Medigap in Ohio (2026): Plan G, Plan N, and Switching Rules

How Medigap fits with Original Medicare

Medicare Supplement (Medigap) plans are private insurance policies sold alongside Original Medicare. They pay second on your medical bills — Medicare pays its share first, and the Medigap policy covers some or all of what's left (the Part A and Part B deductibles, coinsurance, copays, and in some plans, foreign travel emergencies).

Three things to understand about Medigap structure:

• Medigap policies are standardized by letter. A Plan G from Aetna covers identical benefits to a Plan G from Cigna or Mutual of Omaha — the only difference is price, customer service, and rate stability over time.
• You keep your Medicare card and use it as primary. Any provider that accepts Medicare accepts your Medigap. There's no network — you can see any specialist, get a second opinion at any hospital, travel anywhere in the U.S. (Plan G includes some foreign travel emergency coverage too).
• You buy Part D separately. Medigap doesn't include prescription drug coverage. You add a stand-alone Part D plan to get Rx coverage, and the two work independently.

The trade-off: higher monthly premiums in exchange for very low out-of-pocket costs at the point of care and maximum provider flexibility. For most retirees with stable health and a desire for predictability, Medigap is the simpler structure to navigate.

The 10 standardized plans (and what's actually sold in Ohio)

Federal law defines 10 standardized Medigap plan letters. Not all are actively sold to new enrollees:

If you turned 65 (or otherwise became Medicare-eligible) before January 1, 2020, you can still buy Plan C, Plan F, and high-deductible Plan F. For everyone else — anyone newly eligible since 1/1/2020 — those plans are unavailable, and Plan G is the equivalent (the only difference being you pay the Part B deductible yourself).

Ohio's 2026 Medigap market includes the 10 standardized plans plus the high-deductible F and G variants — 12 total plans across the carriers actively selling in Ohio.

Plan G — the most popular choice

For most Ohioans newly enrolling in Medicare in 2026, Plan G is the default recommendation. It covers:

• Part A deductible ($1,736 in 2026) — you owe $0 if you're admitted to a hospital.
• Part A hospital coinsurance ($434/day for days 61–90, $868/day for lifetime reserve days) — fully covered.
• Part A skilled nursing facility coinsurance ($217/day days 21–100) — fully covered.
• Part B coinsurance/copayment (the 20% Medicare doesn't pay) — fully covered.
• First three pints of blood, Part A hospice coinsurance/copayment, Part B excess charges — fully covered.
• Foreign travel emergency (up to plan limits) — 80% covered after $250 deductible, lifetime max $50,000.

What Plan G does not cover: the $283 Part B deductible. You pay that first $283 of your annual Part B costs out of pocket each year. After that, Plan G picks up the 20%.

Plan G premiums in Ohio vary by ZIP code, age, gender, and carrier. A 65-year-old non-tobacco user can expect monthly premiums anywhere from the high $100s to the mid $200s. Tobacco users and older enrollees pay more. The same Plan G from different carriers can vary by $50–$80/month for the identical benefits — which is why shopping multiple carriers matters.

Plan N — lower premium, small copays

Plan N is the cost-sensitive alternative to Plan G. It covers everything Plan G covers, with three exceptions:

• You pay a copay of up to $20 per office visit.
• You pay a $50 copay for an emergency room visit that doesn't result in admission.
• Plan N does not cover Part B excess charges. If you see a non-participating provider who charges more than Medicare's approved amount (up to 15% above), you owe the difference.

In exchange, Plan N typically has $30–$60/month lower premiums than Plan G. For Ohioans who don't visit the doctor frequently and live near providers who accept Medicare assignment (most major Ohio health systems do — Cleveland Clinic, OSU Wexner, UH, Mercy, Premier, TriHealth), Plan N can be a strong cost-saving option. The small copays add up only if you're visiting providers regularly.

High-deductible Plan G

For Ohioans who want catastrophic protection but are willing to pay the first $2,950 out of pocket, high-deductible Plan G is the lowest-premium option. Premiums are often $30–$50/month — a fraction of regular Plan G — but you pay all your Medicare-allowed costs (deductibles, coinsurance) until you've spent $2,950 for the year. After that, Plan G coverage kicks in.

High-deductible Plan G is best for retirees who are healthy, can comfortably cover the $2,950 deductible from savings, and want low monthly premiums in exchange for taking on more risk in a high-cost year. It's a niche choice — most Ohioans land on regular Plan G or Plan N instead.

