Is Medicare Plan G right for you?

Published: Dec. 17, 2020 at 12:23 p.m. ET By Home Media

Key takeaways

·        Medicare Plan G is the most comprehensive coverage you can buy if you became eligible for Medicare after December 31, 2019.

·        Plan G has essentially the same benefits as Plan F, except for the Part B deductible.

·        Annual premiums for Medicare Plan G typically cost between $1,500 and $2,000.

·        Some insurance companies offer extra perks and benefits for vision and dental care with Medicare Plan G.

Medicare Plan G is the most popular Medicare Supplement plan among those newly eligible for Medicare. That’s not surprising since Plan G has the most comprehensive coverage (except for Plan F, which isn’t available to new beneficiaries).

Plan G is also one of the most expensive plans, which is why it makes sense to consider your health needs and budget before you choose a Medicare Supplement plan. Here are the facts about Medicare Plan G, and tips on how to decide if it’s the right plan for you.

What does Medicare Plan G cover?

There are many out-of-pocket costs with Original Medicare (Part A and Part B). Depending on the care you need, you could pay:

·        Part A deductible ($1,408 per benefit period in 2020. You can have multiple benefit periods in a calendar year)

·        Part B deductible ($198 per year in 2020)

·        Part A daily coinsurance for hospital, skilled nursing facility, and hospice stays (between $176 and $704 per day in 2020, depending on the facility and length of stay)

·        Part B coinsurance (20% of allowable charges)

·        Part B excess charges (providers who do not accept assignment can charge as much as 15% above Medicare rates)

Medicare Plan G covers all of those out-of-pocket costs, except for the Part B deductible.

Medicare Plan G benefits at a glance

Part A deductible	100%
Part A hospital inpatient coinsurance	100% plus an additional 365 days of benefits when Original Medicare is exhausted
Part A skilled nursing facility coinsurance	100%
Part A hospice coinsurance and/or copayments	100%
Part B coinsurance and/or copayments	100%
Part B excess charges	100%
Blood for transfusion	100% of the first three pints
Foreign travel emergencies	80% up to the plan’s limits (usually $50,000 in lifetime benefits)

What is the difference between Medicare Plan G and Plan F?

Plan G is essentially Plan F without coverage for the Part B deductible. In 2015, Congress signed the Medicare Reauthorization Act, which included a rule eliminating Medigap plans that paid the Part B deductible. The rule applied to all new plans sold on or after January 1, 2020.

Plan F, which is the most popular Medigap plan among all Medicare beneficiaries, is no longer available to anyone who first became eligible for Medicare after December 31, 2019. If you had Plan F before January 1, 2020, you can keep your plan. If you’re new to Medicare, Plan G gives you the same comprehensive coverage minus the Part B deductible.

RELATED: Find the right Medicare Supplement plan option for you here. 

How much does Plan G cost?

Plan premiums depend on many factors, including your age, sex, ZIP code, and smoking status. Premiums also vary by insurance company.

The chart below shows sample plan premiums for some of the most popular insurance companies. The premiums listed are for a 65-year-old female nonsmoker living in the midwest.

Medicare Plan G sample premiums

Aetna Medicare Plan G	$133
Blue Cross Blue Shield Medicare Plan G	$138
Cigna Medicare Plan G	$122
Humana Medicare Plan G	$142
Mutual of Omaha Plan G	$126

Understanding your health-care costs with Medicare Plan G

Paying an extra $125 a month (or more) in Medicare premiums can seem like a lot, but you get completely predictable health care costs in return. Your costs are also evenly spread over the course of the year in the form of monthly premiums. This is especially nice since medical expenses are often unexpected, leaving you with a large bill due all at once.

Example: Beverly sees her doctor an average of four times a year, which includes an annual physical with blood work and a chest X-ray to monitor her high blood pressure. Last year, she had a bad flu that turned into pneumonia. She spent four days in the hospital and had two weeks of home health visits after she was discharged.

The following chart compares her Medicare costs for the year with and without Medicare Plan G.

	ORIGINAL MEDICARE	MEDICARE PLAN G
Part B premium	$1,735	$1,735
Medigap premium	$0	$1,500
Part A deductible	$1,408	$0
Part B deductible	$198	$198
Part A coinsurance	$0  (Daily coinsurance doesn’t apply for hospital stays of fewer than 30 days)	$0
Part B coinsurance (doctor visits, X-rays, lab tests, home health care)	$1,000	$0
Total out-of-pocket costs	$4,341	$3,433

Medicare Plan G frequently asked questions

Does Plan G pay for prescription drugs?

Medicare Supplement plans only pay for covered expenses under Part A and Part B. Original Medicare doesn’t typically cover prescription drugs, and you don’t get any additional coverage with Medicare Plan G.

Plan G can’t be used to cover prescription drug costs under Part D. The good news is that most companies that sell Plan G also sell Part D plans, so you can still get all your Medicare coverage in one place.

Do you get SilverSneakers with Plan G?

SilverSneakers is a common benefit with Medicare Advantage plans, but it’s not usually offered with Medicare Supplement plans. Some insurance companies do offer extra perks that are similar, such as fitness benefits or discounted gym memberships. Check the plan brochure to see what’s available.

Can you get vision and dental coverage with Plan G?

These benefits aren’t standard with Medicare Supplement plans, but many insurers sell companion vision and dental policies. You pay a separate monthly premium for the coverage.

A few companies combine extra benefits with their Medicare Supplement plans. For example, Humana sells a Healthy Living Plan G that includes vision, dental, and SilverSneakers benefits for one monthly premium.

Do you have to use network providers with Plan G?

There are no provider networks with Medicare Supplement plans. This means you can use your plan with any provider that accepts Medicare. Most providers automatically bill your Medigap plan.

Is there a cap on annual benefits?

There is no limit on how much your plan pays each year. You can’t “use up” your benefits. Plan G pays 100% of your out-of-pocket costs (except for the Part B deductible), regardless of the cost of your medical care.

Is there a high-deductible Medicare Plan G option?

High-deductible Plan G is a new option for 2020, but not all insurance companies offer it. High-deductible Plan G has the same benefits as original Plan G after you meet the plan’s annual deduction of $2,340. It is important to note that the Part B deductible may not count toward Plan G’s annual deductible.

Is Medicare Plan G right for you?

If predictable health-care costs are important to you, Plan G offers that complete peace of mind you are seeking. In return for this peace of mind, you can expect to pay between $1,500 and $2,000 a year in premiums. If the Plan G premium strains your budget, you might want to consider Medicare Plan N. It has essentially the same benefits as Plan G, but you pay a small copayment (typically $20 or less for doctor visits and $50 or less for emergency room care) at the time of service. Plan N premiums are usually around $50 a month.

If you frequently use providers that don’t accept Medicare assignment, Plan G can save you money on Part B excess charges. However, several states prohibit excess charges. If you live in a state without excess charges, you may be able to save money with Plan D. Plan D covers everything that Plan G covers, except for Part B excess charges. The monthly premium is also usually lower.

Your choice of Medicare coverage is an important decision. It’s a good idea to think about the benefits you can’t live without, and how much you want to spend before you make a choice. The Medicare Plan Finder can show you what’s available in your area. If you need more information, a licensed Medicare expert usually has details and insights about locally available plans. Call 844-475-4253 to figure out which plan is right for you. 

https://www.marketwatch.com/story/is-medicare-plan-g-right-for-you-01608225809?mod=mw_latestnews