Medigap Plan D is one of 10 standardized Medicare Supplement Insurance plans available to beneficiaries. It covers most out-of-pocket costs left by Original Medicare. This includes your Part A deductible, Part B coinsurance, skilled nursing facility costs, and foreign travel emergencies. However, it does not cover Part B excess charges or the annual Part B deductible.
This distinction is what separates Plan D from the more expensive Plan G. For beneficiaries whose doctors all accept Medicare assignment, this coverage gap rarely matters in practice. Plan D sits between Plan G and Plan N in the Medigap lineup. It offers strong hospital and outpatient protection at a lower premium than Plan G. As a result, it deserves consideration from enrollees seeking comprehensive coverage at a competitive price.
What Does Medigap Plan D Cover?
Medigap Plan D covers the major cost-sharing gaps in Original Medicare. It pays 100 percent of your Part A coinsurance for hospital stays. This includes daily coinsurance for days 61 through 90 and lifetime reserve days. It also covers an additional 365 days of hospital care after Medicare benefits end. The plan pays the full Part A deductible of $1,736 per benefit period in 2026.
Plan D also covers skilled nursing facility coinsurance for days 21 through 100. Hospice care coinsurance under Part A is fully covered as well. The first three pints of blood each year are included. These benefits match what Plan G and Plan N offer on the Part A side.
On the Part B side, Plan D pays the 20 percent coinsurance for Medicare-approved outpatient services. This applies to doctor visits, lab tests, durable medical equipment, and outpatient surgery. For example, if Medicare approves a $1,000 procedure, Plan D pays the $200 you would owe. Foreign travel emergency care is also included. It covers 80 percent of costs after a $250 deductible, up to a $50,000 lifetime maximum.
There are two notable gaps in Plan D coverage. It does not pay the annual Part B deductible, which is $283 in 2026. It also does not cover Part B excess charges. These are amounts that non-participating doctors can charge above the Medicare-approved rate. The excess is limited to 15 percent by federal law. In practice, most doctors accept assignment and never charge these fees.
| Benefit | Plan D Coverage |
|---|---|
| Part A Hospital Coinsurance + 365 Extra Days | Covered |
| Part A Deductible ($1,736 in 2026) | Covered |
| Part A Hospice Care Coinsurance | Covered |
| Part B Coinsurance (20%) | Covered |
| Skilled Nursing Facility (Days 21–100) | Covered |
| Blood (First 3 Pints) | Covered |
| Foreign Travel Emergency | Covered (80%) |
| Part B Deductible ($283 in 2026) | Not Covered |
| Part B Excess Charges | Not Covered |
Medigap Plan D Benefits Table
| Coverage Area | Medigap Plan D | Plan G | Plan N |
|---|---|---|---|
| Part A Coinsurance + 365 Extra Days | Yes | Yes | Yes |
| Part A Deductible | Yes | Yes | Yes |
| Part A Hospice Care | Yes | Yes | Yes |
| Part B Coinsurance | Yes | Yes | Yes* |
| Part B Deductible | No | No | No |
| Part B Excess Charges | No | Yes | No |
| Skilled Nursing Facility (Days 21–100) | Yes | Yes | Yes |
| Blood (First 3 Pints) | Yes | Yes | Yes |
| Foreign Travel Emergency (80%) | Yes | Yes | Yes |
*Plan N requires copays of up to $20 for some office visits. It also charges up to $50 for ER visits not resulting in a hospital admission.
How Much Does Medigap Plan D Cost?
Plan D typically costs less than Plan G from the same insurance carrier. The premium difference reflects one benefit that Plan G adds: Part B excess charge coverage. In most cases, the savings are modest but consistent. However, Plan D usually costs more than Plan N. That gap exists because Plan D offers full coinsurance coverage without copays.
Insurance companies use three pricing methods for Medigap policies. Community-rated plans charge the same premium regardless of your age. Issue-age-rated plans base your premium on your age at enrollment. Attained-age-rated plans start lower but increase as you get older. Typically, attained-age plans seem affordable at first but cost more over a lifetime.
Premiums vary widely by carrier, location, age, and gender. The same plan from different companies in one zip code can differ significantly. As a result, comparing quotes from multiple insurers is essential. One useful strategy is to compare Plan D and Plan G quotes from the same carrier. If the annual savings exceed your likely excess charge exposure, Plan D is the better value. Your state insurance department or Medicare’s online plan finder can help you compare options.
