Medicare Plan G, or Medigap Plan G, is a Medicare Supplement Insurance plan. It helps cover some extra charges from Medicare Part A and Part B.
Medicare is a federal health insurance plan. Part A works for hospital insurance, while Part B covers medical expenses. Everyone is eligible for Medigap Plan G during the Medigap Open Enrollment Period.
After the open enrollment period, a plan may cost more or, an insurer may deny it, depending on a person’s health.
In this article, learn about Medigap Plan G, who is eligible, coverage, costs, and enrollment.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medigap Plan G is a type of Medicare Supplement Insurance. Private companies offer these insurance plans to help pay for gaps in Original Medicare. These gaps include deductibles, coinsurance, and copayments.
The federal government standardizes Medigap plans, meaning every Medigap Plan G will offer the same basic benefits.
However, some private insurance companies may offer additional plan benefits. They can decide which policies to offer in a person’s resident state. They do not offer all plans in all states and do not have to provide Medigap Plan G.
Certain states standardize their Medigap plans in different ways. These include:
People need to compare Medigap Plan G benefits before choosing their plan.
Everyone is eligible for all Medigap policies during the Medigap Open Enrollment Period, which starts in the month when a person turns 65 years of age and ends after 6 months.
To qualify, the individual must also have enrolled in Medicare Part B.
People will get the best price and have the most choice during the Open Enrollment Period.
After open enrollment, insurance companies are allowed to use medical underwriting to determine a person’s health status. The results may influence a company’s decision to offer coverage, how much it will charge, and what it will limit.
Although insurance companies may offer additional benefits in different states, Medigap Plan G must cover standard medical expenses, including:
- Part A hospital and coinsurance costs up to an additional 365 days after the end of Medicare benefits
- Part A hospice coinsurance or copayments
- Part A deductible
- Part B coinsurance or copayments
- Part B excess charge
- skilled nursing facility coinsurance
- blood — the first 3 pints
- 80% of foreign travel emergency expenses up to the plan limit
Part B excess charges are costs over the amount Medicare approves for a procedure or service.
In some states, a doctor can bill 15% more than Medicare allows for a medical service. Medigap Plan G typically pays the difference.
Medicare Part A and Part B do not cover medical expenses if a person is traveling outside of the United States. However, Medigap Plan G will cover some foreign travel expenses up to the plan limit. People can check the limit in their individual policies.
Learn more about what Medigap Plan G covers.
What does Medigap Plan G not cover?
Medigap Plan G does not cover:
- the Part B deductible
- prescription medication
- vision care and eyeglasses
- dental care
- hearing aids
- long term care
- private duty nursing
Each private insurance company decides the premium cost for Medigap Plan G. This is the cost someone pays every month to keep the policy.
Medigap policies have standardized benefits but not premiums. The following may affect the premium cost:
- a person’s gender
- a person’s age
- a person’s geographical location
- any added benefits above the standardized benefits for Medigap Plan G
Medigap Plan G offers a standard policy and a high-deductible policy in some states. The annual deductible for the high-deductible plan is $2,800 in 2024. Not every state offers a high deductible plan.
A person pays the premiums for Medigap Plan G to the private insurance company where they buy the policy. They pay the premiums for Medicare Part A and Part B to Medicare.
Medicare has an online tool called Medigap Plan Finder to find Medigap policies and insurance companies in various states. A person enters their zip code, and the tool shows available policies and contact information, plus:
- general costs, including a range of premiums for the state
- payment for covered services
- estimated out-of-pocket costs
A person’s first step in enrollment is to find companies offering Medigap Plan G in their state. To do this, they can use the online tool from Medicare. The State Health Insurance Assistance Program and State Insurance Department will also have this information.
Only private insurance companies sell Medigap Plan G. People purchase the plans through companies selling in the state where they live.
Each insurance company will ask the person to complete an application, though they cannot ask for family history or genetic testing.
The insurance companies must provide clearly worded information on what they include in their policy. If an individual has questions, they need to find the answers before paying the first premium.
They also need to make out the check, bank draft, or money order to the company and not to an insurance agent.
Medigap Plan G is a Medicare Supplement Insurance plan to help pay expenses from Medicare Part A and Part B. It is also called Medicare Plan G.
A person is eligible to enroll during the Open Enrollment Period. However, if they delay enrolling in Medigap Plan G until after the Open Enrollment Period, the insurer may deny them a policy.
Private insurance companies provide Medigap Plan G. Some insurance companies offer additional benefits with their policies.
The federal government standardizes the benefits in Medigap Plan G, but the premiums are not the same everywhere. This means each policy will offer the same basic coverage but may charge different premiums.