benefit period): 45 days, 25 in coinsurance period = $5,425 Medigap pays
• Total Medigap value: $14,105 in one year

Critical Enrollment Periods: When You Can Buy Medigap

Unlike Medicare Advantage, which has annual Open Enrollment, Medigap has very limited enrollment opportunities with significant consequences for missing them.

Medigap Open Enrollment Period: Your Guaranteed-Issue Right

Your Medigap Open Enrollment Period is a 6-month window that begins the month you’re both 65 or older AND enrolled in Medicare Part B. During this period:

• Insurance companies cannot deny you coverage
• Cannot charge you more due to health conditions
• Cannot impose waiting periods for pre-existing conditions
• Must sell you any Medigap plan they offer

This is your best—and often only—opportunity to get comprehensive Medigap coverage at standard rates regardless of health status.

Guaranteed Issue Rights: Limited Special Enrollment

Outside Open Enrollment, you have guaranteed issue rights (can’t be denied coverage) only in specific situations:

• Medicare Advantage plan ends: If you’re in a Medicare Advantage plan that terminates or leaves your area, or if you move out of the plan’s service area
• Trial rights: If you joined Medicare Advantage when first eligible and leave within 12 months, you can buy certain Medigap plans
• Employer coverage ends: In some states, if you lose employer group coverage
• PACE or demonstration project ends: If you lose coverage from these programs

These rights typically limit you to Medigap Plans A, B, C, D, F, G, K, or L, depending on your situation.

Underwriting: What Happens If You Apply Outside These Periods

If you apply for Medigap outside Open Enrollment and don’t have guaranteed issue rights, you face medical underwriting:

• Health questionnaire: Detailed questions about medical conditions, prescriptions, treatments
• Potential denial: Companies can refuse to sell you a policy
• Higher premiums: If approved, you may pay substantially more due to health conditions
• Pre-existing condition exclusion: Coverage may exclude conditions present in the 6 months before enrollment for up to 6 months

Common conditions that often lead to denial or higher rates: cancer (within 5-10 years), heart disease, COPD, diabetes with complications, kidney disease, stroke, Parkinson’s disease, Alzheimer’s or dementia, cirrhosis, and many others.

Medigap Premiums: What to Expect in 2026

Medigap premiums vary significantly based on location, age, insurance company, and pricing method, but typical ranges provide planning guidance.

Average Premium Ranges by Plan (2026)

• Plan G: $140-225/month (varies by state and age)
• Plan F: $180-270/month (higher due to older, sicker population)
• Plan N: $100-180/month (lower-cost alternative with copays)
• High-Deductible Plan G: $40-75/month (plus $2,950 annual deductible)

Age 65 beneficiaries typically pay less; premiums increase with age in most states. Geographic variation is substantial: premiums in New York and Connecticut average 40-60% higher than in Iowa or North Dakota.

Premium Pricing Methods: Understanding Your Future Costs

Medigap companies use three pricing methods that affect how your premiums change:

1. Community-Rated (No Age Rating)

Everyone pays the same premium regardless of age. A 65-year-old and an 85-year-old pay identical rates. Premium increases occur only due to inflation and healthcare costs, not age. This method is least common but most predictable.

2. Issue-Age-Rated

Premiums are based on your age when you buy the policy and don’t increase due to age—only inflation. A policy purchased at 65 stays at “age 65 rates” even when you’re 80. This provides premium stability and long-term value.

3. Attained-Age-Rated (Most Common)

Premiums increase as you age, in addition to inflation adjustments. Most insurers use this method. While it offers lower initial premiums, costs rise substantially with age. A policy that costs $150/month at age 65 might be $250/month by age 80.

Example premiums showing how pricing methods affect long-term costs. Inflation adjustments apply to all methods.

Household Discounts

Many insurers offer 5-12% premium discounts when both spouses buy policies from the same company. This can save hundreds annually and is worth considering when shopping.

Medigap vs. Medicare Advantage: Why MA Plans Don’t Help with SNF Gaps

A crucial distinction: Medigap only works with Original Medicare. If you have a Medicare Advantage plan, Medigap cannot help you—and Medicare Advantage plans handle SNF coverage very differently.

