Medicare, a federally-sponsored health insurance program for people over 65, covers the cost of essential medical services, like hospital stays, surgeries, preventative care, and diagnostic testing. However, you’re still responsible for covering some of the costs, like copays, coinsurance and deductibles.
There is a way to get help if you have Original Medicare. It’s called Medicare supplement insurance or Medigap. Private insurance companies offer 10 different types of Medigap policies to help seniors with their medical bills.
Which Medigap policy is right for you depends on your situation, what you want from a Medicare supplement policy and how often you receive health care.
- Medigap Plan G covers out-of-pocket Medicare Part A hospital costs and Part B expenses.
- Private insurance companies sell Medigap policies like Plan G to help pay expenses for the federal Medicare program.
- Plan G also covers coinsurance for skilled nursing facility and hospice care and out-of-pocket costs for surgeries, diagnostic testing and ambulance transport.
- Medicare supplement Plan G doesn’t cover non-Medicare services, such as vision and dental care or long-term care, or the Part B deductible.
- Some states also have high-deductible Plan G policies that are the same as standard Plan G except you have to pay the deductible before the Medigap policy kicks in.
- Medigap policies aren’t available for people with Medicare Advantage. They are only for people with Original Medicare plans.
What is Medigap?
Medigap is a supplemental insurance that helps pay for those out-of-pocket costs associated with Original Medicare. There are several types of Medicare supplement plans available, which are identified by letters: A, B, C, D, F, G, K, L, M, and N.
All Medigap plans cover Part A coinsurance. Besides that, the policies differ. Here are some areas where the supplement plans differ:
- Part B coinsurance and copayment
- Part A hospice care coinsurance or payment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B excess charges
- Foreign travel emergency care
- Out-of-pocket limit
Medicare Plan G is one of the most common Medigap plans, which offers coverage for many of the out-of-pocket costs you have to pay after receiving treatment. However, Medicare Plan G does have a few limitations.
What is Medicare Plan G?
Medicare Plan G is a supplemental insurance plan that covers the services that Medicare provided through Social Security doesn’t include.
Medigap Plan G covers most of the out-of-pocket costs related to Original Medicare Part A and Part B. That includes copayments, deductibles, and coinsurance.
Recently, Medicare Plan G has gained popularity as a replacement for Medicare Plan F, which was phased out for those new to Medicare starting in January 2020. Plan G covers all of the same out-of-pocket costs as Plan F, except the Plan B deductible. Medicare stopped allowing Medigap plans to cover Part B deductible for newly eligible for Medicare beneficiaries.
One important distinction to make with Medigap is that Medicare Plan G is only available if you have Original Medicare. You cannot purchase Plan G, or other Medigap plans, if you have Medicare Advantage.
You can purchase Medicare Plan G supplemental plans through private insurance carriers.
“Although Medicare Plan G is sold through private insurance companies, the plan covers the same services no matter which insurance company you decide to work with,” says Laura Decker, co-founder and president of the Employee Benefits Division at SSGI, an independent health insurance and employee benefits broker.
How does Medicare Plan G work?
If you have Medicare Plan G, your Original Medicare policy pays for your medical treatment, like doctor’s visits, x-rays, screenings, or lab tests. Then, your Medicare Plan G coverage kicks in to pay for the rest of the out-of-pocket costs that Original Medicare doesn’t cover.
Plan G works with any doctor or hospital that accepts Medicare. A standard Plan G doesn’t have a deductible. So, once you reach your Medicare Plan B deductible for the year, the Medigap policy kicks in. There is also a high-deductible Plan G offered in some states. That deductible is $2,340.
If you want to purchase Medicare Plan G, the best time to do it is during the six-month period after you turn 65. Waiting until a later open enrollment to get a Medigap policy may limit your chances of finding an affordable plan that covers you.
“This is the time that you can apply for Medigap coverage without having to answer any medical questions about pre-existing conditions. If you miss this time, you can be denied for a Medigap plan,” says Decker.
Let’s take a look at what Plan G and high-deductible Plan G cover.
|Standard Plan G||High-deductible Plan G|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes|
|Blood (first three pints)||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes|
|Skilled nursing facility care coinsurance||Yes||Yes|
|Part A deductible||Yes||Yes|
|Part B deductible||No||No|
|Part B excess charge||Yes||Yes|
|Foreign travel exchange (up to plan limits)||80%||80%|
Why do people buy Medicare Supplement Plan G?
