Medigap Plan G: A Comprehensive Overview of Benefits and Costs

Medicare Supplement plans, also known as Medigap, can help pay for the out-of-pocket costs associated with Original Medicare. There are 10 standardized plans for people with Medicare to choose from, each covering a different set of out-of-pocket costs, or different percentages and limitations. Medigap Plan G is a popular choice: In 2020, 27% of people with Medigap plans were enrolled in Plan G. Learn how Medicare Supplement Plan G works, what it covers, and how to sign up.

What Is Medigap Plan G?

Medigap Plan G is a Medicare Supplement Insurance Plan available to those enrolled in Original Medicare. It covers almost all out-of-pocket medical services and treatment costs after you’ve met your Medicare Part B deductible, which means you pay zero coinsurance or copays. However, though Medigap Plan G offers one of the most comprehensive coverages out of all Medicare Supplement Insurance Plans, it’s also among the most expensive options. 

The best time to purchase Medigap Plan G policy is during the six month Medigap Open Enrollment Period (OEP), which occurs once you’re 65 and enrolled in Medicare Part B. If you enroll in Medigap Plan G after this one-time period ends, it does get more complicated. After OEP, you may be subject to medical underwriting if you attempt to enroll. As a result, it’s possible to be denied coverage.

How Does Plan G Work?

While Medigap Plan G is one of the most popular Medicare Supplement Insurance Plans, it’s not suitable for everyone. Here’s everything you need to know about how Medigap Plan G works to decide whether it’s right for you. 

Eligibility

People with Original Medicare may be eligible for Plan G if enrolled in Part A, and Part B. Those who get their Medicare coverage through a Medicare Advantage plan are not eligible unless they switch back to Original Medicare.

For Medicare members under 65, eligibility may vary depending on location. Some states require insurers to make Medigap plans available to people under 65 who have a disability, but others do not. Contact your state’s Department of Insurance for more information.

If you’re eligible and ready to purchase Medigap Plan G, be sure to do so within the Medigap open enrollment period. It starts as soon as you’re enrolled in Medicare Part B and are 65 or older. After this period, Medigap Plan G could cost more, or you could be denied coverage due to health issues. 

What Medicare Supplement Plan G Covers

Benefits	Plan G	Plan A	Plan B	Plan C	Plan D	Plan F	Plan K	Plan L	Plan M	Plan N
Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Part B coinsurance or copayment	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	100% coinsurance; but copays may still apply
Part A hospice care coinsurance or copayment	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes
Part A deductible	Yes	Not covered	Yes	Yes	Yes	Yes	50%	75%	50%	​Yes
Part B deductible	Not covered	Not covered	Not covered	Yes	Not covered	Yes	Not covered	Not covered	Not covered	Not covered
Part B excess charge	100%	Not covered	Not covered	Not covered	Not covered	Yes	Not covered	Not covered	Not covered	Not covered
Out-of-pocket limit	N/A	N/A	N/A	N/A	N/A	N/A	$6,940 in 2023	$3,470 in 2023	N/A	N/A
Blood (first three pints)	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes
Skilled nursing facility care coinsurance	Yes	Not covered	Not covered	Yes	Yes	Yes	50%	75%	Yes	Yes
Foreign travel exchange up to plan limits	80%	Not covered	Not covered	80%	80%	80%	Not covered	Not covered	80%	80%

Plan G covers 100% of the following out-of-pocket costs in Original Medicare:

• Part A deductible: $1,600 per benefit period in 2023
• Coinsurance for inpatient hospital care: $400 per day for days 61 to 90; $800 per day for days 91 and beyond
• Additional lifetime reserve days: 365 days of inpatient hospital care in addition to the 60 lifetime reserve days in Original Medicare
• Coinsurance for skilled nursing facility care: $200 per day for days 21 to 100
• Coinsurance/copays for hospice care: Up to $5 per hospice-related drug and 5% of the Medicare-approved amount for respite care
• Coinsurance for Part B services: 20% of the Medicare-approved amount
• Blood transfusions: First three pints of blood
• Part B excess charges: Fees charged by providers in excess of the Medicare-approved amount

Medigap Plan G also covers 80% of the medical bills for certain emergency care provided outside the United States. This coverage has a lifetime cap of $50,000.

