Medicare Supplement Plan G Summary:
This article is an in-depth exploration of Medicare Supplement Plan G, the most comprehensive and popular of all the Medigap plans available to new Medicare patients.
Medicare Supplement Plan G is one of the ten standardized Medical supplement insurance (“Medigap”) plans available in most states. It covers all out-of-pocket costs for Original Medicare services except for the Part B deductible, which is $217, as of 2023.
Medicare Supplement Plan G offers the most coverage of any of the Medigap plans currently available to new Medicare beneficiaries. Plan F covers everything including the Part B deductible, but it’s closed to new Medicare patients.
Overall, Medicare Supplement Plan G is a great match for people looking for the most possible protection against high medical costs in retirement, who can afford the premiums.
What is Medigap?
Medicare is a vital safety net for millions of Americans. But it doesn’t cover everything. Even with Medicare, beneficiaries still face potentially thousands of dollars in deductibles, copays, co-insurance, and other budget-busting out-of-pocket medical costs that can derail your retirement plans.
That’s why nearly all Americans over age 65 who have left the workforce need at least some additional financial protection against the high cost of medical care, over and above Original Medicare (Parts A and B).
Medigap is specialized insurance that you can buy to help fill in the “gaps” Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
Medigap, also called “Medicare supplement insurance,” refers to a system of private specialized insurance policies that help pay for medical services that fall under Medicare Part A and Part B, but that you would otherwise have to pay out of pocket.
Medigap plan benefits are standardized by law. They are identical in almost all states.
Some Medigap plans pay benefits for services not covered under Medicare, such as expenses for Medical care outside of the United States.
Learn more at Medicare.gov
What is Medicare Supplement Plan G?
Medigap Plan G is the most comprehensive and popular Medicare plan currently available to new Medicare beneficiaries.
Medigap Plan G covers all out-of-pocket costs for services normally approved under Medicare Parts A and B, except for your Medicare Part B deductible of $226, as of 2023.
Once you pay that Part B deductible amount, Medicare Supplement Plan G will pay for all additional costs for the year.
Medicare Supplement Plan G Benefits
Once you’ve met your deductible for Medicare Part B (physicians’ charges, lab fees, durable medical equipment, and pints of blood), your Medicare Supplement Plan G will cover all your out of pocket costs for the following:
- Hospitalization deductibles, copays, and coinsurance under Medicare Part A, up to 365 days after your Part A benefits are used up.
- Your Medicare 20 percent Part B coinsurance.
- Skilled nursing care coinsurance
- FIrst three pints of blood
- Hospice copayments and coinsurance
- Excess physicians’ charges under Part B
- 80% of foreign emergency care (up to plan limits)
Enrolling in Medicare Supplement Plan G
Once you’re enrolled in Medicare Parts A and B, it’s possible to enroll in Medicare Supplement Plan G or any other Medigap plan at any time.
But the best time to enroll is during your Initial Enrollment Period, which begins the first month in which you have enrolled in Medicare Part B and you are age 65 or older.
As long as you complete your enrollment during this six month window, you are guaranteed enrollment at the best available price – regardless of your medical history or condition. That’s a valuable benefit called guaranteed issue: During your Medigap open enrollment or other qualified guaranteed issue period, you cannot be turned down, or charged a higher premium for medical reasons.
Guaranteed Issue Rights
During a guaranteed issue period, such as initial open enrollment, insurance companies cannot discriminate against you due to your medical history:
- The insurance company must sell you a policy (provided you can pay the premium)
- They can’t exclude any benefits because you have a pre-existing condition.
- They cannot charge you a higher premium because of your past or present medical condition, history of claims, or any other medical information.
- They cannot impose a “waiting period” before they will pay benefits relating to a pre-existing condition.
- You won’t have to take a medical exam or submit medical records.
Your initial open enrollment period is a one-time event. It cannot be repeated or changed. And once it elapses, you can’t reset the clock!
If you miss your open enrollment, and you don’t qualify for a special enrollment period, Medicare supplement insurance companies will go over your medical records when you apply. They can charge you a higher premium due to medical issues in your file.
And they can even decline your application altogether.
If you’ve recently enrolled in Medicare Part B, and you have already turned age 65 or older, you should make your final Medicare decisions and enroll in a Medicare Supplement, Medicare Advantage, or health sharing plan such as the Medi-Share 65+ plan as soon as possible.