Plans K and L — cost-sharing structure

Plans K and L work differently from G and N: they pay 50% (Plan K) or 75% (Plan L) of most Medicare-covered services until you hit an annual out-of-pocket maximum, then 100% after that. For 2026:

• Plan K out-of-pocket cap: $8,000
• Plan L out-of-pocket cap: $4,000

The trade-off compared to Plan G: lower monthly premium, but you take on real cost-sharing on routine care until you hit the cap. K and L are also niche choices, often picked by retirees who want a hybrid of low premium and catastrophic protection without the deep first-dollar coverage of Plan G.

Ohio has no birthday rule (and why it matters)

A "birthday rule" is a state-level Medigap consumer protection that lets enrollees switch to another Medigap plan with equal or lesser benefits each year — usually in a 30-, 60-, or 63-day window around their birthday — without medical underwriting. As of 2026, roughly 16 states have some form of birthday rule, including California, Idaho, Illinois, Maryland, Oregon, Nevada, Oklahoma, Louisiana, Kentucky, Indiana, Delaware, and several others.

Ohio is not one of them. Ohio HB400, which would have created a birthday rule for Ohio Medigap enrollees, died on December 31, 2024, when the General Assembly session ended without final passage. As of May 2026, no birthday rule legislation has been reintroduced.

Practical implication: once your initial Medigap Open Enrollment Period (the 6-month window starting when you're 65 and enrolled in Part B) ends, switching Medigap plans in Ohio requires medical underwriting. The new carrier can ask 15–20 health questions, check your prescription history, and either approve you, charge a higher rate, or deny you based on pre-existing conditions.

Switching Medigap plans in Ohio

You can apply to switch Medigap plans in Ohio at any time of year — there's no enrollment window restriction. But approval isn't guaranteed. Three scenarios:

1. Within your initial Medigap Open Enrollment Period (the 6 months starting the first month you're both 65 and enrolled in Part B): guaranteed-issue, no underwriting. You can choose any plan from any Ohio carrier without health questions.
2. Outside the initial OEP, but with a guaranteed-issue right: federal law grants guaranteed-issue rights in specific situations — your employer plan ended, your Medicare Advantage plan terminated coverage in your area, you moved out of your MA plan's service area, your Medigap insurer became insolvent, and a few others. Document these carefully and apply within the 63-day window.
3. Outside the initial OEP, no guaranteed-issue right: medical underwriting applies. Pre-existing conditions can mean denial, a higher rate, or a waiting period before coverage begins.

If you pass underwriting, the new carrier issues a policy with a start date — typically the first of the following month. Don't cancel your old policy until the new one is confirmed active, to avoid a coverage gap.

Under-65 disabled enrollees: Ohio's special rules

Ohioans who qualify for Medicare under 65 — usually due to a disability that's qualified them for SSDI for 24 months — have specific Ohio protections that don't apply to typical 65+ enrollees.

Under recent Ohio law:

• Insurance companies that sell Medigap to Ohioans 65+ must offer the same plans to under-65 disabled Medicare beneficiaries at the same prices, with no preexisting condition exclusions.
• There's a special enrollment window from January 1 to July 1 each year for under-65 disabled enrollees to enroll in Medigap.
• Under-65 disabled enrollees also get a 60-day birthday window each year to switch to a different insurer offering the same coverage at a better price. This is essentially a birthday rule that applies only to the under-65 population.

This is a significant consumer protection unique to Ohio's under-65 Medicare beneficiaries. If you're under 65 and on Medicare, talk to OSHIIP or a licensed Ohio agent who knows the under-65 Medigap rules — many carriers' general intake processes default to the 65+ rules and miss the under-65 protections.

Carriers selling Medigap in Ohio

Major Medigap carriers active in Ohio for 2026 include:

• Aetna (CVS Health)
• Anthem Blue Cross Blue Shield of Ohio
• Cigna
• Humana
• Mutual of Omaha
• UnitedHealthcare / AARP
• Medical Mutual of Ohio (Ohio-based, strong regional presence)
• Plus several smaller and regional carriers and rate-history specialists

The same Plan G letter benefits are identical across carriers — what varies is the monthly premium, the rate-increase history (how aggressive the carrier has been with annual increases), customer service, and discounts (household discount if your spouse is also enrolled with the same carrier, non-tobacco discount, paperless billing discount). Plan G premiums across carriers in the same Ohio ZIP code can vary by $50–$80/month for identical benefits, so shopping multiple carriers — typically through an independent agent — pays off.