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Medicare Plan G: Everything You Need to Know

Medigap Plan G covers 100% of the ‘gaps’ or out-of-pocket costs in Medicare with the exception of the Medicare Part B deductible.

7 mins read
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Considering that there are many different plans under the Medicare umbrella, it’s no surprise that the nuances of each type of Medicare can be challenging to negotiate.  

This article is a comprehensive evaluation of Medicare Plan G, which falls into the category of Medicare Supplement or Medigap plans. It offers full coverage of out-of-pocket expenses under Medicare, except for the Medicare Part B deductible. Let’s understand more about the coverage, cost, enrollment process, and benefits associated with Medicare Plan G.

Introduction to Medicare Plan G

Medicare Plan G is designed to cover some of the gaps in Original Medicare, which includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). These gaps in coverage can result in beneficiaries having to pay for certain services out-of-pocket, either partially or entirely.

Private insurance companies provide Medicare Plan G to cover the cost of those coinsurance and copayments not covered under Original Medicare. It is an attractive option for individuals who want robust coverage without the higher premiums associated with other plans.

What Does Medigap Plan G Cover?

Medicare Plan G provides comprehensive coverage to supplement Original Medicare. Let us take a closer look at its benefits in detail.

Comprehensive Coverage Breakdown

Here’s a breakdown of the services and costs that Medicare Plan G covers:

  1. Medicare Part A coinsurance and hospital costs: Medicare Part A only covers a portion of the costs when you require hospitalization. You are responsible for any applicable coinsurance and additional expenses beyond the coverage limit. Medicare Plan G steps in to cover these excess costs, giving you peace of mind during hospital stays.
  2. Medicare Part B coinsurance or copayment: Plan G also pays the 20% coinsurance or copayment required for Medicare Part B services for most outpatient treatments and doctor visits. 
  1. Blood transfusions: Plan G provides coverage for the first three pints of blood required for a medical procedure, which are not covered under Original Medicare.
  2. Part A hospice care coinsurance or copayment: Plan G pays the required coinsurance or copayment for hospice care that you would otherwise need to pay out of pocket. 
  3. Skilled nursing facility care coinsurance: Medicare Part A covers skilled nursing facility care, but it requires beneficiaries to pay coinsurance for stays that exceed the coverage duration. Medicare Plan G covers these coinsurance costs as well. 
  4. Part A deductible: The deductible for Medicare Part A is the amount that beneficiaries must pay before their Medicare coverage begins. Medigap Plan G takes care of this deductible.
  5. Part B excess charges: Medicare Plan G also covers the excess fees that some doctors might charge over the Medicare-approved amount for particular services. 

Comparison with Other Medigap Plans

Medigap Plan G offers comprehensive coverage to bridge the gaps left by Original Medicare and provide financial protection against out-of-pocket expenses. To reiterate, it covers almost all out-of-pocket expenses related to Original Medicare except the Medicare Part B deductible.

Let’s now examine how Medicare Plan G stacks up against other Medicare Supplement or Medigap plans.

Medigap Plan F

Medigap Plan F is one of the most popular options among Medicare beneficiaries because of its comprehensive coverage, which includes the Medicare Part B deductible. As of 1 January 2020, however, this plan is no longer applicable to new Medicare beneficiaries. Beneficiaries who were eligible before that date can continue to enrol in Plan F. 

Medigap Plan N

Medigap Plan N offers many of the same benefits as Plan G but with cost-sharing for certain services. Beneficiaries with Plan N coverage may need to pay copayments for some doctor visits and emergency room visits. The plan also does not cover excess charges that some providers charge over Medicare-approved amounts. 

Other Medigap Plans

There are several other Medigap plans besides the one discussed above, each offering a unique combination of coverage benefits. They include Plans D, K, L, and M, along with High Deductible coverage options for particular plans. Together, these plans address different gaps in Original Medicare and allow beneficiaries to tailor their coverage to meet specific healthcare needs and budgets.

Cost and Affordability of Medigap Plan G

Let’s look at the premiums and out-of-pocket expenses associated with Medigap Plan G.

Premiums and Out-of-Pocket Expenses

The cost of Medigap Plan G varies depending on various factors, including your age, location, and the private insurance company you choose. Premiums are determined using three different rating methods: community-rated, issue-age-rated, and attained-age-rated. 

Make sure to compare prices from different insurers to find the right options for your needs.

Factors Affecting Plan G Premiums

The cost of Medigap Plan G can vary based on several key factors. 

  1. Age at the Time of Enrollment: Insurance companies use age-rating calculations to determine premiums, which means that the younger you are when you enrol, the lower your initial premium is likely to be. 
  2. Geographical Location: Healthcare costs can vary significantly across different regions, states, and even cities. Areas with higher healthcare expenses typically have higher premiums. 
  3. Premium-Rating Methods: Insurance companies use three different premium-rating methods to calculate Plan G premiums:
  1. Community-rated premiums remain the same for everyone in a given area, regardless of age. 
  2. Issue-age-rated premiums are based on your age at the time of enrollment. The younger the age, the lower the premium. 
  3. Attained-age-rated premiums increase as you age. They may be less expensive than issue-age-rated premiums initially, but gradually go up as you age. 

