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All You Ever Wanted to Know About Insurance

Medigap Plan G

 Plan G – Medigap Plan G is one of about ten Medigap plans available to Medicare beneficiaries. Medigap Plan G has become increasingly popular since 2020, and we’ll discuss why that is a bit later. You might also hear Medigap plans referred to as Medicare supplements – both terms refer to the same kind of insurance.

All Medigap plans serve as secondary insurance to Original Medicare, including Parts A and B. As you may know, Original Medicare doesn’t pay for 100% of your healthcare costs. You’ll have deductibles, copayments, and coinsurance expenses. A Medicare supplement plan will pick up some (or all) of those remaining costs. Some supplements cover more than others, and Plan G is undoubtedly one of the best options.

Medicare Supplements Are Standardized Plans

What does that mean, and why is it important to know? In 1990, the National Association of Insurance Commissioners agreed to standardize the Medigap plans to alleviate some of their confusion. Before standardization, there were many Medigap options, and you could add riders to your Plan. That created a lot of redundancy, so the group decided to simplify Medicare supplement insurance.

Now, each of the ten Medigap plans remains the same from one year to the next, one state to the next, and one insurance company to the next. Once you enroll in a Medigap plan, your coverage will never change.

What does Medigap Plan G cover?

Plan G offers excellent healthcare benefits. It will cover virtually all out-of-pocket expenses that aren’t paid for by Medicare Parts A and B. This includes:

  • Part A deductible
  • Part A coinsurance plus an additional 365 days of hospital costs
  • Part A hospice coinsurance/copayment
  • Skilled nursing facility care coinsurance
  • Blood (3 pints)
  • Part B coinsurance/copayment
  • Part B excess charge
  • 80% of foreign travel emergencies

The only thing not listed here is the Medicare Part B deductible. So, as long as your service is covered under Medicare, the only out-of-pocket expense you’ll have if you enroll in Plan G is the Part B deductible. In 2022, that deductible is $233.

What doesn’t Plan G cover?

We mentioned that Plan G does not include the Medicare Part B deductible payment. However, there are some other aspects you should be aware of when enrolling in any Medigap plan.

Medicare supplements only provide coverage for things that Original Medicare also covers. You will not find coverage for prescription drugs or routine dental, vision, and hearing services. You will need to enroll in a separate Medicare Part D prescription drug plan to get your medications covered by insurance. (And you absolutely should enroll because you’ll pay the penalty later if you don’t!)

For beneficiaries who would like coverage for the other services listed, plenty of dental, vision, and hearing (DVH) plans are available at very affordable prices. (There is no penalty for not having those extra plans.)

Why is Medigap Plan G so popular?

Plan G has always been a popular choice among beneficiaries. However, it became even more popular in 2020 due to MACRA. The simplistic style of coverage and outstanding benefits attract many people to this Plan.

MACRA stands for the Medicare Access and CHIP Reauthorization Act, and it was passed into law in 2015. One goal of MACRA was to increase provider participation in the Medicare program by providing more reimbursements for services to providers who performed quality care. While the goal benefits both providers and patients, the program will find a way to increase payments to providers. One way to do that was to eliminate Medigap plans that provided 100% cost-sharing benefits.

Plan F, the most popular Plan until 2020, provided such benefits. (As did its high-deductible option and Plan C.) With Plan F, enrollees had no out-of-pocket costs because they also included the Part B deductible coverage. So, Plan F, the Plan with the most comprehensive coverage, was put on the chopping block.

Plan F was not eliminated. Many beneficiaries still have Plan F, and others can still enroll. The only requirement is that you must have turned 65 before January 2020. Surprisingly, even individuals eligible for Plan F often switch to Plan G.

The reason? Rising premiums associated with Plan F. The premiums for Plan G are the next highest after Plan F; they often save enrollees more than the $233 they need to pay the Medicare Part B deductible.

Which providers accept Plan G?

Any healthcare provider who accepts Original Medicare will also accept your Medicare supplement. There are no provider networks associated with Medigap plans, which is why they are so popular. You won’t be limited on which providers you can see, and you’ll be able to use your Medigap plan if you travel to another part of the country.

Approximately 96% of providers accept Medicare, so you’ll have no issues finding one who accepts your Medigap plan.

Guaranteed Issue Rules with Medigap Plan G

When you first become eligible for Medicare (around your 65th birthday), you have guaranteed issue rights to any Medigap plan. That means that you do not have to pass medical underwriting to enroll in a plan. You cannot be denied coverage due to a pre-existing health condition, nor can the insurance company charge you higher premiums. You’ll only have guaranteed issue rights outside of your initial Medicare eligibility in certain instances.

The two other times you’ll have guaranteed issue rights is when you lose other credible coverage or have a Medicare Advantage trial right. Let’s break these two events down just a bit further.

You can choose to delay Medicare enrollment past age 65 if you’d like. Those who continue to work and have coverage through their employer (or spouse’s employer) often delay enrollment because their employer pays for part of their group policy. As long as your group plan has been deemed “credible,” you can postpone Medicare enrollment without penalty.

