Medicare Plan G is a Medigap 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, and Part B covers medical expenses. Everyone is eligible for Medicare Plan G, also known as 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.
People who are 65 years of age or older are eligible for Medicare coverage. Some people who are younger and have a disability are also eligible.
In this article, learn about Medicare Plan G, who is eligible, coverage, costs, and enrollment.
Medicare Plan G is part of Medigap. Private companies offer Medigap Supplement Insurance Plans to help pay for gaps in Original Medicare. These gaps include deductibles, coinsurance, and copayments.
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 plans are standardized by the Federal government, which means every Medicare 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 Medicare Plan G.
People should compare Medicare 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 most choices, 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.
People have two choices to reduce out-of-pocket expenses with Original Medicare:
- A Medigap Plan, such as Medicare Plan G.
- Medicare Part C, also known as a Medicare Advantage Plan.
- People cannot have a Medigap Plan and a Medicare Advantage Plan at the same time.
Medicare Plan G and a Medicare Advantage Plan have different benefits. It is important to compare the costs and benefits before deciding which is best for an individual’s circumstances.
Although insurance companies may offer additional benefits in different states, Medicare Plan G must cover standard medical expenses:
- 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 (first 3 pints)
- foreign travel, 80% of 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, and Medicare Plan G pays the extra amount.
Medicare Part A and Part B do not cover medical expenses if a person is traveling outside of the U.S. However, Medicare Plan G will cover foreign travel expenses up to the plan limit. People should check the limit in their individual policy.
Each private insurance company decides the premium cost for Medicare Plan G. This is the cost a person 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 Medicare Plan G
Medicare Plan G offers a standard policy and a high-deductible policy in some states. The annual deductible for the high-deductible plan is $2,370. Not every state offers a high-deductible plan.
A person pays the premiums for Medicare Plan G to the private insurance company where they buy the policy. They pay the premiums for Medicare Part A and 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 Medicare Plan G in their state. To do this, they can use the online tool from Medicare. The State Health Insurance Assistance Program (SHIP) or State Insurance Department will also have this information.
Only private insurance companies sell Medicare 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, although they cannot ask for family history nor genetic testing.
The insurance companies must provide clearly worded information on what they include in their policy. If an individual has questions, they must be sure to get answers before paying the first premium.
They should also make out the check, bank draft, or money order to the company and not to an insurance agent.
Medicare Plan G is a Medigap Supplement Insurance plan to help pay expenses from Medicare Part A and Part B. It is also called Medigap Plan G.
A person is eligible to enroll during the Open Enrollment Period. However, if they delay enrolling in Medicare Plan G until after the Open Enrollment Period, the insurer may deny them a policy.
Private insurance companies provide Medicare Plan G. Some insurance companies offer additional benefits with their policies.
The federal government standardizes the benefits in Medicare Plan G, but the premiums are not the same everywhere. This means each policy will offer the same basic coverage, but it may charge different premiums.