What Does Medigap Plan G Cover?

Happy seniors reading over the coverage of Medigap Plan G.
Plan G is nearly as comprehensive as Plan F, which was by far the most popular Medigap plan until it was phased out in 2020.

Medicare Supplement Plan G – also called Medigap Plan G – is one of the most popular Medigap plans in the country. Next to Plan F, Plan G is the most comprehensive Medigap plan on the market. But, unlike Plan F, which has been phased out for new enrollees, Plan G is available to anyone on Medicare, regardless of whether you’re new to the program or not.  

What Does Plan G Cover?

Plan G is nearly as comprehensive as Plan F, which was by far the most popular Medigap plan until it was phased out in 2020. Plan F covered 100% of all gaps in Medicare, and Plan G is almost just as good with one exception: Plan G does not cover the Medicare Part B deductible. For 2021, the Part B deductible is $203.

If you’re disappointed that Plan G doesn’t cover the Part B deductible, don’t be. Plan F has higher premiums than Plan G. What you save in a year when paying lower monthly premiums for Plan G may well be more than what you save by not paying the Part B deductible if you’re enrolled in Plan F. In fact, some folks enrolled in Plan F find it more cost-effective to switch to Plan G. 

Plan G covers everything that Medicare Part and B cover at 100%, except for the Part B deductible. This means that you will never have to pay any out-of-pocket expenses for covered services and treatments after you pay the Part B deductible. 

Similar to Medigap Plan F policies, Plan G also covers “excess charges.” While most doctors accept Medicare, you may find a doctor that does not. Doctors that do not accept the full Medicare-approved amount have the right to charge you up to 15% more than the Medicare amount for approved services and procedures. This is called an “excess charge.” However, if you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, excess charges are illegal. 

Who is Eligible for Plan G? 

 If you are on or qualify for Original Medicare, then you are likely eligible for a Medicare Supplement Plan. You must also be an American citizen and/or legal resident of the U.S. for at least five years to qualify for Medicare. Additionally, if you have worked for 10 years or more in the U.S., you will receive Medicare Part A without a premium. If you have not worked for 10 years in the U.S., then you may still be eligible for Part A, though you will have to pay the premium. And, usually, to become eligible for Medigap, you should either be turning 65 or be on Social Security disability. 

You may also be eligible for Medicare if you have amyotrophic lateral sclerosis (ALS). Further, cancer and other diseases such as early-onset Alzheimer’s disease may be considered a disability if it meets Social Security Disability criteria. 

Senior couple enjoying outdoors as they discuss Medigap Plan G.
The ideal time to enroll in Plan G – or any Medigap plan – is during your Medigap Open Enrollment Period (OEP).

How and When Can You Enroll in Plan G?

Open Enrollment Period 

The ideal time to enroll in Plan G – or any Medigap plan – is during your Medigap Open Enrollment Period (OEP). Your OEP will start when you turn 65, and your Medicare Part B is effective. If you are 65 or older and on Medicare, you can buy a Medigap policy at any time, though you may be subject to medical underwriting and health screening if you choose to enroll outside of your OEP. Crucially, if you enroll during your OEP, then providers must charge you the same price for the same plan regardless of your medical history or current medical status. 

If you are under 65 years old and on Medicare, you may be eligible for a Medigap plan depending on where you live. Certain states require Medigap insurance providers to sell Medigap plans to all Medicare enrollees, regardless of age. Each state has its own unique set of rules regarding health screening, rates, and Open Enrollment periods for beneficiaries under the age of 65. If you aren’t sure whether you are eligible for a policy or not, feel free to reach out to our offices to have one of our licensed agents assist you. 

After Open Enrollment

Generally, if you enroll in a Medigap plan outside of your OEP, you will become subject to medical underwriting. What this means is that you will likely have to pay higher premiums if you have a preexisting health condition. Unfortunately, you can even be denied coverage. However, if you live in Connecticut, Massachusetts, Maine, or New York, then under state law health insurance companies must offer you a Medigap policy if you’re eligible. 

Switching From Medicare Advantage

If you have a Medicare Advantage plan but would like instead to have a Medigap plan, you can switch to Original Medicare during your Annual Election Period, which is from October 15th to December 7th every year. You can also switch during the Medicare Advantage OEP, which happens every year from January 1st to March 31st. During these periods, you can apply for a Medicare Supplement Plan

Most states will not offer you guaranteed-issue rights when you switch plans, which means you could be subject to medical underwriting and thus higher premiums. However, some states will protect you and grant guaranteed-issue rights. As always, you can contact our office to get advice from one of our licensed agents if you have any questions. 

Why Choose Medigap Plan G?

Medigap Plan G is the most comprehensive Medigap policy on the market if you’re new to Medicare. Since premiums vary by location, you can expect to pay anywhere from $99 a month up to $476 a month for your plan’s premiums. While these costs may sound high, by choosing Plan G, you will receive the most coverage possible. 

With Plan G, almost all of your out-of-pocket costs will be covered after you have paid your $203 Medicare Part B deductible. You will not even be responsible for copays or coinsurance. 

Medigap Plan G is growing in popularity every single year, and it’s easy to see why. Costs are reasonable, and the comprehensive coverage brings peace of mind to policyholders. Call or email us today to get more information about Medigap Plan G rates in your area.

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