6 Medicare Supplement Changes Affecting Specialists

Medicare supplement changes affecting specialist visits — Image Source: Shutterstock

Seniors buy Medicare Supplement insurance for one reason. They want the freedom to see any doctor. They want to avoid the network restrictions of Advantage plans. In 2026, that freedom is becoming more expensive. Structural changes to Medigap plans are creating friction at the specialist’s office.

You might have a policy that claims to cover everything. Yet, you are facing new bills for cardiology and orthopedics. Inflation and legislative tweaks have altered the landscape. Specialists are enforcing collection rules they once ignored. Here are the six Medigap changes affecting your access to specialists this year.

1. The Plan F Price Spiral

Plan F was once the gold standard. It covered every penny of cost-sharing. It has been closed to new entrants for years. The pool of members is aging and getting sicker. Premiums for Plan F are skyrocketing in 2026. Healthy seniors are fleeing to cheaper plans. This leaves the remaining members facing massive rate hikes. Many cannot afford to keep the plan. They are dropping coverage and losing that “zero balance” access to specialists.

2. Plan N Copay Enforcement

Plan N has become the popular alternative to Plan F. It requires a copay of up to $20 for office visits. In the past, specialists often billed this later. In 2026, office administrators are collecting this upfront. They treat it like a commercial insurance copay. You must pay before you see the doctor. If you see multiple specialists a week, these twenties add up fast. It creates a cash-flow barrier to necessary care.

3. The Part B Deductible Gap

Most seniors now have Plan G. Plan G covers everything except the Part B deductible. That deductible has risen again for 2026. It is now roughly $283 per year. You must pay this entire amount out of pocket. You usually pay it during your first specialist visit of the year. Your cardiologist bill might be $283 higher than you expected in January. Medigap will not pay a dime until this is met.

4. The Return of Excess Charges

Doctors who do not accept Medicare “assignment” can charge more. They can bill up to 15% above the approved amount. This is called an “excess charge.” Plan G covers this. Plan N does not. More specialists are opting out of assignment due to low reimbursement rates. If you have Plan N, you are now liable for that 15%. This surcharge appears frequently on bills for surgery and advanced imaging.

5. The Underwriting Blockade

Many seniors are trying to leave Medicare Advantage plans. They want to return to Medigap to see specialists. In 2026, insurers are strictly enforcing medical underwriting. If you have a pre-existing condition, you will be denied. You cannot switch back to a Supplement plan just because you got sick. You are effectively locked out of the specialist network you want. Only a few states offer “Guaranteed Issue” rights to bypass this.

6. Medigap Select Restrictions

Insurers are pushing “Medigap Select” policies to lower premiums. These plans function like a PPO. They limit coverage to specific hospitals and specialists. If you go out of network, Medigap pays nothing. You are responsible for the full Medicare Part A deductible. You might schedule surgery with a specialist thinking you are covered. If their hospital is not in the “Select” network, you face a massive bill.

Check Your Card

Do not assume your card works everywhere like it used to. Read the “Plan” letter on your card. If it says N or Select, ask about extra fees. Ask your specialist if they accept Medicare assignment. In 2026, the wrong letter on your card can cost you thousands.

Did your specialist charge you an “excess fee” this year? Leave a comment below—tell us which Medigap plan you have!