Many retirees enrolled in Original Medicare quickly realize there are many out-of-pocket costs associated with Medicare. From copays to deductibles, you might get stuck paying quite a bit when you visit your healthcare provider. In addition, Medicare Part B has coinsurance amounts that you will need to pay when you receive service. A Medigap plan can help pay for some of these 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 items not paid for by your Medicare coverage. There are ten different options when it comes to Medicare Supplement plans, and Plan G is one of the best available. 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 will need to pay your Medicare Part B deductible and copays when you receive one of these covered services. Medigap Plan G policies are sold and administered by private insurance companies. Medigap coverage is standardized in 47 states, so these insurance companies follow the state rules when it comes to coverage details. Only Minnesota, Massachusetts, and Wisconsin set their own rules when it comes to Medigap coverage.
What Medicare Supplement Plan G Covers
You already know that Medicare supplement insurance plans help fill the gap in Medicare coverage to pay for items not covered by Original Medicare. But what exactly does Plan G pay for? Medigap Plan G and Medigap Plan F were considered to be 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.
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 and deductibles. The first three pints of blood for a transfusion will be covered by Plan G, and skilled nursing facility care coinsurance will be paid by Plan G. Blood transfusions after the first three pints are covered by Medicare Part A.
A Medigap Plan G policy will also cover Medicare Part B coinsurance or copayment amounts for outpatient services and medical equipment. 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. 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 you might be out of luck if you have a foreign travel emergency. These can often be extremely expensive, and Medigap Plan G coverage can help cover these costs. This can be especially beneficial if you travel outside the United States on a frequent basis.
Services Not Covered By Medicare Plan G
Now that you know what Plan G will cover let’s discuss some of the things that it does not cover. One of the most obvious items that Plan G will not cover is your Medicare Part B deductible. In fact, Medigap plans cannot legally cover your Part B deductible any longer. This took effect in 2020, and Medigap plans sold to new members can no longer cover this expense. If you were enrolled in a Medigap plan that covered your Part B deductible prior to 2020, then you will be allowed to keep that plan.
Next, Plan G does not cover prescription drug costs. You will need to be enrolled in a Medicare Part D plan to receive prescription drug plan coverage, and your Plan G will not assist with any of the out-of-pocket costs associated with that coverage. Similarly, Plan G does not provide payment assistance for long-term care. If you require a stay in an assisted living facility, you will need to pay for that care out of your own pocket. You will also need to pay for private duty nursing on your own. Plan G coverage does not include private duty nursing.
Finally, Plan G does not include any dental or vision benefits. If you need dental care or need an eye exam, neither Original Medicare nor Plan G will cover these costs. Some Medicare Advantage Plans do provide dental and vision coverage; however, you cannot be enrolled in both an Advantage plan and a Medigap Plan G.
Medicare Plan G Costs For 2023
Since most people exploring these plans are receiving Social Security benefits, they often want to know the cost associated with these plans. The cost of Medigap insurance varies 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 different factors. Your insurance company will examine things like whether or not you smoke or vape, your location, your 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 $100 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 $152 per month for Plan G coverage. If you choose to enroll in the high-deductible Plan G, you can expect to pay a premium of around $70 per month.
— Plan G Deductibles
Most Plan G policies have a zero deductible. This means that they will start paying for items not covered by Medicare right away. However, Plan G is available in a high deductible plan as well in some states. This means that you must meet your deductible amount before the plan starts to pay anything. In 2023, the Plan G high deductible is $2,700. Remember that the high deductible plan is not available in all areas. You can expect to pay lower premiums on the high deductible plan as a tradeoff. 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 that you would normally need to pay when using only 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 that they do not have to pay for them out of their own pocket.
Eligibility & Enrollment For Medicare Plan G
So, who is eligible for a Plan G Medigap policy, and how do you enroll? Generally, if you are eligible for Original Medicare, then you can likely sign up for Plan G coverage. This means that you need to 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, there is no work credit requirement for Plan G. However, remember that you might be paying a Part A and Part B premium in addition to your Plan G premium in that case.
For younger individuals, you can become eligible for Medicare 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. Once you determine that you are eligible for Plan G, how do you enroll?
You can enroll in Medigap Plan G at many different times, 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 that your premium is likely to increase based on your overall health and wellness, plus your pre-existing conditions.
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 you are enrolled in Original Medicare. If you are already on a Medicare Advantage Plan, then you can switch your coverage to Plan G instead during Medicare’s annual open enrollment period or the Medicare Advantage selection period. To learn more about these Medigap Medicare programs, you can visit Medicare.gov.
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 are no longer allowed to cover the Plan B deductible. While Plan F covers this deductible, new Plan F coverage can no longer be sold. So, if you are enrolled in Original Medicare and need help paying for copays and coinsurance amounts, then Plan G coverage might be right for you.
Frequently Asked Questions
What is the maximum out-of-pocket for Medicare Plan G in 2023?
Medigap plans do not have a maximum out-of-pocket amount. These plans pay for items not covered by Original Medicare. When it comes to Plan G, your Medicare Part B deductible is not covered. This means that you would be required to pay the 2023 Part B deductible of $226 when receiving Part B services. In addition, you might choose to enroll in the high-deductible Plan G coverage. This amount will be $2,700 in 2023. So, 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. There are no copays or coinsurance amounts associated with the coverage, so the deductibles are essentially your out-of-pocket maximum for the coverage.
What is the difference between Medicare Plan G and Medicare Plan F?
Plan G and Plan F are very similar. In fact, 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. If you were already enrolled in Plan F prior to this date, you could continue your coverage.