When you lose that employer coverage, you’ll have guaranteed issue rights for either Plan G or Plan F, depending on when you turn 65. If you turned 65 before 2020, you’d be able to get Plan F using the guaranteed issue rules. If you turn 65 in 2020 or later, you’ll be granted Plan G.

A similar rule applies the first time you enroll in a Medicare Advantage plan. Medicare Advantage plans are also referred to as Medicare Part C and are quite different than Medicare supplements. If you choose to enroll in an Advantage plan for the first time, you have a suitable trial period. If you decide you would prefer to switch back to a Medicare supplement plan during that period, you will have guaranteed issue rights to whichever Plan you were enrolled in before trying Part C.

Some states have additional rules around Medigap guaranteed issue rights. For example,  California, Oregon, Idaho, Illinois, and Nevada all have a period around your birthday when you can switch Medigap plans or carriers.

Medigap Plan G: The Greatest Value Medicare Supplement?

“Plan G as in Greatest Value” is how you’ll hear some Medicare advisors refer to Plan G. Of course, this is subjective since we all have unique healthcare and financial situations. However, there is no denying that Plan G is the only Medicare supplement for new Medicare enrollees that has entirely predictable out-of-pocket costs.

Other Medigap plans, while still providing excellent benefits, will leave you with expenses like Part B excess charges, office visit copayments, and only a percentage of cost-sharing benefits. Looking for the minor out-of-pocket expenses and hassle, look no further than Plan G.

The average 65-year-old female will pay around $120 per month, and a male will pay around $140.

How much does Plan G Cost?

The cost of Plan G is not the same for everyone. Your monthly premium will depend on various personal factors and from whom you buy the Plan. Personal information like your age, gender, tobacco use, and zip code are critical factors determining your premium. As you probably guessed, men pay more than women, older people pay more than younger ones, and tobacco users pay more than non-users. In addition, if you live in an area with a higher cost of living, your premiums will probably be higher.

To give you a general idea of the cost of Plan G, the average 65-year-old female will pay around $120 per month, and a male will pay around $140. This can vary considerably based on your location and which insurance carrier you enroll with. Keep in mind that Medigap plans tend to increase in price as you age.

Plan G Versus Medicare Advantage

You can compare Plan G to other Medicare supplements and know you’re comparing apples to apples. If you compare any Medigap plan to Medicare Advantage, it’s more like comparing apples to oranges. They both provide more coverage than Original Medicare, but they work pretty differently.

It would help if you took some time to understand the differences between Medicare Advantage and Medigap insurance, but we’ll review their key differences here.

Cost: You can find Part C plans for as little as $0 per month. If you’re looking at Plan G, you probably won’t be able to find it for less than a monthly premium of $110. That being said, Medicare Advantage plans are not free. You’ll have deductibles, copayments, and other coinsurance expenses that you wouldn’t have if you enrolled in Plan G.

Networks: We said that you could use your Medigap plan nearly anywhere. That’s not true of Medicare Advantage plans. There are a few types of Advantage plans, and you’ll need to know which network your Plan uses and then find providers within the Plan’s network. This limits your choices and can also be a problem if you travel frequently.

Benefits: Part C plans often include benefits that Original Medicare and Medicare supplements do not. Some include prescription drug coverage and other extra benefits like dental care, gym memberships, meal delivery, transportation to doctor’s appointments, and more. You’ll have to consult the Plan’s summary of benefits to determine which ones are included in each Part C plan.

Both Medicare supplement plans and Medicare Advantage plans offer excellent value. You’ll need to consider your healthcare and budget needs to determine which one would be the best fit for you.

How do I enroll in Medigap Plan G?

Have you decided Plan G is suitable for you? Or do you still have a few questions? Either way, our licensed insurance agents are here to help.

If you are new to Medicare or have been enrolled for many years, we can help you shop for Plan G rates. We are contracted with many insurance companies, so we can compare rates between carriers to ensure you get competitive pricing. After all, why pay more for an insurance plan that is the same wherever you get it? Plus, Songer Benefits, Inc. only works with trusted insurance carriers with excellent ratings and customer service. We’re sure to find you a Medicare plan that you’ll be satisfied with.

Our services come at no cost to you, and we’re happy to answer questions and walk with you through your entire Medicare journey. If you have more questions or are ready to talk to one of our Medicare advisors, call us.

Frequently Asked Questions

Is Plan G the best Medicare supplement?

Plan G offers the most coverage for newly-eligible Medicare beneficiaries. Plan F has slightly more benefits but is not available to everyone.

Is Plan G better than Medicare Advantage?

IF you’re looking for the most predictable coverage and most nominal out-of-pocket costs, Plan G is better than Medicare Advantage. However, both plans offer great benefits, and one is not always better than the other. 

Does Plan G cover dental?

No, routine dental care is not included in Plan G.

Is Plan G better than Plan F?

Plan G doesn’t offer as much coverage as Plan F, but the difference is minimal. In addition, it has lower monthly premiums.