Medicare Advantage SNF Coverage Structure

Medicare Advantage plans replace Original Medicare and typically charge copays for SNF stays rather than coinsurance:

• Days 1-20: $0 to $200 per day copay (varies by plan)
• Days 21-100: $150 to $300+ per day copay (varies by plan)
• Annual out-of-pocket maximum: After you reach this limit ($9,250 maximum in 2026), the plan pays 100%

Unlike Medigap’s clean “pays 100% of coinsurance” benefit, Medicare Advantage SNF copays vary dramatically by plan. Some plans offer favorable copays; others are expensive. Critically, you cannot add Medigap to a Medicare Advantage plan to reduce these copays.

Switching from Medicare Advantage to Medigap

If you have Medicare Advantage but realize you want Medigap’s SNF coverage protection, switching is possible but faces obstacles:

• You must disenroll from Medicare Advantage (allowed during Annual Enrollment, January-March, or when you move)
• You must have or re-enroll in Medicare Part B
• You’ll likely face medical underwriting unless you have guaranteed issue rights
• Health conditions may lead to denial or unaffordable premiums

The message: choose carefully between Medigap and Medicare Advantage initially, during your Medigap Open Enrollment Period, when you have guaranteed access.

Shopping for Medigap: How to Find the Best Value

All Plan G policies provide identical benefits—they’re standardized by federal law. Therefore, your decision comes down to price, company reputation, and pricing method.

Step 1: Compare Multiple Companies

Premiums for identical coverage can vary 40-60% between companies in the same area. Get quotes from at least 5-6 insurers:

• Use your State Health Insurance Assistance Program (SHIP) for free counseling
• Check Medicare.gov’s plan comparison tool
• Work with independent insurance brokers who represent multiple companies
• Contact insurers directly for quotes

Step 2: Verify Company Financial Ratings

You’re entering a long-term relationship with this insurer. Check:

• A.M. Best ratings: Look for A- or better
• Customer complaint ratios: Available through state insurance departments
• Market presence: Established companies with long Medigap histories preferred

Step 3: Understand the Pricing Method

Ask each company whether they use community-rated, issue-age-rated, or attained-age-rated pricing. Project your premiums forward 10-20 years to understand long-term costs.

Step 4: Review Rate History

Ask for the company’s rate increase history over the past 5-10 years. Some companies start with low premiums but increase aggressively; others maintain more stable rates.

Step 5: Consider Household Discounts

If you’re married, evaluate whether buying from the same company (with discount) beats split purchases from different low-cost providers.

Plan N: A Budget-Friendly Alternative

If Plan G premiums strain your budget, Plan N offers excellent SNF protection at 25-35% lower cost, with trade-offs you should understand.

What Plan N Covers

Plan N covers everything Plan G covers (including full SNF coinsurance) except:

• Part B deductible: You pay the $262 annual deductible (same as Plan G)
• Doctor office visit copay: Up to $20 per visit
• Emergency room copay: Up to $50 (waived if admitted)
• Part B excess charges: Not covered (when doctors charge above Medicare-approved rates)

For SNF coverage specifically, Plan N performs identically to Plans G and F—it pays 100% of the $217 daily coinsurance for days 21-100.

When Plan N Makes Sense

Plan N is a smart choice if:

• You rarely visit doctors (thus few $20 copays)
• You live in a state where few doctors charge excess fees
• You want comprehensive SNF protection at the lowest possible premium
• You’re comfortable with small copays in exchange for premium savings

Example: Plan N premium is $130/month vs. Plan G at $180/month. You save $600 annually. Even with 12 doctor visits ($240 in copays), you’re still $360 ahead. Your SNF coinsurance coverage is identical between plans.

High-Deductible Plan G: Lowest Premiums

For those seeking catastrophic protection at minimum premium cost, High-Deductible Plan G offers another option.

How High-Deductible Plan G Works

You pay the first $2,950 of Medicare cost-sharing out of pocket in 2026, then the plan pays 100% of all additional costs for the rest of the year, including:

• Part A deductibles and coinsurance (including SNF)
• Part B deductibles and coinsurance
• Part B excess charges
• Foreign travel emergency

Premiums are typically $40-75/month ($480-900 annually), making this the lowest-cost Medigap option.

