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Filling the gaps Medigap doesn't cover
By Vadim Marusin, licensed Medicare insurance agent in Washington (WAOIC #1365574). Insurer data checked against the state chart current as of October 8, 2026.
Medigap pays your share of Medicare-covered care. Prescriptions, dental, vision, hearing aids and long-term care sit outside Medicare, so they sit outside Medigap too. Here's how people on Original Medicare cover them.
What Medigap never covers
- Outpatient prescription drugs. Medigap policies sold since January 1, 2006 don't include drug coverage.
- Routine dental care: cleanings, fillings, crowns, dentures.
- Routine vision care: eye exams for glasses, glasses and contacts.
- Hearing aids and routine hearing exams.
- Long-term custodial care in a nursing home or at home.
- Private-duty nursing.
Medigap follows Medicare: if Medicare covers a service (for example, cataract surgery, or a medically necessary eye exam for diabetes), your Medigap plan pays its share. If Medicare doesn't, Medigap doesn't.
Part D: prescription drugs
People with Original Medicare and Medigap add a stand-alone Part D prescription drug plan. You choose it during your Medicare initial enrollment period, and you can change it every fall during Medicare's open enrollment (October 15 to December 7).
Three things to know:
- The late penalty is permanent. If you go 63 days or more without Part D or other creditable drug coverage after your initial enrollment period, you'll pay a penalty added to your Part D premium for as long as you have Part D: 1% of the national base premium for each month you were without coverage.
- Out-of-pocket costs are capped. Since 2025, Part D limits what you pay for covered drugs in a year; the cap is $2,100 in 2026.
- Compare every year. Plans change their drug lists and pharmacy networks annually. Medicare.gov's plan finder ranks plans on your actual drug list. SHIBA (1-800-562-6900) will run the comparison with you for free.
Medigap Assist focuses on Medicare Supplement policies; for Part D comparisons, SHIBA and Medicare.gov are the best neutral sources.
Dental
Options people on Original Medicare use:
- Stand-alone dental insurance, often with waiting periods for major work (crowns, implants) and an annual maximum.
- Dental discount plans, which aren't insurance but reduce the price at participating dentists.
- Paying directly, sometimes the cheapest route if you need only cleanings.
Check waiting periods and annual maximums against the work you expect. A policy with a $1,000 yearly maximum and a 12-month wait on crowns may not help much in year one.
Vision and hearing
Stand-alone vision plans cover exams and an allowance for glasses or contacts. For hearing aids, compare a hearing plan or discount program with over-the-counter hearing aids, which the FDA has allowed since 2022 for mild to moderate hearing loss.
Long-term care
Neither Medicare nor Medigap pays for long-term custodial care. Medigap does pay the skilled nursing facility coinsurance (Plans C, D, F, G, M and N in full; K and L partially) for Medicare-covered skilled stays of up to 100 days after a qualifying hospital stay. Long-term care insurance, hybrid life policies and Washington's WA Cares Fund are separate planning topics.
Common questions
Can I buy a Medigap plan that includes dental?
No standardized Medigap plan includes dental. Some insurers sell separate dental plans, sometimes with a discount if you have their Medigap policy; that's a separate policy.
Do I need Part D if I don't take any drugs?
If you don't have other creditable drug coverage, enrolling in a low-premium Part D plan when first eligible avoids a lifelong late penalty if you need drugs later.
Does Medigap pay for my glasses after cataract surgery?
Medicare Part B covers one pair of glasses or contacts after cataract surgery with an intraocular lens, and Medigap pays its share of that Medicare-covered cost.