Medicare Supplement

Medicare Supplement Insurance (Medigap) Plan G in 2021

Medicare Plan G, a Medigap plan, pays for many of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t cover. Medicare Plan G, which is similar to Plan F, can be worth the cost if you expect significant medical bills during the year.

Medicare offers an alphabet soup’s worth of parts and plans. The big four are:

  • Part A hospital coverage
  • Part B medical coverage
  • Part C Medicare Advantage plans
  • Part D prescription drug plans

After that come the 10 different Medigap plans – otherwise known as Medicare Supplement insurance – which each have a letter title, including Plans A, B, C, D, G, F, K, L, M and N.

Medicare may appear more like Scrabble, but this lettering system for Medigap plans is useful in helping beneficiaries know exactly what coverage they are getting. That’s because Medicare ensures that every Medigap plan letter has the same basic benefits everywhere in the U.S. (except Massachusetts, Minnesota and Wisconsin, which standardize their Medigap plans differently). So a Plan G policy in Alaska covers the same out-of-pocket Medicare costs as Plan G in Hawaii.

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Each lettered plan offers different coverage and cost, though, and some are more popular than others. One of the top-selling Medigap plans is Plan G.

What is Plan G?

Medicare Plan G is the second most popular Medicare Supplement after Plan F, partly because it covers the most gaps in coverage of any Medigap plan available to new Medicare beneficiaries who first became eligible for Medicare after January 1, 2020.

All Medigap plans help pay for the costs that Parts A and B (also known as Original Medicare) may not cover, such as deductibles, copayments and coinsurance. But each Medigap plan covers different charges at different amounts.

Medicare Supplement Plan G covers:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits run out
  • Part A deductible ($1,484 in 2021)
  • Part A hospice care coinsurance or copayment
  • Part B coinsurance or copayment
  • Part B excess charges
  • Blood (the first three pints needed for a transfusion)
  • Skilled nursing facility coinsurance
  • Foreign travel emergency care (up to plan limits of $50,000)

The only thing that Plan G does not cover that Plan F does is the Part B deductible. However, Plan F is no longer available to those who became eligible for Medicare after

Jan. 1, 2020. So for the newly eligible, Plan G may be the best option for the most extensive Medicare Supplement coverage.

Once you meet your Part B deductible, Plan G covers Part B outpatient medical services such as doctor visits, lab work, chronic disease supplies, durable medical equipment, X-rays, ambulance transportation, surgeries and a great deal more.

What does Medicare Supplement Insurance Plan G cover?

Medigap Plan G

Benefit Area

Covered by Medigap Plan G

Medicare Part A coinsurance and hospital costs

Medicare Part B coinsurance or copayment

First 3 pints of blood

Part A hospice care coinsurance or copayment

Coinsurance for skilled nursing facility

Medicare Part A deductible

Medicare Part B deductible

No

Medicare Part B excess charges

Foreign travel emergency costs

80%

How much does Medicare Plan G cost?

The premium you pay for a Plan G policy may depend on where you live, your gender and – depending on when you apply for Plan G – your health status. According to MedicareSupplement.com, the average monthly premium for Plan G is $122.78 per month.

It’s easy to see how Plan G can quickly save you money, depending on the health care services you need. All those Medicare copays and coinsurance costs for supplies and services can add up quickly.

How Plan G can help you save money

Let’s imagine a situation where the Plan G premium is $120 a month where you live. That’s $1,440 a year.

  • If you are admitted to the hospital for inpatient care, you would have to pay a Part A deductible of $1,484 for each benefits period in 2021 before your Part A benefits kick in.

  • Since Plan G pays for the Part A deductible, you would have saved $44 already in this example.

  • If you need services like surgery, you are 100% covered for the surgery copays and coinsurance costs that Medicare Part A doesn’t cover.

Even if you don’t need inpatient hospitalization, your savings could potentially be substantial with Plan G if you have a chronic medical condition.

  • Let’s consider a hypothetical example that imagines you have diabetes. Over the course of a year, you will need several doctor visits, occasional lab tests, supplies like glucose test strips and lancets and maybe a new glucose meter. Those are covered by Part B.

  • Without Plan G, your yearly cost for all that care would be the Part B deductible of $203 plus all the copays and coinsurance required for your diabetes supplies and care.

  • With Plan G, once you pay the deductible, you are 100% covered for those costs; you never pay another dollar that year.

What are Medicare Part B excess charges?

Some doctors and other providers bill patients for what are called excess charges. These are additional charges that are above what Original Medicare approves as the full payment for a specific service or product.

Medicare has set payment rates for covered services. Some doctors or other providers don’t “accept assignment,” which means they don’t accept the Medicare-approved amount as the full payment. They are allowed, by federal law, to charge up to 15% in excess charges above the Medicare-approved amount. State law may add more limits in some states.

So, if Medicare allows a fee of $100 for a doctor’s office appointment, a physician who doesn’t accept assignment may charge an additional 15% ($15) for the appointment. Medicare Part B pays 80% of only the allowed rate, or $80. You are responsible for the remaining 20% of the allowed rate ($20) plus the excess charge of $15, for a total of $35.

Plan G coverage, though, is the only Medigap plan (besides Plan F) which pays both the $20 coinsurance and the $15 excess charge in this example.

What Plan G doesn’t cover

As we already stated, Plan G does not cover the Part B deductible. In addition, no Medigap plan, including Plan G, covers routine dental care.

Plan G will cover the coinsurance on any medications covered by Part B, which are usually drugs that are administered in a clinical setting, such as a doctor’s office or outpatient chemotherapy or infusion center. It does not cover outpatient retail prescriptions, which are covered by Medicare Part D prescription drug plans.

Find out if Plan G is right for you

A licensed insurance agent can help you learn about Medicare Supplement Insurance Plan G and other Medigap plans that may be available where you live. Call to speak with a licensed agent today.

Learn more about Medigap plans in your area

Visit MedicareSupplement.com
David

About the author

David Levine is an award-winning writer and editor whose work has been featured in the New York Times, New York Daily News, Sports Illustrated, American Heritage, U.S. News & World Report and others.

David has covered health, health insurance and health policy topics – among many others – since 2017. He earned a Bachelor's Degree in English from the University of Rochester and currently lives in Albany, New York.

 

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