Medicare Supplement Plan G is an option for people who want to lower out-of-pocket costs.
“The main reason why people buy Medicare Plan G is to offset out-of-pocket health insurance costs,” says Alex Kronk, author of “A Pocket Guide to Medicare Advantage – 2022” and founder of The Health Plan Critic.
For people who visit the doctor often, having Plan G coverage can almost entirely eliminate their out-of-pocket costs, which can significantly lower health care expenses. It also gives peace of mind if you face unexpected medical bills.
Another reason why people buy Medicare Plan G is that they’re no longer eligible to purchase Plan F. Plan G is nearly identical to Plan F except that it doesn’t cover the Medicare Part B deductible, which is $203.
How much does Medicare Supplement Plan G cost?
Although Medicare Plan G is a supplement rather than a true insurance policy, it has monthly premiums that you must pay to keep your coverage in force.
“For people who are 65, the cost of Medicare Part G starts around $145 a month and will increase each year as the individual ages,” Decker says.
Keep in mind that if you choose a high-deductible Plan G, your premium will be lower than a standard Plan G, but the deductible is higher, so you pay more out-of-pocket costs with high-deductible Plan G.
What does Medicare Supplement Plan G cover?
Medicare Plan G covers almost all of the out-of-pocket costs associated with Original Medicare, including the Part B excess charges. The excess charge lets doctors charge up to 15% higher for Part B medical services than Medicare bills for them.
Medicare beneficiaries would otherwise get hit with that charge, but Plan G helps pay those costs. That said, excess charges are fairly rare and eight states forbid the practice.
“Plan G covers coinsurance on Part A and Part B, the Part A deductible, excess charges, emergencies during foreign travel, and more. The caveat is that the charges must be for Medicare-approved services,” says Scott Maibor, managing director of Senior Benefits Boston.
In addition, Plan G covers coinsurance for skilled nursing facilities and hospice care, as well as blood (first three pints). Plan G also helps with out-of-pocket costs for surgeries, diagnostic testing and ambulance transport.
What doesn’t Medicare Supplement Plan G cover?
Although Medicare Plan G offers comprehensive coverage for out-of-pocket costs, there are some things that it won’t cover. Most notably, Plan G doesn’t cover the Medicare Part B deductible.
Maibor explains that, in short, Plan G doesn’t cover non-Medicare services. Examples of things that aren’t covered include routine vision and dental care, hearing aids, long-term care, annual physicals, and acupuncture.
Another thing that Plan G doesn’t cover is prescriptions. If you want prescription drug coverage, you can purchase Plan D coverage, which pays for many common prescription medications.
Frequently Asked Questions
Which is better: Medigap Plan F or G?
Medicare Plan F and Plan G are similar, so you might be wondering which one is better.
“Plan F offers more comprehensive coverage but is no longer available to newly-eligible supplemental Medicare enrollees (starting in 2021). Plan G is the next best, which is available to all eligible enrollees but offers slightly less coverage,” Kronk says.
Ultimately, Plan F is the better option in terms of coverage, but you can no longer purchase Plan F unless you’re already enrolled. Plan G is just as good and is similarly priced to Plan F.
What is included in Medicare Supplement Plan G?
Medicare Plan G covers most out-of-pocket costs associated with Original Medicare. It covers coinsurance, copayments, deductibles, and excess charges.
It also covers foreign travel emergency care, up to your plan’s limit.
What is the monthly premium for Medicare Part G?
The monthly premium for Medicare Part G depends on a few factors, including the insurance company. Some insurance plans are also based on age, while others are not.
Additionally, the cost of Plan G can depend on where you’re located. The cost of Medicare Part G starts at around $145 per month.
What is the best Medicare Supplement Plan G for 2021?
Before you purchase Medicare Plan G, it’s important to compare a few providers that offer this type of coverage.
Top-rated health insurance companies that sell Plan G include Humana, Cigna, Mutual of Omaha, and Blue Cross Blue Shield. These providers allow you to get a personalized rate quote online to easily see which company is the cheapest.
Find out which Medigap policies are available in your area by going to the Medicare site. you can enter your Zip code and find out the plans in your area.