SNF Protection with High-Deductible Plan G

Consider this scenario: You need a 60-day SNF stay (40 days in coinsurance period):

• Part A deductible: $1,736
• SNF coinsurance: 40 × $217 = $8,680
• Total Medicare costs: $10,416

Your costs: $2,950 deductible, then $0 (plan pays remaining $7,466)

For major medical events or extended SNF stays, High-Deductible Plan G provides excellent catastrophic protection. However, if you have only modest medical costs ($2,000-3,000 annually), standard Plan G might offer better value despite higher premiums.

Coordination with Other Coverage Options

Medigap works alongside other coverage strategies when Medicare SNF coverage nears exhaustion.

Medigap + Hospital Indemnity

Some beneficiaries pair Medigap with hospital indemnity insurance. While Medigap covers Medicare-approved costs, hospital indemnity pays fixed cash amounts for any hospital or SNF stay, regardless of what Medicare covers. This combination provides:

• Complete coverage during Medicare’s 100-day SNF period (Medigap)
• Cash payments if care extends beyond 100 days (hospital indemnity)
• Financial cushion for non-medical SNF costs

Medigap Delays Medicaid Spend-Down

By covering SNF coinsurance, Medigap preserves your assets during rehabilitation stays. Without Medigap, paying $17,360 for an 80-day stay depletes savings that could otherwise be protected under Medicaid spousal impoverishment rules.

When SNF Coverage Exhausts

After Medicare’s 100-day limit, Medigap cannot extend coverage. At this point, explore:

• Medicare appeals if coverage was terminated incorrectly
• Medicaid long-term care for ongoing custodial care
• Long-term care insurance if you have a policy
• Home health care or assisted living as less expensive alternatives
• VA Aid & Attendance if you’re a veteran

Common Medigap Mistakes to Avoid

Mistake 1: Missing Open Enrollment

Delaying Medigap purchase past your 6-month Open Enrollment Period is the most costly error. Health conditions that develop even in your first year of Medicare can make you uninsurable or face prohibitively expensive premiums.

Mistake 2: Choosing Medicare Advantage Without Understanding Trade-offs

Many new beneficiaries choose Medicare Advantage for low premiums and extra benefits (dental, vision), then regret the decision when facing serious illness requiring specialist care or SNF stays. The choice between Medigap and Medicare Advantage should be deliberate, not default.

Mistake 3: Buying Plan F When Plan G Is Better Value

If you’re still eligible for Plan F, compare it carefully against Plan G. Unless Plan F premiums are within $20-22/month of Plan G, you’re overpaying for $262 worth of coverage (the Part B deductible).

Mistake 4: Not Shopping Multiple Companies

Buying the first Medigap policy offered without comparison shopping often costs hundreds annually. Benefits are identical; only prices differ.

Mistake 5: Ignoring Pricing Methods

Choosing the lowest initial premium without understanding whether it’s attained-age-rated can lead to affordability problems in later years when premiums spike.

Conclusion: Medigap’s Essential SNF Protection

Medigap Plans G and F provide invaluable protection against Medicare’s $217 daily SNF coinsurance for days 21-100, potentially saving you up to $17,360 during a full stay. At monthly premiums of $120-250, even a single moderate SNF stay can justify years of coverage—and Medigap also protects against Part A and Part B cost-sharing across all Medicare services.

The key to accessing this protection is acting during your 6-month Medigap Open Enrollment Period when you cannot be denied coverage or charged more for health conditions. This window begins the month you’re both 65+ and enrolled in Medicare Part B. Miss this opportunity, and you may never have affordable access to comprehensive coverage again.

For 2026, Plan G represents the best value for most new Medicare beneficiaries, offering comprehensive coverage at lower premiums than Plan F. Plan N provides a budget-friendly alternative at 25-35% lower cost with modest tradeoffs. High-Deductible Plan G offers catastrophic protection for those willing to shoulder moderate costs in exchange for minimal premiums.

Remember that Medigap cannot extend coverage beyond Medicare’s 100-day SNF limit or pay for custodial care Medicare doesn’t cover. When those limits approach, you’ll need to explore Medicaid, long-term care insurance, or less expensive care alternatives. However, for Medicare’s coverage period, Medigap eliminates the financial stress of mounting daily charges and allows you to focus on recovery rather than bills.

For personalized Medigap shopping assistance, plan comparisons, and enrollment guidance, contact Trusted SR Solutions. We represent multiple highly-rated insurance carriers and can help you find the best Medigap coverage for your needs and budget during your guaranteed-issue enrollment period.