Medigap are supplemental insurance plans. Medicare Plan G has a monthly premium and helps pay out-of-pocket costs from Medicare Part A and Part B.
Medicare Part A and Part B may not cover certain services, even if they may be necessary. These can include long-term care, dental care, eye examinations, hearing exams, or hearing aids.
When a service is not covered, people must pay for the cost out of pocket.
In this article, learn how Medicare Plan G can help cover costs that original Medicare does not cover, what Plan G covers, and its related costs. There is also a comparison of plans and information on how to enroll.
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.
When a service is not covered by Medicare Part A and Part B, people must pay for the cost out of pocket. This is the “gap”.
Medicare Part A covers costs from being a patient in a hospital or under hospice care. It also helps pay part of the costs of staying at a skilled nursing facility, nursing home, or home health care.
Medicare Part B covers services Medicare considers medically necessary. These may include tests to diagnose a person’s condition or treatments, and ambulance, mental health care, or durable medical equipment. Part B also covers preventive services, such as flu shots or cancer screening.
To find out if Medicare covers what is needed, a person can talk with their doctor. They may also check online at Your Medicare Coverage.
Medicare Plan G is a Medigap policy. These policies help cover the gap between Part A and Part B coverage and what is paid out of pocket. This includes the costs of deductibles, copayments, and coinsurance.
It is important to note Medigap policies no longer cover a person’s Part B deductible.
Medicare Plan G helps cover:
- Part A deductible
- Part A hospital costs and coinsurance up to one year after Medicare Part A benefits are used
- Part A hospice copayments or coinsurance
- first 3 pints of blood
- Part B copayments or coinsurance
- skilled nursing facility coinsurance
- Part B excess charges
- foreign travel costs (80% up to the plan limit)
To qualify for a Medigap policy, a person must have Medicare Part A and Part B. Each Medigap policy is standardized by the federal government. This means each plan covers the same things and some can cover extra expenses.
The premiums for Medicare Plan G will vary, depending on what area of the country a person lives in, their age, and their gender. The premiums for the Medigap policy are paid to the private insurance company. The premiums for Part B are paid to Medicare.
Medicare Plan G has a standard policy and some states offer a high deductible policy. The premiums vary as follows:
People who choose the standard Plan G pay a monthly premium that varies between states. This does not include the Part B premium.
People can check the costs for supplemental insurance in their location and find a policy online. Medicare has an online search tool people can use based on their zip code.
There are several types of supplemental insurance plans.
It’s important to note that starting January 1, 2020, Plan F is no longer offered to new enrollees in Medicare. This occurred when Medigap stopped covering the Part B deductible. However, people covered by Plan F before January 1, 2020 can keep the plan.
Somesupplement insurance plans pay Part B excess charges. When a doctor has acontract with Medicare, they accept payment from Medicare. This is calledtaking Medicare assignment.
A person may decide to visit a doctor who does not accept Medicare assignment. The doctor is allowed to charge more than the Medicare-approved price for the service. The added charge is called a “Part B excess charge.”
This chart shows the differences between Plan G, Plan N, and Plan F.
|Plan G |
|Plan N||Plan F|
|Skilled nursing facility||yes||yes||yes|
|Part A deductible||yes||yes||yes|
|Part B deductible||no||no||yes|
|Part B excess charges||yes||no||yes|
|Part B coinsurance||20% of medical costs that Part B does not pay||$20 for doctor visits, $50 for emergency visits, plan pays 100% of other Part B costs||20% of medical costs that Part B does not pay|
|Foreign travel emergencies in the first 60 days of the trip||80% after $250 deductible with lifetime limit of $50,000||80% after $250 deductible with lifetime limit of $50,000||80% after $250 deductible with lifetime limit of $50,000|
Private insurance companies must offer supplemental insurance policies, such as Plan G, during the Initial Enrollment Period (IEP). The standardized policy is guaranteed to be renewed each year when the premiums are paid.
A person should consider their current and future medical needs before deciding on a Medigap plan. Switching policies later may not be possible. Not all private insurance companies provide insurance in all states.
The State Health Insurance Assistance Program (SHIP) may help a person find a comparison guide for their state.
The Medicare online tool shows plans offered in a person’s area, what is covered, the approximate cost, and the company’s contact information.
The programs are standardized, but the premiums are not. This means the same policy offered by different companies can have different prices.
Private companies must use a clearly worded summary of the plan’s benefits and costs. A person should read it carefully to ensure they are buying the right policy for their needs.
Medicare Plan G supplement insurance helps cover the out-of pocket “gap” cost that includes the Medicare Part A deductible and copayments and coinsurance for Part A and Part B.
All Medigap policies are offered by private insurance companies. A person pays the premium for Medigap to the private insurance company, and the premium for Medicare Part B to Medicare.
The premium for Medicare Plan G depends on a person’s age, gender, and location.
The Medicare online tool helps people learn the costs and companies that offer insurance in their area. A person should consider current and future medical needs before purchasing. Switching to a different Medigap policy later may not be possible.