Medigap Plan D: Coverage, Costs, and How It Compares to Other Plans
Medigap Plan D is a mid-level Medicare Supplement plan that covers most out-of-pocket costs except the Part B deductible and Part B excess charges. Here's what you need to know.
Medigap Plan D is a mid-level Medicare Supplement plan that covers most out-of-pocket costs except the Part B deductible and Part B excess charges. Here's what you need to know.
Medigap Plan D is one of the 10 standardized Medicare Supplement plans available in most states. It's designed to help cover the out-of-pocket costs that Original Medicare (Parts A and B) doesn't pay—things like deductibles, coinsurance, and copayments.
Important: Medigap Plan D is not the same as Medicare Part D. Despite the similar names, they're completely different. Medigap Plan D is a Medicare Supplement plan that helps pay medical costs. Medicare Part D is prescription drug coverage. Medigap plans do not cover prescription drugs—if you need drug coverage, you'll need a separate Part D plan.
Medigap plans are standardized by the federal government, meaning Plan D offers the same benefits regardless of which insurance company sells it. The only difference between Plan D policies from different insurers is the price.
Medigap Plan D covers:
Medicare Part A coinsurance and hospital costs: Covers 100% of the coinsurance you'd owe for hospital stays. In 2026, that means coverage for the $434/day coinsurance for days 61-90 and $868/day for lifetime reserve days.
Additional 365 days of hospital coverage: After you've exhausted your Medicare hospital benefits, Plan D covers up to an additional 365 days of hospital costs.
Medicare Part A deductible: Covers 100% of the Part A hospital deductible ($1,736 per benefit period in 2026).
Part A hospice care coinsurance or copayment: Covers 100% of your share of hospice care costs.
Medicare Part B coinsurance or copayment: Covers 100% of the 20% coinsurance you typically owe for Medicare-approved services after meeting your Part B deductible.
Blood (first 3 pints): Covers the cost of the first three pints of blood you need for a medical procedure each year.
Skilled nursing facility care coinsurance: Covers 100% of the coinsurance for skilled nursing facility stays (days 21-100). In 2026, that's $217/day.
Foreign travel emergency care: Covers 80% of emergency medical costs when you're traveling outside the United States, up to plan limits. This benefit has a separate $250 deductible and a lifetime maximum (typically $50,000).
Plan D does not cover everything. Understanding these gaps helps you decide if Plan D is right for you:
Medicare Part B deductible: You pay the annual Part B deductible yourself ($283 in 2026). This is a key difference from Plan C (which covers the Part B deductible but is only available to those Medicare-eligible before 2020).
Medicare 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 D does not cover these excess charges. This is a key difference from Plan G (which does cover excess charges).
Prescription drugs: Like all Medigap plans, Plan D does not cover prescription drugs. You'll need a separate Medicare Part D plan for drug coverage.
Dental, vision, and hearing: Medigap plans do not cover routine dental care, vision exams, eyeglasses, or hearing aids.
Long-term care: Medigap does not cover custodial care in a nursing home or assisted living facility.
Plan D sits in the middle of Medigap coverage levels. Here's how it compares to the most popular alternatives:
Plan D vs. Plan G
Plan G is the most popular Medigap plan for new Medicare beneficiaries. The main difference: Plan G covers Part B excess charges while Plan D does not. Both plans require you to pay the Part B deductible yourself ($283/year in 2026).
When to choose Plan D over Plan G: If all your doctors accept Medicare assignment (meaning they won't charge excess fees), Plan D and Plan G provide essentially the same benefits. Plan D may have a lower premium, making it the better value if excess charges aren't a concern.
When to choose Plan G over Plan D: If you see specialists who don't accept assignment, or you want protection against any possibility of excess charges, Plan G is the safer choice. The premium difference is often small.
Plan D vs. Plan C
Plan C and Plan D are very similar—the only difference is that Plan C covers the Part B deductible while Plan D doesn't. However, Plan C is only available to people who became Medicare-eligible before January 1, 2020. If you became eligible after that date, Plan D (or Plan G) is your closest alternative to Plan C.
Plan D vs. Plan N
Plan N typically has lower premiums than Plan D but higher cost-sharing. Plan N doesn't cover the Part B deductible or Part B excess charges, and it may require copays of up to $20 for some doctor visits and up to $50 for emergency room visits that don't result in hospital admission.
When to choose Plan D over Plan N: If you visit the doctor frequently and want to avoid copays, Plan D's full Part B coinsurance coverage (with no copays) may be worth the higher premium.
