If you are approaching age 65 or you've already passed that milestone, you are probably aware of the basic Medicare options available. Along with enrolling in Original Medicare, many seniors also sign up for a Medicare supplement plan — also known as Medigap — to help pay for out-of-pocket costs not covered under Original Medicare. One popular Medigap plan is Plan G. In this guide, we will cover everything you need to know about Medigap Plan G, including how it works, its coverage and costs, and the pros and cons of enrolling.
How Does Medicare Part G Work?
To qualify for Plan G, you must already be enrolled in Medicare Part A and Part B. You cannot purchase a Medigap plan if you have a Medicare Advantage (Part C) plan, because the two can't be combined. Assuming you meet the aforementioned criteria, you can shop for a plan from a private insurer, enroll, and pay your monthly premium to begin your coverage.
Did You Know? A comprehensive Medigap plan could potentially save you thousands of dollars per year on deductibles, coinsurances, copays, and many other out-of-pocket medical expenses.
Medigap kicks in only after Medicare has paid its portion of medical costs. Original Medicare will pay for its approved portion of your medical expenses, and then Plan G will help pay for your remaining out-of-pocket expenses. Most Plan G coverage limits are standardized, but Massachusetts, Minnesota, and Wisconsin set their own standards for Medigap.
What Does Medigap Plan G Cover?
Your coverage may differ if you live in one of the three states listed above, but the majority of older adults can depend on Medigap to cover these costs:
- Part A coinsurance and hospital costs, up to an extra 365 days beyond standard Medicare benefits
- Part A deductible
- Part A hospice care coinsurance or copayment
- Part B coinsurance or copayment
- Part B excess charges (when a provider charges more than Medicare's approved amount for outpatient care)
- The first three pints of a blood transfusion
- Skilled nursing facility care coinsurance
- Emergency health care for the initial 60 days when traveling abroad1
What Is Not Covered Under Medigap Plan G?
The list above should give you a good idea of Medicare Supplement Plan G coverage, but it is important to understand what your Medigap plan does not cover. Here are some common medical expenses that are not covered under Plan G, regardless of the state in which you reside:
- Part B deductible
- Prescription drugs
- Nursing homes or similar long-term care
- Dental care
- Vision care
Medicare Plan G Pros and Cons
Now that you understand more about what Medicare Supplement Plan G covers, let's take a look at the pros and cons of enrolling.
What We Like About Plan G
- Offers comprehensive coverage: Many older adults are surprised to find that there are many costs Original Medicare does not cover. It can leave seniors with high annual deductibles and monthly premiums, even if you qualify for no-premium Part A coverage. Medigap Plan G offers more comprehensive health coverage to ensure that the majority of your standard health-care expenses are covered.
- Greatly reduces out-of-pocket expenses: Out-of-pocket expenses — including premiums, coinsurances, copays, and deductibles — are often the greatest costs you will face with Medicare. Fortunately, paying a monthly premium for Medigap Plan G greatly reduces most of your out-of-pocket costs.
- Has more doctors to choose from: Any doctor who accepts Medicare also has to accept Medigap Plan G, which means you can essentially get nationwide coverage with your plan. That gives Plan G a leg up over some Medicare Advantage plans that are not accepted by every doctor or facility that accepts Medicare. Medicare.gov also provides a useful tool to find doctors and clinics that accept Medicare and Medigap plans in your area.
Things to Keep in Mind About Plan G
- Difficult to add or switch Medigap plans: Medicare beneficiaries are not granted the right to switch Medigap plans under federal law. That doesn't mean you cannot switch plans, but the rules can make it complex, especially if you want to switch between Medigap plans. You are able to enroll in a new Medigap plan without medical underwriting only during your initial enrollment period or the 30-day “look back” period that starts when you enroll in a plan. Otherwise, you may pay high fees to enroll and could be denied coverage if you have pre-existing conditions.
