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What Does Medigap Plan G Cover?

Female Doctor Explaining Report To Patient In Clinic what Medigap Plan G covers

Medigap Plan G – Plan G is one of ten Medicare supplements available to Medicare beneficiaries. It’s also one of the most popular supplements since it takes care of nearly all out-of-pocket medical expenses leftover from Original Medicare.

What is a Medigap plan?

Medigap plans are supplemental insurance that Medicare beneficiaries can purchase to help pay for the costs that remain after Original Medicare pays. See, Original Medicare (Parts A and B) does not cover 100% of your medical costs. Unless you have a Medigap plan, you’ll be left with deductibles, copayments, and coinsurance costs. In addition, there are no out-of-pocket limits on what you might be responsible for in a given year.

To give you an idea of what Plan G covers, let’s review your Part A and B costs.

Each part of Medicare has a deductible. In 2022, the Part A deductible is $1556, and the Part B deductible is $233. The Part B deductible must only be paid once per year, but the Part A deductible is based on a “benefit period.” A benefit period starts when you get admitted to the hospital and ends when you’ve been out of the hospital for 60 days. So, you could pay that amount multiple times in one year.

Next, you’ll have copayments and coinsurance costs. Under Part A, your cost is determined by how many days you’ve been in the hospital. Other than your deductible, you won’t pay anything for your first 60 days. From day 61 to day 90, you’ll pay $389 per day. Starting on day 91, you’ll be responsible for the full cost of your room and board expenses. (Unless you have any of your 60 lifetime reserve days left. If you do, your cost will be $778 per day.)

Under Part B, your coinsurance generally works as an 80/20 split, with you paying for 20% of the cost. You can see how all these expenses can add up quickly and why so many people enroll in a Medicare supplement insurance plan.

What are the benefits of Plan G?

Now that you know what costs are left after Medicare pays, let’s look at your Plan G coverage.

Plan G includes benefits for:

  • Part A deductible
  • Part A coinsurance and an additional 365 days of hospital costs
  • Skilled nursing facility care coinsurance
  • Part A hospice coinsurance/copayment
  • Part B coinsurance/copayment
  • Part B excess charges
  • First 3 pints of blood
  • 80% of foreign travel emergencies

You may have noticed that the only thing not listed here is the Part B deductible. If you enroll in Plan G, that is the only out-of-pocket cost you’ll have all year.

What isn’t covered by Plan G?

In addition to the Part B deductible, there are some other coverage gaps you should consider before enrolling in Plan G. Medicare supplements do not include coverage for any service not also covered by Original Medicare.

What does that include? Prescription drug coverage is not included in Medicare supplements. You will need to enroll in a separate Part D drug plan to get prescription drug coverage. Whether you are taking medications or not, it’s important to enroll in a Part D plan so that you are not penalized later.

Other than that, the other services beneficiaries miss in a Medigap plan are dental, vision, and hearing care. There are very limited services covered by Part B, but only in cases when there is a medical condition present like glaucoma. Otherwise, there are no benefits for routine services. Some people choose to pay for these things as they need them, while others enroll in a DVH (dental, vision, hearing) policy to reduce their spending.

Old couple with a car at the beach happy with Medigap Benefits
You can use your Plan G with any doctor or healthcare provider that accepts Medicare

Which doctors accept Plan G?

You can use your Plan G with any doctor or healthcare provider that accepts Medicare. This wide acceptance is another advantage to having a Medicare supplement. Regardless of which insurance company you enroll with, your Plan G can be used just about everywhere. About 96% of providers accept Medicare assignment, so you’ll have coverage all over the United States.

This is in stark contrast to Medicare Advantage Part C plans. While these types of Medicare plans also over great coverage and benefits, you will be limited to a certain network of providers, which some people find too limiting.

Who can enroll in Plan G?

Anyone who is enrolled in Part A and Part B can enroll in Medicare supplement Plan G. This is one reason why Plan G has become so popular. Prior to 2020, most Medicare beneficiaries were choosing Plan F, which offers a little more coverage than Plan G. (It pays the Part B deductible.)

However, no one who turns 65 after January 1, 2020, is allowed to enroll in Plan F.

If you are enrolling in Plan G during your Initial Enrollment Period (IEP), which is a 7-month window around your 65th birthday, you’ll have guaranteed issue rights to Plan G. What that means is that you will not have to pass medical underwriting to get Plan G, nor will your premiums be higher due to current or past health conditions. These same guaranteed issue rules would apply to you if you delayed Medicare enrollment past the age of 65 because you were covered under another credible plan.

Outside of your IEP, you may not be able to get Plan G without going through medical underwriting. Some states have less strict rules around this issue, so you’ll need to ask your licensed insurance agent about which rules apply in your state.

How much does Plan G cost?

The average cost for Plan G falls between $120 and $200, but there are quite a few factors that go into that number. The insurance company will consider your age, gender, and tobacco use, as well as where you live.

In addition, some insurance companies have higher rates than others, which is why it’s important to have your insurance agent shop at different carriers. The benefits of Plan G remain the same no matter where you buy it, so you might as well find a company with competitive rates!

How To Enroll In Medigap Plan G

Whether you’ve decided to enroll in Plan G or you have more questions, our Medicare advisors are ready to help. We can educate you on all your Medicare options so that you can choose the type of Medicare plan that makes the most sense for you.

There is no cost to use our services, so give us a call today and schedule an appointment with one of our Medicare experts!

Frequently Asked Questions

Which is better? Plan G or Plan F?

Plan F offers more comprehensive coverage, but it does come with higher premiums that often cost more than the extra benefits. Plus, Plan F is only available to people who turned 65 before January 2020.

Is Medicare Advantage better than Plan G?

There is never one-size-fits-all when it comes to Medicare plans. Plan G and Medicare Advantage are very different, and you’ll need to consider how each one works before deciding which is best for you.

Does Plan G cover dental?

No, you’ll need a separate dental insurance policy if you want dental coverage.

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