What is Medicare Supplement Insurance Plan G? A Medigap policy that will become your favorite!

Original Medicare doesn’t pay all the costs for covered health care services and supplies. Medicare Supplement Insurance (also referred to as Medigap) policies sold by private insurance companies help pay some of the remaining health care costs. This includes Medicare copayments, coinsurance, and deductibles. Members pay a monthly premium to the insurance carrier for the Medigap policy, in addition to their monthly Part B premium they pay to Medicare.

Medicare Supplement Plan G is one of 10 Medigap plans that provides coverage for certain out-of-pocket expenses not covered by Original Medicare. Medigap Plan G is one of the more complete Medigap plans, second only to Medigap Plan F in terms of coverage. It covers most Medicare Part A and Part B coinsurances and copayments with the exception of Medicare Part B deductible.

Since insurers can no longer offer Medicare Part F to enrollees who become eligible for Medicare after 2020, Plan G is the most complete Medigap policy for first-time enrollees. Here’s what you need to know about the coverage and what your best moves are to protect your finances against health care costs now and in the future.

What is Medigap Plan G and who is it available for?

An enrollee signs up for Original Medicare through the Social Security office. But they purchase a Medigap policy from a licensed insurance agent. The Medigap Plan G monthly premium varies from insurer to insurer. But all must follow certain guidelines set by the Centers for Medicare & Medicaid Services (CMS).

Medigap G plans are for those enrolled in Original Medicare (Part A and Part B) and looking for additional coverage. If you’re not enrolled in Part A and Part B, a Medigap policy is not available for you.

How does Medicare Supplement Insurance work?

Original Medicare pays costs first. Medigap policies cover the gaps in coverage with Original Medicare. Medigap pays any remaining costs after the member pays their annual Medicare Part B deductible which is $240 for 2024.

What does Medicare Plan G cover?

Medigap Plan G offers a lot of coverage. But it’s also one of the more expensive Medigap options.

Does Medigap Plan G cover prescriptions?

No, Medigap policies do not include prescription drug coverage. If you’re interested in getting prescription drug coverage, you need to enroll in a Medicare prescription drug plan (Part D). 

Does Medigap Plan G cover eye exams?

No, Medigap policies do not include routine vision care in their basic benefits just as Original Medicare does not. If you’re interested in getting vision coverage through your Medigap Plan G carrier, check with your insurer to see if a standalone policy is available. 

How does Medigap Plan G cover hospital costs?

That monthly Medigap Plan G premium goes a long way toward reducing hospital costs. This Medigap policy covers all hospital expenses, including the Medicare Part A hospital deductible which is $1,632 for 2024. When a hospital stay goes for longer than 60 days, there is a daily copay that can be quite expensive. Plan G covers those copays and also provides an additional 365 days in the hospital after Medicare benefits run out.

Plan G also covers costs from care you receive at a skilled nursing facility.

Services not included

Medigap Plan G does not cover:

• Cosmetic Procedures.
• Long-Term Care: Plan G does not cover long-term care, such as nursing home care or in-home health services.
• Acupuncture.

Medigap costs 

The cost of a Medigap policy varies depending on the insurer and the specific benefits included in the policy. In general, Medigap policies have a monthly premium (the monthly amount you pay for your insurance). And some may have out-of-pocket costs (the amount you pay when you receive care).

Key factors that affect Medigap costs:

• The insurer you choose: Private insurance companies offer Medigap policies, so the cost of a plan may vary depending on the insurer.
• The benefits included in your plan: Medigap policies typically cover things like copayments, coinsurances, and deductibles. Some policies may also offer coverage for things like foreign travel, emergency care, and excess charges.
• The deductible: Some Medigap policies have a deductible which an enrollee pays out-of-pocket before the Medigap policy begins to pay for covered services.
• Your location: Medigap policies are nationwide. But the cost of a plan may vary depending on the state or county of residence.
• Whether you smoke: As with all insurance plans, Medigap monthly premiums may be higher for smokers than non-smokers.

Medigap Plan G deductible

Medigap Plan G does not have its own deductible. Instead, you pay Medicare Part B deductible.

