Medigap for Expats: What It Covers, What It Doesn't, and When to Buy It
Original Medicare has real gaps — and Medigap was designed to fill them. Several plans also include foreign emergency coverage, which sounds perfect for retirees moving abroad. The reality is more nuanced. Here's what the coverage actually does, where it stops, and why when you buy matters more than which plan you pick.
Updated · Published
What Is Medigap?
Original Medicare (Parts A and B) leaves you responsible for deductibles, copays, and coinsurance that add up fast. A serious hospitalization can leave you on the hook for thousands of dollars in cost-sharing. Medigap — also called Medicare Supplement Insurance — is a private policy you layer on top to cover those gaps.
Plans are standardized by the federal government and labeled A through N. That matters: the benefits for each lettered plan are identical regardless of which insurer sells it. Plan G from Aetna covers exactly the same things as Plan G from Humana or any other carrier. You're shopping on price and company reputation, not coverage details.
The standardization rule — what it means for you
Because plans are standardized, the only questions that matter are: which lettered plan fits your needs, and which insurer offers the best premium in your state? For expats, add one more: does the plan include foreign travel emergency coverage? Plans C, D, F, G, M, and N all do — Plans A, B, K, and L don't.
The Foreign Travel Emergency Benefit: How It Works
Plans G and N (the two most relevant for most people enrolling today) include a foreign travel emergency benefit. Here's exactly how it works:
So if you have a $10,000 emergency abroad: you pay the $250 deductible, then 20% of the remaining $9,750 ($1,950), for a total out-of-pocket of $2,200. The plan covers $7,800. That's meaningful protection for a hospital stay. But it's not unlimited.
The limitation most expats miss: the 60-day trip clock
Medigap foreign coverage only applies during the first 60 days of a trip. The clock starts when you leave the US. If you're on day 61 of an extended stay and you have a medical emergency, the Medigap benefit doesn't apply.
This is why Medigap foreign coverage is designed for travelers, not permanent expats. It's a safety net for the first two months of a trip, not a substitute for international health insurance.
What Medigap foreign coverage doesn't cover
Routine doctor visits, specialist care, or ongoing treatment abroad
Any care after day 60 of a trip
Care that exceeds the $50,000 lifetime cap
Medical evacuation back to the US (a separate cost that can run $50,000–$100,000+)
Prescription medications abroad
Dental, vision, or hearing care
Plan G vs. Plan N: Which Is Right for You?
Plan GMost popular choice
~$120–180/month at 65Covers nearly everything Original Medicare doesn't: Part A deductible ($1,676 in 2026), coinsurance, skilled nursing facility costs, and Part B excess charges. The only gap is the annual Part B deductible ($257 in 2026), which you pay once a year.
No copays for doctor or emergency room visits
Covers Part B excess charges (what doctors charge above Medicare's approved amount)
Foreign travel emergency: 80% after $250 deductible, up to $50,000 lifetime
Best for: people who want maximum US coverage, visit specialists regularly, or want to minimize unpredictable out-of-pocket costs.
Plan NLower-premium option
~$90–140/month at 65Similar core coverage to Plan G — Part A deductible, coinsurance, skilled nursing — but with two differences: it doesn't cover Part B excess charges, and you pay small copays for office visits (up to $20) and emergency room visits (up to $50).
Lower monthly premium than Plan G
Foreign travel emergency: same 80%/$250/$50,000 benefit as Plan G
Up to $20 copay per doctor visit, up to $50 per ER visit
Does not cover Part B excess charges
Best for: generally healthy people who don't visit doctors often and want a lower monthly premium. The copays and excess charge exposure are manageable if you're not a frequent healthcare user in the US.
For expats, the foreign coverage is identical — so other factors drive the choice
Both Plan G and Plan N offer the same foreign travel emergency benefit: $250 deductible, 80% coverage, $50,000 lifetime. The choice between them comes down to your US healthcare usage — how often you'll see doctors when you're back, whether your providers accept Medicare assignment (which eliminates the excess charge risk), and whether the premium savings from Plan N are worth the copay exposure.
The Guaranteed Issue Window — Don't Miss It
This is the most important timing fact in this entire guide. When you first enroll in Part B at 65, federal law gives you a 6-month open enrollment window during which every Medigap insurer must sell you a policy at standard rates — no health questionnaire, no medical underwriting, no rejections. The window opens the month you turn 65 and enroll in Part B.
Miss the window and the rules change
After your 6-month open enrollment period closes, most states allow insurers to use medical underwriting. That means they can charge you more based on your health history, exclude pre-existing conditions, or decline to cover you at all.
A KFF analysis found that in states without additional protections, roughly a quarter of Medigap applicants who applied outside the open enrollment window were denied coverage or charged higher rates due to health conditions.
