Medicare Supplement Plan G: What you need to know about the Medigap policy

Medicare, a federally-sponsored health insurance program for people over 65 and those with certain disabilities such as end-stage renal disease or ALS, usually 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 several 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. 

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 (no longer available for newly eligible recipients), 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.

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.

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 $233.

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.

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.

Disclaimer: 

Insure.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply. 

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