- Does not cover Part D benefits: One of the main reasons people choose Medicare Advantage (Part C) is that many plans include Part D, vision, dental, and hearing coverage (the degree of coverage varies by plan). Part C, however, disqualifies you from enrolling in Medigap. If you want Medigap and all the benefits that come with Medicare Advantage, you will have to get stand-alone plans for prescription drugs (Part D), vision, dental, and hearing.
- Costs may outweigh benefits for healthy seniors: Plan G has higher premiums than many other Medigap plans. The costs may outweigh the benefits, especially if you don't see the doctor very often. If you are not getting treated frequently or accumulating substantial out-of-pocket costs, you could be paying more for a level of coverage that you don't really need.
Medicare Part G Cost 2022
Like any Medigap plan, Plan G prices vary substantially by location and provider. Seniors in some states can also enroll in High-Deductible Plan G, in which you must pay the first $2,340 of deductibles, copayments, and coinsurance per year before Plan G kicks in. That does not count the actual premium of your Medigap plan either.
Since costs vary so much, you will need to shop for Medigap Plan G in your area to get exact prices. Nonetheless, it is important to have some idea of what to expect. In 2022, for example, Medigap Plan G in Georgia has monthly premiums ranging from $111 to $3,304 for a standard plan, or $40 to $2,024 for a high-deductible plan.2 These plans do not cover your Part B deductible, which averages $170.10 per month in 2022.
Compared to other Medigap plans, Plan G is a high-benefit, high-premium plan. You can get slightly lower premiums — and fewer benefits — with Medigap Plans A or B. Medigap Plans C, D, and F are similar to Plan G for price and overall benefits. For significantly lower costs, you should consider Medigap Plans K, L, M, or N.
Medicare Plan F vs. Plan G
Many people compare Medigap Plan F and Plan G since they offer similar benefits. Medigap Plan F, however, is no longer available to people who became eligible for Medicare on or after January 1, 2020. That means Plan F is not a viable option for many seniors. If you have Medigap Plan F, you can pay similar Medigap premiums and get all the same benefits as Plan G, plus your Part B deductible is fully covered.
Plan F and Plan G are very similar, with two major exceptions: Plan G is still available to new enrollees and Plan F is not, and Plan G does not cover the Part B deductible while Plan F does.
How to Enroll in Medicare Supplement Plan G
Your Medigap initial enrollment period is the best time to enroll in Medigap Plan G. This six-month period begins as soon as you are enrolled in Medicare Part B. During this enrollment window, you will have access to a wider range of plans and prices, with no medical underwriting required. You cannot be refused a plan or charged more because you have health problems or pre-existing conditions.
Things can get a bit tricky if you miss your Medigap initial enrollment period. You can still enroll in Plan G at virtually any time after this period, but there is no guarantee that an insurance provider will accept your application. If you have pre-existing conditions, you may not meet their medical underwriting requirements. Insurance providers can also charge more for plans outside the initial enrollment period, and you may have to pay a late-enrollment fee.
FYI: Debating between a Medigap and Medicare Advantage plan? Visit our Medigap vs. Medicare Advantage guide to learn more.
There are a few exceptions to these limited windows. If you signed up for Medicare Advantage when you first became eligible for Medicare, then you have a 12-month window to disenroll, enroll in Original Medicare, and sign up for a Medigap plan without losing your Guaranteed Issue rights. That will grant you access to all the same plans and prices you would have gotten during your Medigap initial enrollment period. You also have a small window to enroll in Medigap without medical underwriting if you had a Medicare Advantage plan but were dropped from it by moving out of state. You can learn more about enrolling in Medigap Plan G and other special circumstances that apply to Medigap enrollment on Medicare's website.
Is Medigap Plan G Right for Me?
Plan G has high benefits and high premiums. If you want to get Plan G benefits at a lower cost, you will have to enroll in a high-deductible plan, which will automatically increase your deductible costs. Plan G is the best Medigap plan for seniors who are able to pay a higher monthly premium to reduce out-of-pocket expenses. It is particularly good for older adults who frequently visit the doctor or require regular medical treatment, since it can cover most of the copays, coinsurance, and deductibles. If you want a cheaper plan, Medigap Plans K, L, M, and N have lower premiums.