Medigap Plan D premiums vary based on several factors:
Insurance company: Different insurers charge different prices for the same coverage. Always compare quotes from multiple companies.
Your age: Most policies are priced based on your age. Younger enrollees typically pay less.
Location: Premiums vary by ZIP code based on local healthcare costs and market competition.
Tobacco use: Non-smokers often qualify for lower premiums.
Pricing method: Community-rated plans charge the same regardless of age, issue-age plans base price on age at purchase, and attained-age plans increase as you get older.
Plan D premiums are generally lower than Plan G premiums (since Plan D doesn't cover excess charges), but the availability of Plan D varies by insurance company and state. Some insurers don't offer Plan D, focusing instead on the more popular Plan G and Plan N.
Remember: You also pay your monthly Medicare Part B premium ($202.90 standard in 2026) in addition to your Medigap premium.
Plan D may be a good fit if:
• All your doctors accept Medicare assignment (no excess charges)
• You want comprehensive coverage without copays for doctor visits
• You're comfortable paying the $283 annual Part B deductible (2026)
• You want the foreign travel emergency benefit
• Plan D is available in your area at a lower price than Plan G
Consider other plans if:
• You see doctors who might charge excess fees (consider Plan G)
• You want the most comprehensive coverage possible (consider Plan G)
• You want lower premiums and are okay with small copays (consider Plan N)
• You became Medicare-eligible before 2020 and want the Part B deductible covered (consider Plan C or F)
The best time to buy any Medigap plan is during your Medigap Open Enrollment Period. This 6-month window starts the first day of the month you turn 65 and are enrolled in Medicare Part B.
During this period, insurance companies cannot deny you coverage or charge you more because of pre-existing health conditions. You have guaranteed issue rights to any Medigap plan sold in your state.
If you wait until after your Open Enrollment Period, you may be subject to medical underwriting. This means the insurance company can review your health history and may charge higher premiums, exclude coverage for certain conditions, or deny coverage altogether.
Choosing between Medigap Plan D, Plan G, Plan N, and other options can be confusing. The right choice depends on your healthcare needs, your doctors, and how much you're willing to pay in premiums versus out-of-pocket costs.
At Health Plans of NC, our licensed agents can help you compare Medigap plans from multiple insurance companies. We'll help you understand the differences, check if your doctors accept Medicare assignment, and find coverage that fits your budget.
Contact us at 1-800-797-0327 for a free Medigap consultation. We're locally based in North Carolina and understand the plans available in your area.
Is Medigap Plan D the same as Medicare Part D?
No. Medigap Plan D is a Medicare Supplement insurance plan that helps pay out-of-pocket costs for Medicare-covered services. Medicare Part D is prescription drug coverage. They are completely different. If you have Medigap Plan D and need drug coverage, you'll need to purchase a separate Medicare Part D plan.
What is the difference between Medigap Plan D and Plan G?
The main difference is Part B excess charges. Plan G covers Part B excess charges (when doctors charge up to 15% above Medicare-approved amounts), while Plan D does not. Both plans cover the Part A deductible, Part B coinsurance, skilled nursing facility coinsurance, and foreign travel emergency coverage. Neither covers the Part B deductible.
Does Medigap Plan D cover prescription drugs?
No. No Medigap plan covers prescription drugs. If you need prescription drug coverage, you must enroll in a separate Medicare Part D plan. In 2026, the Part D out-of-pocket maximum is $2,100, after which you pay nothing for covered drugs for the rest of the year.
What does Medigap Plan D cost?
Plan D premiums vary based on your age, location, insurance company, and other factors. Generally, Plan D costs less than Plan G but more than Plan N. Get quotes from multiple insurers to compare prices—the same Plan D coverage can cost significantly different amounts from different companies.
Should I choose Plan D or Plan G?
If all your doctors accept Medicare assignment and never charge excess fees, Plan D and Plan G provide nearly identical benefits, and Plan D may cost less. If you see specialists who might charge excess fees, or you want protection against any possibility of excess charges, Plan G is the safer choice. The premium difference is often small enough that Plan G's extra protection is worth it.
Is Medigap Plan D available in North Carolina?
Yes, Medigap Plan D is available in North Carolina. However, not all insurance companies offer Plan D—many focus on the more popular Plan G and Plan N. A licensed insurance agent can help you find which companies provide Plan D in your area and compare prices.