Medigap Plan G Coverage and Costs

Medigap Plan G

Plan G for Medicare Supplement Insurance is widely favored by Medicare members due to its comprehensive coverage of expenses such as coinsurance, copayments, and deductibles that are excluded under Original Medicare also referred to as Medicare Part A and Part B. However, it should be noted that this plan may come with a higher cost compared to other options. To determine whether Plan G is suitable for you, consider the following information.

Plan G of Medigap serves to bridge the gaps left by Medicare coverage, which are the expenses that patients are required to pay out-of-pocket after Medicare covers a portion of the expenses. Among all the Medicare Supplement Insurance plans accessible to new Medicare members, Plan G provides the most extensive coverage for these out-of-pocket expenses.

In most states, there are 10 standard Medigap plans, which are named with letters, but some states such as Massachusetts, Minnesota, and Wisconsin have their regulations. These plans vary in terms of coverage, deductibles, and premiums.

For new Medicare members, Plan G is essentially a substitute for Plan F. Plan F and Plan C are not available for purchase for individuals who became eligible for Medicare after 2019.

It is important to note that Medigap insurance is solely available to beneficiaries enrolled in Medicare Part A and Part B, and it cannot be offered to Medicare Advantage members unless they switch back to Original Medicare.

Medigap plan G Coverage 

Medigap Plan G provides coverage for the following:

  • Hospital costs and Part A coinsurance for up to an additional 365 days after Medicare benefits are exhausted.
  • Part A deductible.
  • Hospice care coinsurance or copayment under Part A.
  • Coinsurance or copayment for Part B.
  • Excess charges for Part B, if healthcare providers charge more than Medicare’s approved amount.
  • First three pints of blood transfusion.
  • Coinsurance for skilled nursing facility care.
  • Emergency medical care services are deemed medically necessary for the first 60 days of international travel. Please note that there are limitations and a deductible applies.

Medicare members who are new to the system can purchase Medigap Plan G for the most extensive coverage. However, there are certain benefits that the most comprehensive Medigap plans, including Plan G, do not cover.

As of 2020, new Medicare members can’t purchase any plan that covers the Part B deductible; however, older plans that include this benefit can still be held by existing members. In addition, Medigap plans, including Plan G, do not cover the following:

  • Prescription drugs.
  • Long-term care refers to non-skilled care received in a nursing home.
  • Dental care.
  • Vision care.
  • Private-duty nursing.

How Much Can Plan G Cost?

Private health insurance companies selling Medigap Plan G are responsible for determining the premiums, despite government regulation of the plans. The prices fluctuate based on multiple factors such as age, location, and tobacco usage. In Atlanta, which is among the average cost regions for popular Medigap plan types in major U.S. metropolitan areas, a non-smoking 65-year-old individual may expect to pay anywhere from $101 to $343 per month for premiums.

Is a High Deductible Plan G the same as Plan G?

No, a High Deductible Plan G is not the same as Plan G. While both plans provide coverage for the same set of benefits, the High Deductible Plan G requires beneficiaries to pay a higher deductible before their coverage begins. Once the deductible is met, the plan covers the same benefits as Plan G.  Therefore, the premiums for a High Deductible Plan G will be lower than Plan G, but the out-of-pocket expenses can be higher. The deductible amount beneficiaries need to meet is 2700$ (this amount is included Part B deductible which price is 226$ in 2023). 

Medigap Plan G Enrollment

Medicare Supplement Plan G requires enrollment in both Medicare Part A and Part B, and pre-existing conditions may affect eligibility depending on when and where you apply. Guaranteed issue rights or the Medicare Supplement Open Enrollment Period allow for enrollment without concern for pre-existing conditions, but otherwise, underwriting health questions may be necessary, potentially leading to coverage denial. To switch from a Medicare Advantage plan to Plan G, returning to Original Medicare is necessary during either the Annual Enrollment or Medicare Advantage Open Enrollment Period. Even then, enrolling in a Medicare Supplement plan outside of the guaranteed issue right window may require underwriting health questions, and pre-existing conditions could lead to coverage denial.

Why is Medigap Plan G a Good Option?

Medigap Plan G is a popular choice among Medicare beneficiaries because it offers comprehensive coverage at a lower cost than some other plans. Here are some reasons why Medigap Plan G is often considered a good choice:

  • Comprehensive coverage: Medigap Plan G provides coverage for all of the same benefits as Medigap Plan F, except for the Part B deductible. This means that Plan G covers most out-of-pocket expenses that Original Medicare doesn’t cover, including copayments, coinsurance, and deductibles.
  • Lower premiums: Medigap Plan G often has lower premiums than Medigap Plan F, which can make it a more affordable option for some people. While you will have to pay the Part B deductible under Plan G, the lower premiums can still save you money in the long run.
  • Stable benefits: Medigap Plan G benefits are standardized across all insurance companies, which means that the coverage you receive under Plan G will be the same regardless of which company you purchase the plan from. This can provide peace of mind that your benefits won’t change from year to year.
  • Freedom to choose providers: With Medigap Plan G, you have the freedom to choose any doctor or hospital that accepts Medicare, without worrying about network restrictions.
  • No referral requirement: Medigap Plan G does not require you to get referrals from a primary care physician in order to see a specialist.

Overall, Medigap Plan G can be a good choice for those who want comprehensive coverage and don’t mind paying the Part B deductible in exchange for lower premiums. However, it’s important to compare plan options and costs to determine which plan best meets your individual needs and budget.

Also, as of December 31, 2019, new enrollees for Medicare Plan F are no longer accepted for those who are eligible for Medicare. Instead, Medicare Plan G has taken its place. This means that if you are enrolling in Medicare for the first time after 2020, Medicare Plan G is the only option available for you to choose from if you want the most comprehensive coverage on the market you can get.

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