Who Should Choose Medigap Plan D?
Medigap Plan D works best for beneficiaries who want comprehensive coverage at a lower cost than Plan G. The only practical difference between these two plans is Part B excess charge protection. If all your doctors accept Medicare assignment, you will never face excess charges. In that scenario, Plan D provides the same real-world protection for less money.
Roughly 97 percent of Medicare providers accept assignment nationwide. In addition, eight states ban Part B excess charges entirely. These include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one of those states, Plan G and Plan D offer identical practical coverage.
However, Plan D may not suit everyone. If you regularly see specialists who do not accept assignment, Plan G provides stronger protection. For budget-focused beneficiaries who can handle small copays, Plan N has the lowest premiums. Also note that fewer carriers sell Plan D compared to Plan G or Plan N. Limited carrier competition can mean fewer pricing options in your area.
Medigap Plan D vs Plan G vs Plan N
These three plans are the most relevant choices for beneficiaries who became eligible after January 2020. Plan G is the most popular Medigap plan in 2026. Plan N is the most affordable comprehensive option. Medigap Plan D falls between them in both coverage and cost.
The critical difference is Part B excess charges. Plan G covers them in full. Plan D and Plan N do not. However, the practical impact is small for most people. Excess charges are capped at 15 percent above the Medicare-approved amount. For example, on a $200 approved charge, the maximum excess would be just $30.
Plan N introduces another distinction with its copay structure. It requires copays of up to $20 for certain office visits. It also charges up to $50 for emergency room visits not resulting in admission. Plan D has no copays for any covered service. As a result, Plan D offers more predictable out-of-pocket costs than Plan N while costing less than Plan G. For most beneficiaries, the choice comes down to how they prioritize premium savings versus coverage certainty.
| Feature | Plan D | Plan G | Plan N |
|---|---|---|---|
| Part B Excess Charges | Not Covered | Covered 100% | Not Covered |
| Office Visit Copays | None | None | Up to $20 |
| ER Copay (No Admission) | None | None | Up to $50 |
| Relative Premium | Middle | Highest | Lowest |
| Best For | Assignment-only doctors | Maximum protection | Budget-conscious enrollees |
How to Buy Medigap Plan D
The best time to buy any Medigap policy is during your Medigap Open Enrollment Period. This six-month window begins when you turn 65 and enroll in Medicare Part B. During this period, insurers cannot deny you coverage. They also cannot charge higher premiums based on health conditions. This is your strongest consumer protection when purchasing supplemental coverage.
Plan D is available in most states across the country. However, Massachusetts, Minnesota, and Wisconsin use their own standardized Medigap plan systems. In those three states, the standard letter-designated plans are not sold. Not every insurance carrier offers Plan D in every other state either. In most cases, Plan G and Plan N have more carriers competing for business.
If you miss your Open Enrollment Period, you may face medical underwriting. Insurers can review your health history and deny coverage or charge higher rates. However, certain guaranteed issue rights protect you in specific situations. For example, losing your Medicare Advantage plan triggers guaranteed issue rights. Always compare quotes from at least three carriers before deciding. Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.
Frequently Asked Questions About Medigap Plan D
Is Medigap Plan D available in all 50 states?
Plan D is available in most states but not all. Massachusetts, Minnesota, and Wisconsin have their own standardized Medigap systems. In those three states, the standard letter-designated plans like Plan D are not sold.
What is the difference between Plan D and Plan G?
The only difference is Part B excess charge coverage. Plan G covers these charges in full while Plan D does not. If your doctors accept Medicare assignment, this difference has no practical impact on your costs.
Does Plan D cover prescription drugs?
No Medigap plan sold after 2005 includes prescription drug coverage. You need a separate Medicare Part D prescription drug plan for medications. You can enroll in both a Medigap policy and a Part D plan at the same time.
Can I switch from Plan G to Plan D to save money?
You can apply to switch plans at any time. However, outside your Open Enrollment Period, the insurer may require medical underwriting. They could deny your application or charge a higher premium based on your health history.
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Official Sources & Resources
For verified Medicare information and enrollment help:
- Medicare.gov: medicare.gov
- CMS.gov: cms.gov
- NAIC Medigap Guide: naic.org
- KFF Medicare Research: kff.org/medicare
- Find Your SHIP: medicare.gov/contacts
Content last reviewed April 2026. If you notice any outdated information, please contact us.