How to Enroll in Medigap Plan G

Let us look at the Medigap Plan G enrollment process by checking eligibility and other details about the enrollment period. 

Eligibility for Plan G

You must first enrol in Medicare Parts A and B before you can buy Medicare Plan G coverage. You can apply for it as long as you fulfil the basic requirements for Medicare coverage. 

Enrolling During the Medigap Open Enrollment Period

You can enrol in Medicare Plan G during the Medigap Open Enrollment Period (OEP). The period begins on the first day of the month in which you turn 65 and extends for six months from that date.

Private insurance companies cannot deny you coverage or charge higher premiums based on pre-existing conditions during the OEP. That means you have access to Medigap plans regardless of your health status. 

Enrolling Outside of the Medigap Open Enrollment Period

If you miss the OEP, you can still apply for Medigap Plan G at any time. Enrolling outside the OEP, however, does not guarantee the same level of protection.

Insurance companies may review your health status during this time, which could lead to higher premium rates or even denial of coverage based on pre-existing conditions.

Certain circumstances such as losing existing coverage may entitle you to a Special Enrollment Period for Medigap plans. You can enrol in Medicare Plan G without being subject to medical underwriting during this period.

Enrollment Periods and Important Deadlines

The Initial Enrollment Period (IEP) is a seven-month period that begins three months before your 65th birthday, includes the month you turn 65, and extends three months thereafter. Missing your IEP may result in higher premiums or even denial of coverage based on your health status.

Steps to Enrol in Medigap Plan G

Enrolling in Medigap Plan G requires careful consideration of various elements and a comparison of different insurance providers. Follow these steps to ensure a smooth enrollment experience:

  1. Understand Your Eligibility: Before enrolling in Plan G, ensure that you are already enrolled in both Medicare Part A and Part B. 
  2. Research and Compare Insurance Providers: Start by researching reputable insurance companies. Look for providers with a track record of reliability, excellent customer service, and competitive premiums.
  3. Obtain Quotes from Multiple Insurers: Contact shortlisted insurance companies to request quotes for Medigap Plan G coverage. Make sure to compare premiums, additional benefits, and insurer reputation.
  4. Understand Coverage Details: Although Plan G is standardized, there may be slight variations in additional benefits or services provided by each insurer. Ensure your chosen plan meets your specific healthcare needs.
  5. Consider Financial Stability and Customer Reviews: Check the financial stability and customer reviews of the insurance companies you are considering. 
  6. Complete the Application Form: Once you have picked an insurance company, proceed to complete the application form. Provide accurate information about your Medicare enrollment and personal details. 
  7. Review and Submit the Application: Carefully review your application before submitting it to the insurance company. Ensure that all details are accurate and up-to-date. 
  8. Wait for Confirmation and Policy Details: Once you’ve submitted your application, wait for confirmation from the insurance company. The insurance company will provide you with policy details, including coverage start dates, premium payment options, and other relevant information once they process your application. 

Benefits of Medigap Plan G

There are various benefits to using Medicare Supplement Plan G. Here are some of its most compelling advantages: 

Flexibility in Choosing Healthcare Providers

Medicare Plan G gives you the freedom to choose your preferred healthcare providers. As long as the provider accepts Medicare, they should accept your Medigap coverage as well. 

Nationwide Coverage and Access to Healthcare Services

Medicare Plan G offers nationwide coverage. You can access it anywhere in the US, whether you’re close to home or travelling across the country.

No Referrals or Network Restrictions

Medigap plans like Plan G do not require referrals to see a specialist. You can seek specialized care directly without the need for a primary care physician referral. Medigap plans also do not have network restrictions, which means you are free to choose any healthcare provider that accepts Medicare.

Potential for Cost Savings Compared to Original Medicare Alone

Medicare Plan G provides significant cost savings by covering deductibles, coinsurance, and copayments. It helps you avoid unexpected out-of-pocket expenses and ensures healthcare costs remain manageable.

Reach out to CoverRight for more information about Medicare Plan G.   

Frequently Asked Questions

What is the Difference Between Medicare Plans G And F?

Medicare Plans G and F are similar in coverage, with the primary difference being that Plan G does not cover the Medicare Part B deductible. Plan F covers it but is no longer available to new Medicare beneficiaries.

Will My Healthcare Providers Accept Medigap Plan G?

If your healthcare providers accept Medicare, they should accept Medigap Plan G as well. 

Can I Switch from Another Medigap Plan to Plan G?

Switching from one Medigap plan to another is possible, but it may be subject to medical underwriting if done outside the initial enrollment period. Consult with Medicare or approved insurance providers to evaluate your options. 

Does Plan G Cover Medical Expenses When Travelling Abroad?

Medigap Plan G does not provide coverage for medical expenses incurred while travelling abroad. You may want to consider other insurance options if you’re travelling abroad.

Josef Katz

Josef is a digital marketing expert, is a podcast host of PrimeLife and formerly a licensed insurance agent. Josef has had an extensive career across the education, healthcare, insurance and financial services sectors and is passionate about educating consumers.

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