Many retirees enrolled in Original Medicare quickly realize many out-of-pocket costs are associated with Medicare. When you visit your healthcare provider, you might get stuck paying quite a bit, from copays to deductibles. In addition, Medicare Part B has coinsurance amounts that you must pay when you receive service.
A Medigap plan can help pay for some expenses that Medicare does not cover. Medigap Plan G options are some of the most comprehensive Medigap plans available, and they can help tremendously with your out-of-pocket costs. So, just what is Plan G, and how does it work? Keep reading as we give you all the details.
What Is Medicare Supplement Plan G?
Medicare Supplement Plan G is a Medigap plan for those enrolled in Original Medicare that helps cover expenses not paid for by your Medicare coverage. There are ten options for Medicare Supplement plans, and Plan G is one of the best available.
Supplements Medicare Part A & B
As you know, Medicare Part A is considered hospital insurance. It covers inpatient care and hospital stays. However, Part A has coinsurance amounts that must be paid. In addition, Part A only pays for a certain number of days in the hospital during each benefit period. A Part G plan can help fill the gap and cover those expenses.
Similarly, Medicare Part B is medical insurance that covers doctor visits, lab tests, and preventive services. However, you must pay your Medicare Part B deductible and copays when you receive one of these covered services.
Private Insurance Plan
Medigap Plan G policies are sold and administered by private insurance companies. Medigap coverage is standardized in 47 states, so these companies follow the state rules regarding coverage details. Only Minnesota, Massachusetts, and Wisconsin set their own rules regarding Medigap coverage.
KEY TAKEAWAYS
- Medigap Part G is one of ten plans offered through private insurers to help cover some of the costs associated with Original Medicare.
- Medicare Supplement Plan G will pay Part A deductible, Part A and B coinsurance and copays, blood for transfusions, and excess fees from providers and medical services in foreign countries.
- Medicare Plan G requires a monthly premium, which varies based on certain conditions. Most plans carry a zero deductible; however, some locations have an option for a high-deductible plan with a lower premium.
What Medicare Supplement Plan G Covers
You already know that Medicare supplement insurance plans help fill the gap in Medicare coverage to pay for expenses not covered by Original Medicare. But what exactly does Plan G pay for? Medigap Plan G and Medigap Plan F are considered the most comprehensive Medigap plans on the market. As of January 2020, Plan F is no longer available to new Medicare enrollees, so Plan G is now one of the best options available. Here is what it covers.
Deductibles and Coinsurance
First, Plan G will cover your Medicare Part A deductibles and coinsurance. It will even pay for hospital stays up to 365 days after your Medicare benefits are used. In addition to hospital benefits, Plan G also pays for hospice care coinsurance, deductibles, and skilled nursing facility care coinsurance.
A Medigap Plan G policy will also cover Medicare Part B coinsurance or copayment amounts for outpatient services and medical equipment.
Blood Transfusion
Plan G will cover and pay for the first three pints of blood for a transfusion. Blood transfusions after the first three pints are covered by Medicare Part A.
Fees Above Medicare Approved Amounts
You probably already know that Medicare Part B only covers amounts up to the Medicare-approved amount. In some cases, your service provider might charge more than this. Usually, you would be responsible for paying the difference. However, if you have a Medigap Plan G policy, it will pay for Part B excess charges up to a certain amount.
Medical Services in Foreign Countries
Your Plan G policy will also pay for emergency medical services in foreign countries, in most cases, up to your plan limits. Typically, Original Medicare does not pay for services outside the United States so that you might be out of luck with a foreign travel emergency. These can often be extremely expensive, and Medigap Plan G coverage can help subsidize the cost. This is especially beneficial if you travel outside the United States frequently.
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Services Not Covered By Medicare Plan G
Now that you know what Plan G will cover, let’s discuss some things it does not cover.
Medicare Part B Deductible
One of the most prominent items that Plan G will not cover is your Medicare Part B deductible. Medigap plans cannot legally cover your Part B deductible anymore. This took effect in 2020, and Medigap plans sold to new members can no longer cover this expense. If you enrolled in a Medigap plan that covers your Part B deductible before 2020, you will be allowed to keep that plan.
Prescription Drugs
Next, Plan G does not cover prescription drug costs. You must be enrolled in a Medicare Part D plan to receive prescription drug coverage, and your Plan G will not assist with any out-of-pocket costs associated with that coverage.
Long-Term Care
Similarly, Plan G does not provide payment assistance for long-term care. If you require a stay in an assisted living facility, you must pay for that care out of your pocket. You will also need to pay for private-duty nursing on your own. Plan G coverage does not include private-duty nursing.
Dental or Vision
Finally, Plan G does not include any dental or vision benefits. Neither Original Medicare nor Plan G will cover these costs if you need dental care or an eye exam. Some Medicare Advantage Plans provide dental and vision coverage; however, you cannot be enrolled in an Advantage plan and a Medigap Plan G.
Medicare Plan G Costs
Since most people exploring these plans receive Social Security benefits, they often want to know the cost associated with them. Medigap insurance costs vary based on a few factors, like your age and location. Here are some of the most common costs associated with Medigap Plan G coverage.
Plan G Premiums
Just like with most insurance coverage, Plan G requires a monthly premium. Beneficiaries can expect the amount of their premium to vary based on several factors. Your insurance company will examine whether you smoke or vape, your location, gender, existing health conditions, and other items to determine the appropriate premium rate.
