Medigap Plan G is a popular plan because it offers comprehensive coverage. We break down Plan G pros, cons, and coverage below.
First, to clear up some potential confusion. Medigap plans A through N are separate from Original Medicare, which is made up of parts A and B. These plans are sold by private insurance companies, whereas Original Medicare is run by the government.
So, Plan G is a supplemental insurance plan that should be referred to as Medigap Plan G, not Medicare Plan G.
All Medigap plans are also known as Medicare supplement insurance. They are designed to cover some out-of-pocket costs you might still incur if you have Original Medicare.
Medigap differs from Medicare Advantage (Part C) plans. Part C is an alternative to Original Medicare that bundles the offerings of Part A and Part B.
By law, you can’t buy both Medigap and Medicare Advantage. But if you have or plan to sign up for Original Medicare, adding Medigap Plan G may be a good choice.
Medigap Plan G in a nutshell
- It covers out-of-pocket costs Original Medicare doesn’t.
- It saves you from the significant costs of long hospital stays, hospice care, and skilled nursing care facilities.
- Monthly premiums can be high.
- You’ll still pay your Part B premium out of pocket.
- Medigap plans, including Plan G, don’t cover prescription drugs.
Plan G is a form of supplemental health insurance. It covers the out-of-pocket costs that are yours to pay after Original Medicare pays its share of your bill.
Plan G coverage includes copays you might incur after seeing your primary care physician or a specialist. It also covers the copays or coinsurance costs of skilled nursing care facilities and hospice care. These costs can add up, and they can be expensive without coverage.
Medigap plans, including Plan G, can’t be purchased along with a Medicare Advantage plan (Part C), only along with Original Medicare (parts A and B).
The best time to buy Medigap Plan G is when you first sign up for Medicare during your initial 6-month enrollment period. You can’t be refused coverage at that time, and you’re certain to get the best price. If you wait, insurers can later refuse to sell you Medigap. They can also charge you higher rates.
Pros of Medigap Plan G
- no network limitations
- accepted anywhere Medicare is accepted
- some states offer high deductible plan G as well as regular deductible plan G
- significantly reduces out-of-pocket costs
Cons of Medigap Plan G
- monthly premiums vary, but typically range from $300 to $800 for female nonsmokers who sign up during open enrollment
- doesn’t cover the Part B monthly premium ($174.70 in 2024)
- doesn’t cover prescription drugs
- Part A coinsurance
- Part A deductible
- Part A hospital costs up to 365 days after Original Medicare benefits are used up
- Part A hospice care coinsurance or copayments
- skilled nursing care facility coinsurance or copayments
- Part B coinsurance and copayments
- Part B excess charges
- first three pints of blood
- 80% of the costs of medical emergencies (up to plan limits) during foreign travel
- prescription drugs
- hearing aids
- vision coverage, including eyeglasses and contact lenses (except after cataract surgery)
- dental care
- private duty nursing care
- long-term nonskilled nursing home care
Medigap plan coverage is standardized, but the rates for each plan are set by the insurer you purchase your plan from.
If you sign up for Medigap Plan G when you first become eligible, you will get the best rates. You also can’t be turned down for coverage at that time. If you opt to buy Medigap plan G later on, medical underwriting will be used to determine your eligibility and rate.
You can purchase a high deductible Plan G in certain states. To be eligible for high deductible Plan G, you must have become eligible for Medicare on or after January 1, 2020. People who became eligible for Medicare prior to this date can’t buy high deductible Plan G.
In 2024, the deductible amount for high deductible Plan G is $2,800. This means you must pay that annual amount out of pocket before your plan starts to provide coverage. High deductible plans typically have lower monthly premiums, and they may be a good choice for you if you are in good health and don’t expect to meet that amount.
As reported by Medicare, here are some estimated Plan G costs in September 2024 for female nonsmokers, age 65 years, who live in Kings County, New York.
Your costs may vary, based on your location, health, age, sex, and tobacco-use profile.
| Insurance company | Plan G premium | High deductible Plan G premium |
|---|---|---|
| Emblem HealthServices Company | $302 | $68 |
| AARP United Healthcare Insurance Company of New York | $306 | not offered |
| Globe Life Insurance Company of New York | $390 | $81 |
| Mutual of Omaha Insurance Company | $476 | not offered |
| Humana Insurance Company of New York | $606 | $109 |
Medicare provides a comprehensive table that compares every Medigap plan. Here are some highlights:
- Plan G covers the Part A deductible but Plan A does not.
- Plan C and Plan F cover the Part B deductible, but Plan G does not.
- Plans A, B, K, and L don’t cover foreign travel emergencies, while Plan G covers 80%.
- Plan G has no out-of-pocket limits, while Plan K has an out-of-pocket limit of $7,060 and Plan L has an out of pocket limit of $3,530 in 2024.
Plan G is better for some people, but Medicare Advantage may be better for others.
Medicare Advantage (Part C) plans cover healthcare costs that Original Medicare (Part A and Part B) does not. This varies by plan but may include items like hearing aids and gym memberships. Many Part C plans also fold in Part D prescription drug coverage.
In contrast, Medigap Plan G covers the out-of-pocket costs that are left over after Medicare covers part of your bills. Medigap plans don’t pay for line items, like eyeglasses, that Original Medicare won’t pay for at all.
- Part A coinsurance
- Part A deductible
- Part A hospital costs, up to 365 days after Original Medicare benefits are used up
- Part A hospice care coinsurance or copayments
- skilled nursing care facility coinsurance or copayments
- Part B coinsurance and copayments
- Part B excess charges
- first three pints of blood
- 80% of the costs of medical emergencies (up to plan limits) during foreign travel
Once you sign up for Medicare Part B, you can purchase Medigap Plan G. There are several ways to do this:
- You can contact a health insurance company you already like and trust to see if they offer Plan G coverage in your area.
- You can use a private health insurance sales agent.
- Medicare has a Medigap policy finder tool you can use, which lists every Plan G option offered in your ZIP code so you can compare them side by side.
Medigap Plan G is supplemental insurance you buy from private health insurance agencies.
Plan G can be used to cover the out-of-pocket costs not paid for by Original Medicare (parts A and B). Medicare and Medigap are designed to cover different costs.
Plan G provides more comprehensive coverage than most other Medigap plans. There is also a high deductible, low premium option offered in many states.
You can’t purchase a Part C (Medicare Advantage) plan if you have a Medigap plan.