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The One Thing Medicare Supplement Plan G Does Not Cover

The One Thing Medicare Supplement Plan G Does Not Cover

Medicare Supplement Insurance, also called Medigap, helps pay for costs left over after Original Medicare pays its share. Medicare Plan G is one of the most popular Medigap policies offered. It provides extensive coverage, but there is one key item Plan G does not cover.

Overview of Medicare Supplement Plan G Cover 

Medicare Supplement Plan G is one of 10 standardized Medigap Plans labeled with letters. Medigap Plans are sold by private insurance companies and are designed to fill gaps in Original Medicare coverage.

Here are the costs that Plan G covers:

  • Eligible for Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • Accept Medicare Part B coinsurance or copayment
  • First 3 pints of blood for a medical procedure
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Medicare Part A deductible
  • Medicare Plan B excess charges
  • Foreign travel emergency care

Plan G also covers 100 percent of most out-of-pocket costs not paid by Original Medicare Parts A and B. It offers very comprehensive coverage.

But Plan G does not cover one thing – the Medicare Part B deductible.

What is the Medicare Part B Deductible?

The Medicare Part B deductible is an annual amount enrollees must pay before Medicare begins covering Part B medical services. In 2023, the standard Part B deductible is $226.

This deductible applies to Part B-covered expenses like:

  • Doctor visit copays
  • Outpatient surgery
  • Lab tests
  • X-rays
  • Durable medical equipment
  • Ambulance transportation
  • Other outpatient services

You must first pay the yearly Part B deductible before Medicare starts chipping in coverage for these types of medical services.

Why Plan G Doesn’t Cover the Deductible

When Medigap Plans were first standardized, some compromises had to be made to balance comprehensive coverage with affordable premium costs.

For Plan G, the compromise was excluding coverage for the Part B deductible. This helped keep Plan G premiums reasonable compared to more robust but costly plans.

The only other Medigap Plan that does not cover the Part B deductible is Plan M. The other 8 Medigap options all include the Part B deductible, but at higher monthly premiums.

So if you want a Medigap Plan that covers the Part B deductible, Plan F, Plan C, or Plans A-F would include this coverage.

How Much is the Part B Deductible?

The Medicare Part B deductible amount changes each year. Here is how much it has been in recent years:

  • 2018: $183
  • 2019: $185
  • 2020: $198
  • 2021: $203
  • 2022: $233
  • 2023: $226

So expect to pay somewhere in the range of $200 annually for the Part B deductible when enrolled in Plan G. This is the primary gap in Plan G coverage to be aware of.

Who Should Enroll in Plan G?

Medicare Supplement Plan G remains a popular choice despite not covering the Part B deductible. It provides robust coverage for a relatively affordable Medigap premium in most states.

Unless you want to pay higher premiums, Plan G can make sense even with the need to pay the Part B deductible out-of-pocket each year. For many, the premium savings outweighs the deductible cost.

When evaluating Plan G, consider factors like:

  • Your expected healthcare costs
  • Plan G premium costs in your state
  • Your household income and budget
  • Your overall health status
  • Any other retiree health benefits you have

For a lot of retirees, Plan G offers the optimal balance between premiums, coverage, and out-of-pocket expenses. It delivers strong coverage at a mid-range price point.

Just remember to budget for the Plan B deductible which will not be covered under Plan G. This is the major coverage limitation to understand.

Alternatives to Plan G

If you want a Medigap Plan that picks up the Part B deductible, alternatives to consider include:

  • Plan F and plan – Plan f covers most comprehensive option but only for those eligible prior to 2020
  • Plan C – Similar coverage to Plan F for newer Medigap enrollees
  • Plan N – Lower premiums than Plans F/G but copays apply
  • Plan A – Lowest premiums but higher out-of-pocket costs

Be sure to compare premiums, coverage, and deductibles when deciding if Plan G or another Medigap policy best fits your needs. A Medicare Advantage Plan is also an alternative way to supplement Original Medicare.

