Medicare Plan G covers more than most Medicare supplement insurance (Medigap) plans. These plans, administered by private medical insurance companies, help cover out-of-pocket costs in Medicare policies.
Medicare is a federal plan that covers health costs for people aged 65 years and older. Younger people with specified health conditions may also qualify.
There are two parts to original Medicare. Part A covers inpatient costs, and Part B covers outpatient services.
Both parts A and B have out-of-pocket costs that may include deductibles, copayments, or coinsurance. These expenses create gaps in coverage.
Medicare supplement insurance plans, also known as Medigap plans, help to cover these additional costs.
Medicare Plan G coverage is currently the most comprehensive and is a popular alternative to the newly discontinued Plan F.
This article explains the coverage available through Medicare Plan G, how to compare Medigap plans, and the out-of-pocket expenses that may apply.
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.
Medicare supplement insurance is also called Medigap. These are additional plans that help pay costs original Medicare does not.
Medigap policies are administered by private insurance companies and the plans can help pay for:
- deductibles
- coinsurance
- copayments
- excess charges
There are ten types of Medigap policies, named by letters.
The current policies are Medigap plans A, B, C, D, F, G, K, L, M, and N.
About Plan C and Plan F
Plans C and F include cover for the Part B deductible.
As of January 1, 2020, Medigap policies are no longer able to cover the Part B deductible for those newly eligible for Medicare.
A person can still buy plan C or F if they were eligible for Medicare before that date but had not enrolled.
If a person had plan C or F before January 1, 2020, they may keep the policy.
About prescription drugs
In the past, some Medigap policies paid for prescription drugs but this stopped on January 1, 2006.
Currently Medicare Part D policies pay for prescribed medication.
Medicare Advantage and Medigap
A person cannot have a Medigap policy and Medicare Advantage at the same time.
It is illegal for a company to sell a person a Medigap policy when they have Medicare Advantage.
Medigap policies supplement original Medicare benefits, and plans must follow standardized Medicare rules.
To have a Medicare Plan G policy, a person must have original Medicare parts A and B. One Medigap plan covers one person only. Additional beneficiaries must have a Medigap policy of their own.
Medigap Plan G covers:
- Part A deductible
- Part A coinsurance and hospital costs for an extra 365 days
- Part A coinsurance or copayment for hospice
- Part A coinsurance for skilled nursing facility care
- Part B coinsurance or copayment
- Part B excess charge
- blood, first 3 pints
- 80% of emergency care received outside of the United States
Medigap policies do not cover:
- long-term care
- dental care
- dentures
- hearing aids
- eyecare
- eyeglasses
- private nursing
Medigap Plan G does not cover the Part B deductible or have an out-of-pocket limit.
A person can only buy Medigap policies offered in their area. Not every policy is available in every state.
Private insurance companies decide what policies they administer, but if they choose to administer in a particular state:
- they do not have to sell every Medigap plan
- they must sell Medigap Plan A
- they must offer Medigap Plans C or F to those eligible
Research
A person can look for policies sold in the area by:
- searching Find a Medigap policy
- calling the State Health Insurance Assistance Program (SHIP)
- calling their State Insurance Department
It may be beneficial for a person to think about their current healthcare needs when researching plan options.
Compare
An individual may like to compare the policy benefits for those available in the area using the side-by-side Medigap plan chart.
The benefits and costs of the same Medigap Plan may differ between companies. Although some main benefits are standardized, companies can charge different premiums.
A person can gain extra information about the companies offering the plans by looking online or talking to a trusted advice service.
Apply
Once a person has chosen a Medigap plan that best suits their needs, they can apply for the policy with the administering insurance company.
Applications can usually be carried out online, by phone, or by calling the company to ask for a paper form, which can then be completed and mailed back.
There are various costs involved with Medigap plans. Costs can include premiums, deductibles, and other charges.
Premiums
A person is required to pay a premium for their Medigap policy, and this is paid directly to the private insurance company.
The premiums for original Medicare are paid directly to Medicare.
Part B deductible
Those who are newly eligible for Medicare are unable to choose a Medigap policy that covers the Medicare Part B deductible, but some plans do pay the Part A deductible.
Excess charges
Excess charges are costs that are higher than the Medicare-approved amounts. Healthcare providers are legally allowed to charge an excess.
Not all plans cover Part B excess charges, but Medigap Plan G does provide coverage for these costs.
Medigap policies are supplement insurance plans administered by private medical insurance companies. The plans help pay for gaps in original Medicare coverage.
Medicare Plan G coverage is comprehensive and is currently a popular alternative to Plan F, which is no longer available to those newly eligible for Medicare.
Not all Medigap plans are available in all areas and companies can choose which policies they administer.
There are out-of-pocket costs for Medigap policies, including a monthly premium.
A person with Medigap Plan G has no out-of-pocket limits and must also pay the Medicare Part B deductible.