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How Does Medicare Plan G Work?

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Medicare is federal health insurance for those 65 years and older or those who qualify earlier due to Social Security disability. One thing to know before your Medicare enrollment is that Medicare does not cover all healthcare services in full. For example, you are responsible for the Part A and Part B deductible, copays, and coinsurance for inpatient and outpatient services. These out-of-pocket costs can be detrimental if you have an expensive procedure. Many beneficiaries purchase Medicare Plan G to help cover those out-of-pocket costs, as Plan G provides substantial coverage. You can see Plan G reviews all over the internet, but how does Medicare Plan G work?

Medicare Plan G explained

Medicare Plan G, also known as Medigap Plan G, works are secondary coverage to Original Medicare Part A and Part B. Plan G only pays out when Medicare pays first. So, if Medicare denies a service, Plan G would, as well. When you have Plan G, you are not restricted to a network of doctors. You can visit any doctor in the U.S. that accepts Medicare and use your Plan G. The doctor must take Plan G as secondary insurance no matter the carrier you purchased the plan through.

Medigap Plan G helps cover nearly all the gaps in Medicare. For example, Plan G covers:

  • Part A deductible
  • Hospital copays/coinsurance
  • Part A hospice care copays/coinsurance
  • First 3 pints of blood
  • Part B copays/coinsurance
  • Part B excess charges

The only out-of-pocket cost you would pay with Plan G for Medicare-approved services is the Part B deductible, $233 in 2022. After you pay the Part B deductible, Plan G will cover the rest of your Medicare-approved services for the year in total.

If you travel often, know Plan G offers a foreign travel emergency benefit up to $50,000. You can only use this benefit in the case of an emergency that happens within the first 60 days of your international travel. You must pay a $250 deductible first, and then your benefit would kick in. Take note this is a lifetime benefit. So, once you spend $50,000, the benefit will go away.

How much does Plan G cost?

Private insurance carriers sell Medigap plans and not the government. There is no set premium for Medicare Plan G, as it depends on multiple factors. For example, a Medigap premium is determined by your gender, age, tobacco use, zip code, and the private insurance carrier you purchase the plan through. Keep in mind that you and your spouse will not have the same monthly premium!

Since premiums vary by carrier, working with a Medicare broker that represents multiple insurance companies is beneficial. A Medicare broker can help you find the most cost-effective plan in your area! With that said, Medigap plans are standardized. Therefore, no matter which carrier you purchase Plan G from, it will still provide the same coverage. The only difference between the carriers is the premium.

When to apply for Medicare Plan G

Every Medicare beneficiary is given a one-time Medigap Open Enrollment period to apply for a Medigap plan. The Medigap Open Enrollment is a six-month-long window based around your Part B effective date. When you apply for Plan G during that six-month window, the private insurance cannot ask you health questions.

Let’s say you fail to apply for a Medigap plan during this time. In that case, you will likely have to go through Medigap underwriting and answer a health questionnaire in most states. If you cannot answer no to the health questions, you will be denied a Medigap plan or charged with a higher monthly premium. However, some states have special Medigap enrollment periods, such as California and Illinois, which allow you to apply for a Medigap plan during a specific time of year without underwriting questions.

Summary

Medicare Plan G is one of the most popular Medigap plans! If Plan G sounds like the plan for you, make sure you don’t miss your Medigap Open Enrollment, and you compare plans among multiple carriers to ensure you are in the most cost-effective plan in your area.

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