Medigap Plan A is the most basic Medicare Supplement plan, covering core benefits at typically the lowest premium. While it helps with Part A and Part B coinsurance, it leaves you responsible for deductibles and other costs. Here's what you need to know.
Medigap Plan A is a Medicare Supplement Insurance plan that helps cover some out-of-pocket costs under Original Medicare, including Medicare Part A (hospital insurance) and Part B (medical insurance). It's also known as Medicare Supplement Insurance Plan A.
Important: Don't confuse Medigap Plan A with Medicare Part A—they're different. Medicare Part A is the hospital insurance portion of Original Medicare. Medigap Plan A is a supplemental insurance policy from a private company that helps cover costs Medicare doesn't fully pay.
There are 10 standardized Medigap plans available (A, B, C, D, F, G, K, L, M, and N). Plan A is the most basic, covering only the four core benefits that all Medigap plans must include. These benefits are the same regardless of which insurance company sells the plan.
Medigap Plan A provides 100% coverage for:
Medicare Part A coinsurance and hospital costs: After you exhaust your Original Medicare hospital benefits, Plan A covers coinsurance for up to an additional 365 days of inpatient care.
Medicare Part B coinsurance or copayment: Plan A covers the 20% coinsurance you'd typically pay for outpatient services, doctor visits, lab work, and other Part B services. This is arguably the most valuable benefit of any Medigap plan.
First three pints of blood: If you need blood for a medical procedure, Plan A covers the first three pints each year that Medicare doesn't cover.
Part A hospice care coinsurance or copayment: Covers your share of costs for hospice care, including drugs for pain management and respite care.
Because Plan A only covers the basic benefits, you'll be responsible for several other Medicare costs:
Medicare Part A deductible: $1,676 per benefit period in 2025 ($1,736 in 2026). This applies each time you're admitted to the hospital.
Medicare Part B deductible: $257 in 2025 ($283 in 2026). You pay this once each year before Part B coverage begins.
Part B excess charges: If a doctor doesn't accept Medicare assignment, they can charge up to 15% more than the Medicare-approved amount. Plan A doesn't cover these excess charges.
Skilled nursing facility coinsurance: $209.50/day in 2025 ($217/day in 2026) for days 21-100 of a covered stay. Plan A doesn't help with this cost.
Foreign travel emergency care: Plan A doesn't cover medical emergencies outside the U.S.
Prescription drugs: No Medigap plan covers prescription drugs. You'll need a separate Medicare Part D plan for drug coverage.
Plan A offers the least coverage of all Medigap plans, but it typically has the lowest premiums. Here's how it compares to some popular alternatives:
Plan A vs. Plan B: Plan B covers everything in Plan A plus the Part A hospital deductible ($1,676 in 2025). Plan B costs more but protects you from a significant expense if you're hospitalized.
Plan A vs. Plan G: Plan G is one of the most popular Medigap plans. It covers everything except the Part B deductible ($257 in 2025). This includes the Part A deductible, skilled nursing facility coinsurance, Part B excess charges, and foreign travel emergencies. Plan G typically costs more but leaves you with minimal out-of-pocket costs.
Plan A vs. Plan N: Plan N covers more than Plan A (including the Part A deductible and skilled nursing coinsurance) but requires copays of up to $20 for office visits and up to $50 for ER visits that don't result in admission. Plan N offers a middle-ground approach with moderate premiums.
Note: Plans C and F are the most comprehensive Medigap options, but they're no longer available to people who became eligible for Medicare on or after January 1, 2020. If you were eligible before that date, you may still be able to purchase these plans.
Medigap Plan A typically has the lowest monthly premium of all Medigap plans because it provides the least coverage. However, premiums vary based on several factors:
Your age: Most plans in North Carolina are "attained-age rated," meaning premiums increase as you get older.
Where you live: Premiums vary by county and region within North Carolina.
The insurance company: Different insurers charge different amounts for the same standardized plan.