Does Medigap Plan G cover the Medicare Part B deductible?

No, Plan G does not cover the Medicare annual Part B deductible. You pay it in addition to your monthly Medigap Plan G monthly premium.

Why a Medigap policy is crucial?

Original Medicare doesn’t pay for all of the costs for covered health care services and supplies. A Medigap policy helps pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. For Part B services, a member usually pays a 20% coinsurance of the Medicare-approved amount after they meet their deductible.

Currently, there are 10 standardized varieties of Medigap policies. All go by letters of the alphabet (A, B, and so on). All plans with the same letter offer the same coverage in most states (the exceptions are Massachusetts, Minnesota, and Wisconsin). And monthly premiums vary by insurer. You can use this tool to compare prices.

Medigap Plan G pros and cons 

Original Medicare is one of the leading health insurance programs in the United States. Medigap Plan G is one of the most popular types of Medicare Supplement Insurance plans. Members love Plan G because of all the advantages they offer, such as: 

• Coverage. Plan G covers a wide range of costs, including hospital stays, skilled nursing facility care and more. They are considered to be the most comprehensive Medigap plan.
• Many plans cover foreign travel emergencies. If traveling outside of the U.S., Plan G may cover up to 80% of expenses.
• More affordable than Medicare Advantage plans. Plan G can be more affordable than some Medicare Advantage plans, making them a great option for budget-conscious enrollees.
• No provider networks. Members can see any Medicare-approved health care provider or facility that accepts Medicare anywhere in the U.S.
• No referrals. Members can see any specialist who accepts Medicare anywhere in the U.S. without a referral from a provider.
• No pre-authorizations. Members can receive Medicare-approved services without pre-authorization.

On the other hand, it’s worth mentioning Medigap Plan G does have disadvantages.

• Part B deductible is not covered. Members must pay it.
• Application can be denied. Like with all Medigap plans, there’s no guarantee a person will get a Plan G policy. To do so, individuals must apply during the Medigap Open Enrollment Period or guaranteed issued rights enrollment window.
• It is not a cheap policy. Due to such extensive coverage, Plan G is an expensive Medigap policy. The costs can go up yearly due to inflation or age. (Members tend to pay more as they get older.) The average increase is between 5 and 8% each year.
• No prescription drug coverage. Members need to purchase a separate Medicare Part D plan to cover prescription drugs.
• No dental, vision or hearing coverage. Members need to purchase a separate policy if they want dental, vision or hearing coverage.

Medigap Plan G vs. Medicare Advantage

It’s important to note that Medicare Advantage plans (also known as Part C plans) are different from Medigap policies. Private insurance companies offer Medicare Advantage plans as an alternative to Original Medicare for Medicare coverage.

Medicare Advantage (MA) plans typically have lower monthly premiums than Medigap Plan G. But they may also have limited coverage. MA plans often use doctors and other providers who are in a plan’s network and service area. MA plans that allow members to see out-of-network providers typically charge more for those services.

You cannot have a Medigap policy with a Medicare Advantage plan. Medigap policies only help pay out-of-pocket costs with Original Medicare.

You must have both Medicare Parts A & B to be eligible to join an MA plan. Members may pay a monthly premium for their MA plan in addition to their monthly Medicare Part B premium. (Most MA plans have low or no monthly premium.)

How to know whether the Medigap Plan G is right for you? 

Health care is not something to leave to chance. For some older Americans, there can be many unknowns about their future health care needs. So how do you know if a Medigap Plan G is right for you? 

It should be clear by now that it’s a great option for those who want complete coverage at a reasonable price. If you’re looking for an insurance policy that covers a wide range of health care costs, Medigap Plan G rates at the top of the list. But whether Plan G is right for a person depends on their individual needs and circumstances. If you are uncertain about whether it is right for you, speak with a licensed insurance agent. They can help you make a decision that’s right for your unique situation. You can also use our Medicare Personal Shopper for help with choosing a plan that works for your needs.

Questions about Medicare?

Shoot us an email: Attain Health.