If you miss initial open enrollment, there are other ways you may be able to qualify for a special enrollment period later (See the FAQs below).
Medicare Supplement Plan G and Prescription Drugs
Medigap plans don’t cover prescription drugs, and Medicare Supplement Plan G is no exception. Most Medigap enrollees want additional protection against the skyrocketing costs of prescription drugs.
So if you opt for Medicare Supplement Plan G – or any other Medigap plan, you should consider purchasing a standalone Medicare Part D policy to go alongside your Medigap policy.
You must pay a premium for Part D coverage. However, most people don’t pay the full premium.
Also, if you don’t sign up for Medicare Part D when you’re first eligible, you may have to pay a late enrollment penalty.
Medicare Supplement Plan G Foreign Travel Benefits
Medicare Supplement Plan G is one of several Medigap plans that provides foreign travel benefits. That means they will help you pay for care outside of the United States. If you plan to travel in retirement, either for pleasure, work, or to visit friends and family abroad, this can be an important consideration.
Medigap Plan G covers foreign travel emergency care if it begins during the first 60 days of your trip.
Your Medigap plan will pay 80% of the cost of medically necessary emergency care, over and above an annual deductible of $250.
There’s a lifetime limit of $50,000 for foreign travel emergency coverage.
Not all Medigap plans cover foreign travel emergency care. However, Plans C, D, E, F, H, I, J, M and N include it, in addition to Plan G.
In contrast, Medicare Advantage plans generally do not cover care you need outside of the United States, or provide only very limited coverage.
Medicare Supplement Plan G vs. Plan F
Medicare Supplement Plan G is the second richest and most comprehensive Medigap plan in the system. The most comprehensive is Medigap Plan F, which is identical to Medicare Supplement Plan G, except that it also covers your Part B deductible.
Medicare Supplement Plan F remains very popular among people who have it. Unfortunately, it’s not available to new Medicare beneficiaries. Congress closed Plan F and Plan C to anyone who was not already eligible for Medicare as of January 1st, 2020.
But if you’re looking for a broad and robust Medicare supplement solution with a comprehensive set of benefits, Medigap Plan G is the next best thing.
Medicare Supplement Plan G vs. Plan N
The primary difference is that Plan N does not cover “excess charges.” These are amounts your doctor charges over and above the standard Medicare reimbursement rate for that amount.
So if you go see a doctor for a $5,000 procedure and your doctor charges $6,000,
- Medicare Supplement Plan F will cover the whole $6,000
- Medicare Supplement Plan G will cover the whole $6,000, minus the Part B deductible, if applicable.
- Medicare Supplement Plan N will cover $5,000, minus the part B deductible, if applicable. You’ll get a bill from your doctor for the balance owed.
Plan N may make sense in the eight states that prohibit excess charges for Medicare services. That’s because where doctors are prohibited by law from charging more than Medicare’s reimbursement rate for any given service, there’s no advantage to paying extra for Plan G over plan N.
Currently, the states that don’t allow Medicare excess charges
- New York
- Rhode Island
Emergency Care – Medicare Supplement Plan G vs. Plan N
In most cases, there is no Plan N copay for urgent care clinics. Just for hospital emergency rooms.
High Deductible Medigap Part G Plans
High deductible Medigap plans can be a great money-saving solution for those who have some savings and can afford to pay a higher deductible. If you choose a high deductible Part G plan, your premiums will be much lower than in a standard Medicare Supplement Plan G.
Your high-deductible Plan G premium may vary with your age, sex, and location. But the high deductible Plan G will have a lower monthly premium in every case.
The downside, of course, is the higher deductible. Medicare high-deductible Plan G policies have a deductible of $2,700 as of 2023. The same goes for high-deductible plan F.
If you don’t mind giving up the right to select any provider you choose, you may consider Medicare SELECT. These plans are similar to a standard Medigap plan, except they’re available at a lower premium.
The trade off is that in exchange for a lower premium, you can’t use your Medigap benefits with every provider who takes Medicare patients. Instead, you’ll need to seek non-emergency care with providers who are in your plan’s network.
If you see a provider outside of your carriers’ network for non-emergency services, Medicare will still cover its part of the bill. But you’ll be responsible for the out-of-pocket costs, which will include the Part A deductible, Part B deductible, co-pays, and the 20% co-insurance for Part B services.