Tobacco use: In North Carolina, tobacco use doesn't affect premiums if you enroll during your six-month open enrollment period.
Discounts: Some insurers offer household, annual payment, or other discounts.
Example North Carolina Plan A premiums (2025):
Age 65: Approximately $106 to $335 per month, depending on the insurer
Age 55 (disability): Approximately $280 to $1,381 per month
Remember: While Plan A premiums are lower, you'll likely pay more out-of-pocket when you need medical care compared to a more comprehensive plan like Plan G. Consider your total potential healthcare costs—not just the premium—when choosing a plan.
Medigap Plan A may be a good choice if you:
Want the lowest possible monthly premium
They are generally healthy and don't expect frequent hospital stays
Are comfortable paying deductibles and other costs when you need care
Don't travel outside the U.S.
Don't expect to need skilled nursing facility care.
However, keep in mind that Plan A's lower premium comes with higher potential out-of-pocket costs. If you're hospitalized, you'll pay the full Part A deductible ($1,676 in 2025) each benefit period. A single hospital stay could cost you more in out-of-pocket expenses than the annual premium difference between Plan A and a more comprehensive plan.
Under federal law, Medigap insurers aren't required to sell policies to Medicare beneficiaries under age 65. However, North Carolina state law (N.C.G.S. 58-54-45) guarantees that individuals under 65 who qualify for Medicare due to disability can purchase Medigap Plan A, D, or G. This protection has been in effect since January 1, 2020.
Key points for under-65 beneficiaries in NC:
Guaranteed issue during open enrollment: You can purchase Plan A, D, or G during your six-month Medigap Open Enrollment Period without medical underwriting.
Higher premiums: Premiums for under-65 beneficiaries are typically much higher. For example, a 55-year-old may pay $280 to $1,381/month for Plan A, compared to $106 to $335/month for a 65-year-old.
Pre-existing condition waiting period: Insurers may impose a waiting period of up to six months for pre-existing conditions. However, if you had prior creditable coverage, this waiting period must be waived.
New open enrollment at 65: When you turn 65, you get another six-month Medigap Open Enrollment Period with access to any plan at standard age-65 rates.
If you're under 65 and considering Medigap, it's especially important to speak with an experienced Medicare agent. Other options—such as Medicare Advantage plans—may offer better value depending on your situation.
Medigap Open Enrollment Period:
The best time to enroll in any Medigap plan is during your Medigap Open Enrollment Period. This one-time, six-month window begins when you're both 65 or older AND enrolled in Medicare Part B. During this period:
Insurance companies cannot deny you coverage
You cannot be charged higher premiums due to health problems
There are no waiting periods for pre-existing conditions
You have guaranteed issue rights to any Medigap plan sold in your state
After your open enrollment period:
If you miss your Medigap Open Enrollment Period, you can still apply for coverage—but insurance companies may use medical underwriting. This means they can:
Deny you coverage based on your health history
Charge you higher premiums for pre-existing conditions
Impose waiting periods before covering certain conditions
Guaranteed Issue Rights:
In certain situations, you may have "guaranteed issue rights" that allow you to buy a Medigap policy outside of open enrollment without medical underwriting. Examples include when your Medicare Advantage plan leaves your area, you move out of your plan's service area, or you lose employer coverage.
Important: There is no annual open enrollment period for Medigap plans, unlike Medicare Advantage and Part D. Your initial six-month window is your best opportunity to enroll.
Choosing the right Medigap plan depends on your health needs, budget, and the level of financial protection you want. While Plan A has the lowest premium, it may not provide sufficient coverage if you incur significant medical expenses.
Our team of dedicated, experienced Medicare agents at Health Plans of NC can help you:
Compare all available Medigap plans in North Carolina
Understand what you'll pay in premiums and out-of-pocket costs
Determine which plan offers the best value for your situation
Get personalized quotes from multiple insurance companies
Explore other options like Medicare Advantage if Medigap isn't the right fit