The Bottom Line

In summary, the key points to understand about Plan G:

  • Plan G covers almost all Medicare out-of-pocket costs with one exception – the Part B deductible
  • You’ll need to pay the Part B deductible of around $200 per year yourself
  • Plan F, Plan C, and Plans A-F include the deductible while Plan G does not
  • Paying the deductible can save substantially on your premium vs more comprehensive plans
  • Consider overall value when choosing between Plan G, other Medigaps, or Medicare Advantage

While it provides extensive coverage, Medicare Supplement Plan G is not 100% comprehensive. But for many Medicare beneficiaries, paying the Part B deductible is an acceptable tradeoff to keep premiums affordable. Just be sure you understand the major coverage gap under Plan G.

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What does Medicare Plan G cover?

Medicare Plan G is a Medicare Supplement insurance plan that covers everything that Medicare Part A and Part B covers, except for the Part B deductible. Plan G covers 100% of all approved costs for Medicare Part A and Part B services, and it has no out-of-pocket costs except for the yearly Medicare Part B deductible amount.

How much does Medicare Plan G cost?

The exact monthly Plan G premium will vary depending on your age and where you live, but on average nationwide Plan G costs between $120-220 per month in 2023. Plan G premiums are standardized so they remain consistent through most of your enrollment in the plan and do not increase as you age unlike some other plans. Your specific Plan G price quote may be less if you enroll around your initial Medicare eligibility.

What is the difference between Plan G and Plan F?

The key difference is that Medicare Plan F also covers the annual Part B deductible, while Medicare Plan G does not. Otherwise, both plans cover all other Medicare copays, coinsurance and deductibles. So Plan F provides slightly more generous coverage than Plan G, but may have a higher premium as a result. Both plans help fill in many of the gaps in Original Medicare.

Who can buy Medicare Plan G?

To purchase Medicare Plan G, you must already be enrolled in both Medicare Part A and Part B. Generally, a person is eligible to buy or accept Medigap Plan G during their Medicare Part B open enrollment period that begins the month they turn 65 and enroll in Medicare Part B. A few states do allow limited open enrollment later on as well.

What benefits does Medicare Plan G offer?

Medicare Plan G provides comprehensive coverage for all coinsurance and deductibles required by Medicare Part A and Part B except the annual Part B deductible. This includes benefits for hospital stays, medical costs, skilled nursing facilities, hospice care and more. It essentially fills in all the gaps in coverage that Original Medicare doesn’t cover. So Plan G policyholders have very low out-of-pocket costs.

Does Medicare Plan G cover prescription drugs?

No, neither Medicare Plan G nor any other Medicare Supplement Plans cover prescription drugs. For prescription coverage you need to enroll in a standalone Medicare Prescription Drug Plan (Part D). Medicare Advantage Plans that offer medical and drug coverage provide an alternative to Original Medicare plus a Part D Plan. But Medicare Supplement Plans only work with Original Medicare Parts A and B.

How do I enroll in Medicare Plan G?

To enroll in Medicare Plan G, you must first contact an insurance agent or company that offers Medicare Supplement Plans in your state. They can provide information on available Plan G policies and assist you in applying for coverage. You can only enroll during your Initial Enrollment Period or other pre-designated Open Enrollment windows. Enrolling may also require satisfactory health underwriting. The insurance company you purchase a plan from will then coordinate directly with Medicare.

Does Plan G cover pre-existing conditions?

Yes, so long as you enroll in Plan G during your initial enrollment period or another designated open enrollment window, it will cover pre-existing medical conditions that may have existed prior to your enrollment in the plan. As a Medicare Supplement Plan, Plan G is guaranteed renewable for life and cannot deny claims or increase premiums based on health status or age, as long as the premiums are paid.

What services does Medicare Plan G include?

In addition to covering all Medicare Parts A and B cost sharing except the annual Part B deductible, Medicare Plan G specifically covers three pints of blood per calendar year, hospice care coinsurance or copayment, care while traveling outside of the U.S., preventive care, and health care received on a cruise ship within the U.S. territorial waters. So Plan G covers nearly everything for very minimal out-of-pocket costs.

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