Navigating the complex world of Medicare can be daunting, especially when choosing the right type of coverage for your healthcare needs. Medicare Supplement or Medigap plans are one option for those looking for additional coverage beyond Original Medicare.
Medicare Plan G is a popular Medigap plan that offers comprehensive coverage for most out-of-pocket medical expenses, making it a great choice for many Medicare beneficiaries. In this article, we’ll explore what Plan G is, its pros and cons, the enrollment process, and alternative options. Then, we’ll run through some frequently asked questions that should help you determine if it’s the right choice for your needs.
Plan G is one of the ten Medicare Supplement plans available to beneficiaries. All of them work the same way – as a secondary insurance plan. When you enroll in a Medigap plan, Original Medicare (Parts A and B) remains your primary insurance plan. While Parts A and B offer excellent benefits, many deductibles, copayments, and coinsurance costs are associated with them.
Plan G will pick up nearly all of those leftover costs. Specifically, it covers:
- Part A deductible
- Part A coinsurance costs (Plan F includes an extra 365 days of coverage)
- Skilled nursing facility coinsurance costs
- First 3 pints of blood
- Part B copayments and coinsurance costs
- Part B excess charges
- Foreign travel emergency, up to plan limits
The only thing missing from this list is the Part B deductible. So, as long as Medicare approves the treatment or service you need, your only cost for the year is the Part B deductible.
Every insurance plan has pros and cons. Choosing a Medicare plan is an important decision as it can greatly impact your coverage and costs. Let’s review a few of the advantages and disadvantages of Plan G.
There are several advantages to enrolling in Medicare Plan G. One of the biggest advantages is that it offers such predictable coverage, so you’ll be protected from unexpected healthcare costs. You’ll also have lots of freedom to choose your providers, as there are no networks when it comes to Medicare Supplements. Lastly, Medigap plans do not often require prior authorizations for treatment. You won’t have any hoops to jump through to get the care you need.
The most obvious downside to Plan G is the monthly premium. Though they aren’t as high as premiums for Plan F, they can still be unaffordable for many people. In addition, premiums increase yearly, so it may not be a good long-term fit for some. However, remember that if you need frequent medical attention, paying the premiums up front and having little out-of-pocket costs may be worth it!
If you’re interested in enrolling in Plan G, there are a few things you’ll need to know. We will review eligibility requirements, enrollment timelines, and why you need to compare options from multiple insurance carriers.
To enroll in Plan G, you must be enrolled in both parts of Original Medicare (A and B). Depending on when you enroll, you may or may not have guaranteed issue rights to a Medicare Supplement plan. We’ll explain enrollment periods in the next section. For now, understand that you only have guaranteed issue rights (or GI rights) for a Medicare Supplement if you enroll in one as soon as you become eligible for Medicare.
What are GI rights? GI rights mean you are guaranteed the Medigap plan of your choosing, regardless of your current or past health history. No insurance company can deny your application or charge you higher rates due to your health. If you wait to enroll in Plan G at a later date, you will likely be subject to medical underwriting. This means you’ll be asked a series of health questions, and the company will consider your enrollment. If you have any chronic or serious conditions, you may be unable to enroll in a Medigap plan. Some states have unique guidelines, but medical underwriting still applies in most cases.
You are first eligible to enroll in Medicare during your Initial Enrollment Period or IEP. This 7-month window begins three full months before your 65th birthday month. During your IEP, you can enroll in Original Medicare and any Medicare Supplement plan you choose, including Plan G. You must enroll with a carrier that offers Plan G in your residential state.
It is possible to delay your Medicare enrollment. If you have other creditable coverage in place – like through an employer’s group plan – it may be smart to postpone your transition into Medicare. If you find yourself in that position, you’ll be eligible for a Special Enrollment Period when you do lose your creditable coverage. You’ll still be able to enjoy GI rights if this happens to you. Other life-changing events may qualify you for an SEP, though you may not have the same guaranteed issue rights for a Medigap plan.
If you miss your IEP and don’t qualify for an SEP, you won’t be able to enroll in Medicare until the General Enrollment Period (GEP). The GEP begins on January 1 and lasts until March 31. However, if you enroll using the GEP, you’ll have to pass medical underwriting to be approved for Plan G.
Many people don’t realize that all Medigap plans offer standardized coverage. This means that each Medigap plan has the same benefits, no matter where you purchase it. For example, if you purchase Plan G in Texas from Company A and your friend purchases Plan G in Florida from Company B, you have the same exact coverage.
All that to say, you need to shop around when looking for a Plan G! Lots of insurance carriers offer Plan G; the only difference you’ll notice between one company and another is the premium amount. You may not necessarily want the cheapest rate, but it should help you narrow down your choices. The company’s AM Best rating and its history of rate increases should also factor into your decision. Fortunately, an independent insurance agent can compare rates from multiple carriers to ensure you get a competitive premium.
Plan G isn’t for everyone. Some people may want more coverage, while others might need a plan that offers lower premiums and fits their budget. You’ll have lots of different options, but the three alternatives most people consider include Plans F and N, as well as a complete alternative to Medicare Supplements called a Medicare Advantage plan. Let’s briefly look at each one.
Plan F is nearly identical to Plan G but offers slightly more coverage. Remember that Part B deductible we mentioned earlier? Plan F includes that in its coverage. So, beneficiaries who choose Plan F have virtually no leftover expenses to pay. However, premiums for Plan F are higher than Plan G and have been known to increase faster. In almost all cases, the added coverage for the Part B deductible doesn’t make up for the extra premium.
The other downside to Plan F is that it has one additional eligibility requirement. You must have turned 65 before 2020 to be eligible for Plan F.
While not as popular as Plan G, Plan N is the fastest-growing Medigap plan on the market today. Like Plan G, it does not pay the Part B deductible. In addition, there are two other out-of-pocket costs to consider. The most notable difference is that Plan N requires some copays. You’ll pay about $20 for every doctor visit and about $50 for every trip to the emergency room. If you are someone who visits the doctor frequently, those copays can add up quickly.
Plan N also does not cover Part B excess charges. Although they’re rarely utilized, healthcare providers can choose to add an extra 15% to the Medicare-approved rate for services. If they do and you have Plan N, you’ll be responsible for the 15% excess charge.
Medicare Advantage (Medicare Part C) is a completely different option. Medicare Advantage plans work differently than Medicare Supplement plans and take much more time to understand. However, if you live in an urban area, they are certainly something you should consider. Medicare Advantage plans come with low monthly premiums (sometimes even $0) and include benefits you won’t find in Original Medicare or a Medicare Supplement. However, some restrictions exist, like utilizing certain provider networks and needing prior authorizations.
If you just want some basic information about Plan G, check out a few of the most common questions we get from our clients about Medicare Plan G in Texas.
No, Plan G does not cover prescriptions. You will need to enroll in a separate Medicare Part D plan to get prescription drug coverage.
Plan G and Plan F are very similar, but Plan F includes coverage for the Part B deductible, while Plan G does not.
Your premium will increase over time due to age, inflation, changes in healthcare costs, and other factors. However, insurance companies cannot raise your premium based on your health status or claims history.