On the low end, you can expect Plan G to cost at least $112 per month. This is for a low-risk individual living in an area with lower health care expenses. However, the premium can go up to nearly $500 per month for someone with a higher health risk living in a more expensive area, like New York. On average, you can expect to pay around $184 monthly for Plan G coverage. If you choose to enroll in the high-deductible Plan G, you can expect to pay a monthly premium of around $82.
Plan G Deductibles
Most Plan G policies have a zero deductible. This means they will start paying for items not covered by Medicare immediately. However, Plan G is also available in a high-deductible plan in some states. This means you must meet your deductible before the plan starts to pay anything.
In 2024, the high deductible for Plan G is $2,800. Remember that the high-deductible plan is not available in all areas. As a tradeoff, you can expect to pay lower premiums on the high-deductible plan. You can always get the help of a licensed insurance agent to assist with selecting the right plan for your situation.
Plan G Copayments
There are no copayments associated with Plan G coverage. That is one of the most significant benefits of enrolling in Plan G. It covers the copayments you usually need to pay with Original Medicare. Original Medicare includes several cost-sharing methods, like utilizing copayments and coinsurance amounts. Plan G exists to help people pay for those items so they do not have to pay for them out of their pocket.
TIP
Most Medigap plans are standardized across states, making them easier to compare. To determine if a Medigap plan is right for you, it helps to balance the various coverage levels with the total costs of each plan.
Eligibility & Enrollment For Medicare Plan G
So, who is eligible for a Plan G Medigap policy, and how do you enroll?
Eligibility Requirements
Generally, if you qualify for Original Medicare, you can likely sign up for Plan G coverage. This means that you must be 65 or older and have been a U.S. citizen or legal permanent resident for at least five years.
While you need at least 40 work credits to receive premium-free Part A coverage, Plan G has no work credit requirement. However, remember that you might be paying a Part A and B premium in addition to your Plan G premium.
You can become eligible for Medicare at a younger age after receiving Social Security disability benefits for 24 months. Those who are diagnosed with ALS or ESRD can also qualify for Medicare. Those individuals will typically also be eligible for Plan G coverage.
Enrollment Process
Once you determine that you are eligible for Plan G, how do you enroll? You can enroll in Medigap Plan G at any time, although the best time to enroll is during the Medigap general enrollment period.
This period starts when you turn 65 and enroll in Medicare Part B for the first time. If you enroll during this initial six-month period, you will pay the same premium for Plan G regardless of your health history. However, if you wait to sign up, then you will be subject to health insurance underwriting. This means your premium will likely increase based on your overall health and wellness, plus your pre-existing conditions.
Medigap Plan G Restrictions
You should also know that you cannot enroll in both Plan G and a Medicare Advantage Plan. You may only enroll in Plan G if enrolled in Original Medicare. Suppose you are already on a Medicare Advantage Plan. In that case, you can switch your coverage to Plan G instead during Medicare’s annual open enrollment or Medicare Advantage selection period. You can explore Medicare’s website to learn more about these Medigap Medicare programs.
The Bottom Line
When it comes to Medigap, there are many different plan options. This includes Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. Plan G is one of the most comprehensive plans available, and it can help you pay for many out-of-pocket expenses associated with your Original Medicare coverage.
It will pay for almost everything not covered by Medicare except for your Plan B deductible. As of 2020, Medigap plans can no longer cover the Plan B deductible. While Plan F covers this deductible, Plan F coverage is no longer available.
So, if you are enrolled in Original Medicare and need help paying for copays and coinsurance, Plan G coverage might be right for you.
Frequently Asked Questions
Medigap plans do not have a maximum out-of-pocket amount. These plans pay for items not covered by Original Medicare.
Regarding Plan G, your Medicare Part B deductible is not covered. You must pay the 2024 Part B deductible of $240 when receiving Part B services. In addition, you might choose to enroll in the high-deductible Plan G coverage. This amount will be $2,800 in 2024.
If you select this plan, you would need to meet this deductible before your Plan G coverage starts to pay for items not covered by Medicare. No copays or coinsurance amounts are associated with the coverage, so the deductibles are essentially your out-of-pocket maximum for the coverage.
Plan G and Plan F are very similar. There is only one key difference between the two.
- Plan G does not cover your Part B deductible, while Plan F does cover it.
However, as of 2020, Plan F is no longer available to new Medicare enrollees. The law now prevents Medigap plans from covering the Part B deductible, so new Plan F coverage cannot be sold. You could continue your coverage if you were already enrolled in Plan F before this date.
No, you cannot purchase both a Medicare supplement plan and a Medicare Advantage plan. These two types of plans are exclusive of each other. Similarly, you cannot buy a Medicare supplement plan if enrolled in both Medicare and Medicaid.
You can, however, switch from a Medicare Advantage plan to a Medicare supplement plan or vice versa. Some situations allow you to change from one plan to another without penalty; however, you will generally not have guaranteed issue rights if you decide to switch from one plan to another.
There is technically no penalty for not enrolling in a Medicare supplement plan. However, if you enroll in a plan later, you could pay substantially higher monthly premiums. If you enroll in a plan during your open enrollment period, you can purchase any plan available in your area for the lowest premium amount.
However, waiting until later means the insurance company can perform full medical underwriting on your application. Any current or previous health conditions can cause the insurance company to charge you more for coverage or even deny your coverage altogether.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