What Medicare Supplement Plan G Does Not Cover

Medicare Supplement Plan G does not cover the Part B deductible, which is $226 in 2023. However, Plans C and F cover this deductible and may be available to people who were eligible for Medicare before January 1, 2020.

Standard Medigap plans, including Plan G, also generally do not cover costs relating to the following:

• Long-term care
• Dental services
• Vision services or eyeglasses
• Hearing aids
• Private duty nursing
• Prescription drugs (may not apply to plans sold prior to January 1, 2006)

Plan G vs. Medicare Advantage

When deciding whether Original Medicare with Medigap is right for you or if Medicare Advantage would better suit your needs, consider your budget, lifestyle, health needs, and preferred doctors.

Medicare Advantage, offered as a replacement for Original Medicare by private, Medicare-approved insurers, could be a more suitable choice if:

• You’re under 65 and are not able to buy a Medigap policy in your state.
• You’re generally healthy and prefer a plan with lower premiums. Some Medicare Advantage plans offer $0 premiums, though there will be deductibles, coinsurance, and copays when you do seek care.
• You want coverage for the additional benefits Medicare Advantage plans may offer, such as prescription coverage through Medicare Part D, or dental, vision, and hearing care. 

Original Medicare combined with Plan G could be a more suitable choice if:

• You like to travel and want coverage you can use throughout the United States. Unlike Medicare Advantage, which restricts your care to in-network physicians, specialists, and facilities, Original Medicare and Plan G allows you to seek care from any provider nationwide who accepts Medicare.
• You have high medical expenses and want help paying for out-of-pocket costs. Depending on the plan and insurer, Original Medicare with Medigap Plan G can be more cost effective than paying the out-of-pocket costs of a Medicare Advantage plan.
• Your preferred doctors accept Original Medicare but are not in a Medicare Advantage plan’s provider network.

Plan G vs. Other Medigap Options

Medicare Supplement Plan G covers more out-of-pocket costs than other Medigap plans, with the exception of Plan F. However, Plan F is not available to people who became eligible for Medicare after December 31, 2019.

With its higher level of coverage, Plan G may be appealing to Medicare beneficiaries with ongoing health care needs. People who rarely need to see a doctor may prefer a plan that covers fewer Medicare costs at a lower premium. 

In some states, insurers may offer a high-deductible Plan G. As the name suggests, these plans require more upfront out-of-pocket payment before Plan G kicks in to begin covering Medicare expenses. This plan may appeal to relatively healthy people who may want the wider coverage that Plan G offers in comparison to other Medigap plans in the event of an unexpected illness or injury, but at a lower premium.

What Costs Are Associated With Plan G?

With Medigap Plan G, you’re generally only responsible for paying the monthly premiums, which typically fall between $100 to $200 per month, and meeting the Part B deductible of $226 in 2023. 

For example, let’s assume you undergo a knee replacement surgery that costs around $25,000. Medicare Part B typically covers 80% of that cost after you meet your Part B deductible. And since Plan G covers all inpatient and outpatient medical expenses not paid for by Medicare, they’ll shoulder the remaining 20%. In other words, your only out-of-pocket costs for the surgery are the monthly premiums and the $226 deductible. 

Consider Plan G If…

As mentioned earlier, despite the high monthly premiums, Medigap Plan G could be worth considering if: 

• You travel frequently and need medical coverage no matter where you are in the country. With Medigap Plan G, you can receive care from any provider in the United States that accepts Medicare. And if you travel internationally, Plan G also covers 80% of your emergency health care costs while you’re abroad. 
• You have medical conditions that require expensive treatments. Since Medigap Plan G covers 100% of the Medicare Part A and Part B copays and coinsurance, it can significantly lower your out-of-pocket costs and reduce your financial burden. 
• Your preferred primary care providers are not in a Medicare Advantage plan’s provider network. In this case, it may make sense to consider Medigap Plan G, or other Medigap plans, to help bridge the gap in your Original Medicare costs. 