The expat timing problem
Many retirees moving abroad are tempted to skip Medigap — they're leaving the US, after all, so why pay for US coverage? The problem is that skipping it at 65 and trying to add it later (when you return, or when you need it) can be difficult or expensive.
The right call for most people is to enroll in Medigap during the guaranteed issue window — ideally before you leave — even if you expect to be abroad for years. The Part B premium is a sunk cost if you're keeping it. Medigap is the insurance against an expensive US medical event during visits home.
State exceptions worth knowing about
Federal law sets the baseline, but some states offer additional protections:
New York and Connecticut — year-round guaranteed issue
In these states, Medigap plans must be sold at standard rates regardless of when you apply or your health status. No enrollment window required.
Massachusetts — annual guaranteed issue window
Has a designated open enrollment period (February–March) each year when you can buy or switch Medigap plans without underwriting.
A growing number of states — birthday and anniversary rules
Several states have a "birthday rule" allowing you to switch Medigap plans without underwriting during a window around your birthday each year (typically 30–63 days). This doesn't let you add Medigap if you've never had it — but it lets current enrollees switch to a better plan or lower premium without health questions.
Other Ways to Get Guaranteed Issue Rights
The open enrollment window at 65 isn't the only path to guaranteed issue Medigap. A few specific life events also trigger it — relevant if you're switching from Medicare Advantage or missed the initial window.
Leaving Medicare Advantage (within 12 months of first enrolling)
If you enrolled in a Medicare Advantage plan for the first time and decide to switch back to Original Medicare within the first 12 months, you have a one-time guaranteed issue right to buy a Medigap plan. You have 63 days from when your Advantage plan coverage ends to apply.
Your Medicare Advantage plan leaves your area or is discontinued
If your plan stops operating in your service area — including being auto-disenrolled because you moved abroad — you typically have 63 days to buy a Medigap plan with guaranteed issue rights. This is one reason why proactive switching (before you go) is better than waiting for the plan to disenroll you: you control the timeline and can ensure you use this window correctly.
Plans eligible under guaranteed issue (post-2020 enrollees)
If you became eligible for Medicare on or after January 1, 2020, you cannot use guaranteed issue rights to purchase Plans C or F (they're no longer available to new enrollees). Plan G is the most comprehensive plan available to you under guaranteed issue, along with Plan N and others.
Why Medigap Isn't Enough on Its Own
Medigap's foreign emergency benefit is a safety net for the first 60 days of a trip, not a comprehensive international coverage plan. If you're spending extended time abroad, living there seasonally, or relocating permanently, you need a separate international health insurance policy.
The $50,000 lifetime cap can be exhausted by a single serious illness or surgery
Coverage stops after day 60 of any trip — ongoing treatment isn't covered
Medical evacuation (which can cost $50,000–$100,000+) is not covered
Routine and preventive care — the visits that keep you healthy — aren't covered
Once you hit the $50,000 lifetime limit, it's gone permanently, not per year
Think of Medigap as your US coverage; international insurance as your abroad coverage
Medigap fills the gaps in Original Medicare when you're in the US — and provides some emergency backup for the start of international trips. International health insurance is your primary coverage once you're living or spending extended time outside the US.
A well-prepared US retiree abroad carries both. The two plans serve different purposes and don't overlap in any meaningful way.
Frequently Asked Questions
Does Medigap cover routine doctor visits or prescriptions abroad?
I've already left the US. Can I still get Medigap?
Does Medigap cover medical evacuation back to the US?
What happens to Medigap's foreign coverage after day 60 of a trip?
Can I switch from Plan N to Plan G later if I want more coverage?
Sources
- Get Ready to Buy Medigap — medicare.gov: Open enrollment period rules, guaranteed issue rights, and the 6-month window starting at Part B enrollment.
- Medigap Purchasing Details: Enrollment Periods, Guaranteed Issue, and More — Medicare Interactive: Comprehensive overview of enrollment windows, qualifying events, and guaranteed issue rules.
- Medicare Coverage Outside the United States — medicare.gov (PDF): Official CMS fact sheet on what Medicare and Medigap cover internationally.
- Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions — KFF: Data on denial rates and premium increases for applicants outside the open enrollment window.
- The Birthday Rule — medicareresources.org: Overview of state birthday rules allowing plan-switching without underwriting.
- Understanding Medigap's Foreign Travel Benefits — MedicareFAQ: Breakdown of the $250 deductible, 80% coverage, $50,000 cap, and the 60-day trip limitation.
Next: International health insurance — your primary coverage abroad
You've got your Medicare situation sorted. Now make sure you have real coverage for the country you're moving to. See which international plans work for US retirees — by age, destination, and coverage level.
Compare International Insurance Plans