You should look at the plan’s network in your area before buying a SELECT plan. If they have a robust network of hospitals, clinics, and providers in your area, and you aren’t attached to seeing any given provider, buying a SELECT plan may make sense.
They aren’t available in all areas.
What is the Average Cost of Medicare Supplement Plan G?
Because Medicare Supplement Plan G is one of the most comprehensive Medigap plans available, second only to Plan F (closed to new Medicare beneficiaries), it also has higher premiums than other plans, all other things being equal.
The monthly cost can vary widely, depending on your carrier.
Also, be aware of how Medicare supplement insurance companies price their policies.
There are three basic approaches:
- Community rated. Everyone pays the same premium, regardless of age.
- Issue age-rated. Your policy is priced based on the age you were when you bought the policy.
- Attained age-rated. Your Medigap policy is priced based on your current age. This means your Medigap premiums will be relatively low when you are 65, and then increase gradually as you get older.
This means that the policy showing the lowest premium now may not be the best deal for you over time. An attained age policy that looks cheap now may become prohibitively expensive as you get older.
The longer you live, the more an attained age-rated policy may work against you.
Conversely, if you are in relatively poor health, an attained-age policy may be the best fit for you.
Medigap Waiting Periods for Pre-Existing Conditions
If you miss your initial open enrollment period, and you don’t qualify for a special enrollment period, your Medigap plan may impose a waiting period on costs related to your pre-existing conditions.
By law, these waiting periods may be for up to six months.
Carriers can exclude coverage for any condition that is treated or diagnosed within six months prior to your Medigap policy becoming effective.
You’ll still get coverage under original Medicare (parts A and B). So they’ll handle most of your big-ticket expenses, even for costs related to your pre-existing condition.
But if you’re under a waiting period and you need care, you’ll still have to pay your Part A deductible and your 20% Part B coinsurance for up to 6 months.
That’s on top of your Part B deductible, which no plan covers other than Plan F, which is no longer available to new Medicare beneficiaries.
Switching to Medicare Supplement Plan G From Other “Creditable Coverage”
If you have a pre-existing condition, most Medigap insurance companies will impose a waiting period before they will pay for costs associated with treating that condition. But there’s an exception:
If you had at least six months of continuous “creditable coverage” before you sign up for your Medigap plan, and you had no more than a 63-day break in coverage, then there won’t be a waiting period. The gaining insurance company must provide coverage for pre-existing conditions from Day One.
So don’t let your coverage lapse!
If you have any questions about what constitutes creditable coverage, or you need to prevent a lapse in coverage, give us a call or make an appointment as soon as possible!
Who Should Consider Medicare Supplement Plan G?
Medicare Supplement Plan G is an excellent solution for any Medicare-eligible person who wants the greatest possible protection against unexpected health care costs, and who can afford the monthly premiums to keep it in force.
If you have limited savings but a reliable retirement income from Social Security and other sources, Medicare Supplement plan G is a powerful tool in your retirement planning tool box. The premium shouldn’t be a problem, but it will protect your nest egg against unexpected shocks from medical bills.
It’s also great if you do a lot of traveling, since other than Medicare SELECT plans, Medigap plans work anywhere in the country, and don’t restrict you to narrow regional care networks.
Plan G also covers up to 80% of medical costs you incur overseas.
Plan G is not a great solution if you will have trouble paying the premium each month. If you let it lapse, you may have trouble getting another policy in place, and may lose some favorable pricing.
If the monthly premiums are a problem for you, you can consider a lower-priced Medigap plan, a low-premium or zero-premium Medicare Advantage plan, or a healthsharing plan such as Medi-Share 65+.
What To Do Now
If you’re ready to enroll in Medicare Supplement Plan G, or you just want to explore the different Medicare strategies available to you, we’re here to help. In fact, we’re here to make it easy for you!
Just click here and make an appointment, and one of our highly-experienced Medicare experts will contact you shortly to go over your options and help you make a decision.
Or you can call us directly at 800-913-3416, and ask to speak with a Personal Benefits Manager.
Don’t wait… In most cases, you only have a limited window of time to enroll in a Medigap plan or Medicare Advantage plan at the best possible price, without having to answer medical questions. You definitely want to make your decision before any applicable initial enrollment periods or open enrollment periods are over!
