People who age into Medicare (health insurance program provided by the U.S. government) are often surprised that Medicare is not free and will leave you with out-of-pocket costs for healthcare services. There is no out-of-pocket maximum with Original Medicare, which can be detrimental for many who do not have a savings account for their healthcare services. Due to this, many beneficiaries opt for a Medicare Supplement plan to help with coverage gaps. There are multiple Medicare Supplement policies on the market, such as Plan F and Plan N, but one of the most popular Supplement plans is Medicare Supplement Plan G (Medigap Plan G). But is Plan G coverage right for you? Keep reading this article to find out!
What is Medicare Supplement Plan G?
Plan G is sold by private health insurance companies and can be offered through a Medicare brokerage. Medicare Supplement insurance works alongside Original Medicare Part A and Medicare Part B. Plan G will only pay out when Medicare pays its share first. Therefore, if Medicare will not cover a service, neither would Plan G.
Medicare Supplement Plan G does not have network restrictions. You can visit any doctor, specialist, or hospital in the United States and use your Supplement plan if the doctor or facility accepts Medicare. If the doctor doesn’t accept Original Medicare, then Plan G will not be able to provide coverage for your healthcare services.
How does Medicare Plan G work?
As mentioned above, Medicare Supplement Plan G pays after Original Medicare pays first. Here is what Plan G covers:
- Part A deductible
- Part A coinsurance and hospital costs
- Part A hospice care coinsurance/copayment
- Skilled nursing facility coinsurance
- First three pints of blood
- Part B coinsurance/copayment
- Part B excess charges
- $50,000 of foreign travel emergencies
As you can see, Plan G covers the majority of the gaps that you have for inpatient and outpatient care. The only expense you would be responsible for during the year is the Part B deductible, which is $233 in 2022. After you pay the Part B deductible, you should not have any other out-of-pocket copays or costs for Medicare-approved services for the remainder of the year.
What is the cost of a Plan G policy?
The cost for Plan G can range from person to person since the premium amount is based upon a number of factors. Medicare Supplement premiums are based on your gender, age, tobacco use, zip code, the insurance company you purchase the plan from, and more. Once enrolled in Plan G, you are responsible for your plan’s monthly payment, or your Medigap policy carrier will drop you from your plan.
Now, a Plan G is a Plan G no matter what. What this means is that Plan G is standardized. So, the Plan G benefits mentioned above will remain the same year-to-year and will provide the same benefits no matter which insurer you purchase the plan from. But each carrier has a different pricing method. Therefore, it’s always best to shop around multiple insurance carriers to ensure you are in the most cost-effective plan in your area.
When can I enroll in Medicare Supplement Plan G?
There is a specific time to enroll in a Medicare Supplement, the Medicare Supplement Open Enrollment. This is a one-time enrollment window, and if you miss it, you may miss out on your chance of enrolling in a Plan G.
The Medicare Supplement Open Enrollment is a six-month window based around your Part B effective date. You can apply for Plan G six months before your Part B effective date or six months after Part B has gone into effect. When you apply for Plan G during this timeframe, you will not have to answer any health questions on the application.
If you were to apply for Plan G outside that window, you would likely be subject to underwriting in most states. You can potentially be denied a Medicare Supplement plan or be charged with a higher monthly rate if you have pre-existing health conditions. But, some states have special Medicare Supplement enrollment rules, such as the state of New York and Maine, where you can apply for a Medigap plan year-around without underwriting.
If you are under the age of 65 and qualify for Medicare due to disability, know that you will have a second Medigap Open Enrollment to enroll in a Medigap plan without underwriting once you reach age 65.
If you want predictable healthcare costs and low out-of-pocket expenses for Medicare-approved healthcare services, then Medicare Supplement Plan G might be right for you! To learn more about your plan options, reach out to a Medicare brokerage to shop around for quotes for the most cost-effective Plan G in your area, or visit Medicare’s website for more information.