Advantages

• Comprehensive coverage: After meeting your Part B Deductible, Medigap Plan G takes care of your copayments, coinsurance, and excess charges. This means you’ll have little to no out-of-pocket costs. You also would not have to worry about paying the 15% excess charges from healthcare providers that do not accept Medicare assignment. 
• Healthcare costs while abroad: Medigap Plan G may also cover emergency health care during the first 60 days you travel outside of the United States.
• Access to any Medicare provider: With Medigap Plan G, you’re not restricted to only in-network healthcare providers. You can seek care from any provider in the country that accepts Medicare patients. 

Disadvantages

• Expensive premiums: Medigap Plan G’s high premiums can be unaffordable if you’re on a tight budget and may not make financial sense if you do not need the level of coverage it provides. 
• Part B deductible: Medigap Plan G does not cover the Part B deductible, which is $226 in 2023. You’ll pay this deductible once a year. 
• One-time enrollment period: If you purchase Medigap Plan G after the six-month enrollment period has ended, you may face higher premiums or have difficulty getting approved, especially if you have preexisting health conditions.

How to Enroll in Medigap Plan G

Those 65 years old or older and eligible for Medicare may enroll in Medigap Plan G at any time throughout the year. Unlike with Original Medicare or Medicare Advantage, there are no set enrollment periods for Medigap plans aside from the Initial Enrollment Period. 

Individual Initial Enrollment Period 

• When: Begins the first month after you have Medicare Part B and are 65 years of age or older. This window lasts for 6 months.
• What You Can Do: Enroll in Original Medicare and Medigap

Under federal law, your 6-month initial enrollment period automatically starts when you’re 65 or older and enrolled in Part B. This is the ideal time to purchase Medigap Plan G because insurers must offer all Medicare beneficiaries who enroll at this time the same rates, no matter your health status or if you have pre-existing conditions. Outside of this period, insurers are allowed to use medical underwriting to set premium rates and may charge more or decline coverage altogether.

Special Enrollment Periods

• When: Varies
• What You Can Do: Get Medigap Plan G

In certain special circumstances, people with Medicare have a guaranteed issue right to buy a Medigap policy. This means insurers are required to sell them a Medigap policy and cannot charge higher premiums due to preexisting conditions. 

Under federal law, some situations that trigger a guaranteed issue right to buy Medigap may include:

• Losing employer health coverage that pays secondary to Original Medicare
• Losing your prior Medigap plan because the insurer went bankrupt
• Switching to Original Medicare after losing your Medicare Advantage coverage

Alternatives To Medigap Plan G

If you do not need Medigap Plan G’s comprehensive coverage or the premiums are out of your budget, consider the following alternatives that may be better suited for your situation. 

Medicare Advantage

Medicare Advantage, or Medicare Part C, is a private insurance plan offered by Medicare-approved health insurance companies. It provides the same basic coverage as Original Medicare but also features extra benefits. 

One reason you may want to consider opting for Medicare Advantage Plans is their substantially lower premium costs. Some Medicare Advantage plans offer premiums as low as $0 per month, whereas a Medicare Supplement Plan G almost always has a monthly premium that falls between $100 to $200 per month.

Also, since Medigap Plan G generally only covers medical services approved under Medicare Part A and B, Medicare Advantage plans will make more financial sense if you need extra benefits such as prescription drug coverage and routine dental, vision, and hearing care. 

Medicaid

Medicaid is a joint federal and state program that provides free or reduced cost medical services to low-income families and individuals. Though Medicaid may require you to pay a small copayment for some items or medical services, it generally would not exceed the maximum out-of-pocket cost sharing limit set by the U.S. government, which is 5% of your monthly or quarterly income.

Plus, your state’s Medicaid program must pay 100% of your nursing home expenses if you require long-term care, whereas Medigap policies typically only cover short-term skilled nursing care. So, you may want to check and see if you’re eligible for Medicaid if your income level is on the lower end and you cannot afford Medigap Plan G. 

Putting It All Together

Without a Medicare supplement plan like Medigap Plan G, you’d have to shoulder costs like coinsurance and copayments yourself, which can quickly strain your budget if you require frequent medical attention. So, while Medigap Plan G’s monthly premiums can be expensive, its comprehensive coverage could save you thousands of dollars in medical expenses over the long run. But as with purchasing any other health insurance product, remember to perform adequate research or speak with a trusted insurance agent if you have questions or concerns.