And don’t worry… Consultations with us are always free. There’s no charge or obligation for using our services.
Medicare Supplement Plan G FAQs
Generally, Medigap plans don’t have “care networks.” You can use your Medicare Supplement Plan G benefits or any other Medigap plan with any provider that accepts Medicare patients.
This is a major advantage for Medigap plans over Medicare Advantage plans. Medicare Advantage plans rely on private managed care organizations to provide Medicare-approved services to patients. They negotiate discounted pricing with care providers in the community. Medicare Advantage plans can be had for very low premiums.
In some cases, Medicare Advantage plans have zero premiums. But the trade off is you lose the ability to select any provider you wish. You have to use a provider or hospital within your plan’s network.
EXCEPTION: Medicare SELECT plans. These Medigap plans impose a network restriction, in exchange for lower pricing. See the section on Medicare SELECT, above, for more information.
Standard Medicare Supplement Plan G policies don’t require you to get a referral before seeing a specialist. Nor do any other standard Medigap plans. This is in contrast to Medicare Advantage plans, which often require you to get a referral from your primary care physician before you can see a specialist and have your plan pay for it.
However, Medicare SELECT plans, including Plan G, typically do require you to get a referral from your PCP before you can use your benefits with a specialist.
Yes. Some carriers offer various discounts and incentives. For example, some Medigap insurance companies will discount prices to attract women, married couples, or non-smokers.
Some carriers also offer discounts for paying premiums electronically, or for holding multiple policies with the same company in your household.
These discounts are worth looking at. When you work with a Medicare Supplement agent, we can help you identify the best carriers offering the best pricing in your area for your specific situation.
If you’re currently in a Medicare Advantage plan and you want to enroll in Medicare Supplement Plan G or any other Medigap plan,
Once your initial enrollment period elapses, there are two times during the year you can switch out of Medicare Advantage:
- Medicare fall open enrollment period (October 15th through December 7th)
- Medicare Advantage Open Enrollment (January 1st through March 31st).
There are several circumstances that may qualify you for guaranteed issue rights, even after your initial open enrollment period has elapsed. For example:
- You move out of your Medicare Advantage plan’s service area
- You lose coverage because your existing Medicare Advantage insurance carrier goes bankrupt
- You lose medical insurance coverage through no fault of your own.
- Your Medicare Advantage plan stops providing care in your area
- Your employer group plan, retiree plan, or COBRA plan is ending and you’re enrolled in Original Medicare, and your plan is a secondary payor (they pay after Medicare pays).
- You’re enrolled in a Medicare SELECT plan and you move out of the SELECT plan’s service area
- You joined a Medicare Advantage plan (or PACE plan) when you were first eligible at age 65 and you want to exercise your trial right to switch to Original Medicare.
- You drop a Medicare Advantage or Medigap policy because they misled you, or because they didn’t follow Medicare rules and regulations.
If any of these circumstances apply, you have up to 63 days to enroll in a new Medicare Supplement Plan G or any other Medigap policy.
Some states require carriers to recognize other circumstances as qualifying for guaranteed issue rights as well.
It’s a great idea to call us or make an appointment as soon as you see any of these situations approaching, so we can go over your options and identify the best one for you.
TIP: Keep any letters, notices, emails, claim denials, or other documents that have your name on them, along with the relevant dates. Keep the postmarked envelopes as well.
You may need to present proof before your new Medigap insurance company will recognize your guaranteed issue right and approve your application without a waiting period or a higher premium.
Don’t allow a break in coverage. You should only cancel your old plan once you have received your new Medigap policy, and you have verified all the information is correct, and you’re getting the protection you thought you were getting
All Medicare supplement policies by law have a 30-day “free look” period. That is, once your policy documents are delivered, you have 30 days to return it.
Medicare Supplement Plan G is the best of the Medigap plans, for those who can afford it. In most cases, it’s better than Medicare Advantage, since it provides more coverage and protection against unexpected copays and coinsurance costs.
But it can be pricey – in some higher-cost areas, Plan G costs more than $300 per month!
If that’s a hardship for you, you may look at some lower-cost alternatives, like less comprehensive Medigap plans, Medicare Advantage, or healthsharing plans like Medi-Share 65+.
Just click here and make an appointment! We’ll go over your needs and budget, and make sure you’re in the plan that best fits your needs, budget, and location!