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.
How Medigap Plan G Works
Like other Medigap plans, Medigap Plan G is supplemental insurance offered by Medicare-approved private insurance companies for people with Original Medicare. All Medigap plans help cover the “gaps” in Medicare coverage by paying for out-of-pocket costs like deductibles and coinsurance. Though there are premiums for Medigap plans, these can be significantly lower than Medicare out-of-pocket costs depending on the type and frequency of care needed, helping to make Medicare more affordable overall. In 2019, 12% of Original Medicare enrollees without Medigap reported having problems paying for medical bills, compared to just 4% of enrollees who had Medigap.
In almost every state, there are 10 standardized Medigap plans, including Plan G: Plan A, B, C, D, F, G, K, L, M, and N. Plans with the same letter are required to cover the same set of Medicare costs no matter which insurer offers it, though premiums may vary from one company to another. Some states also have their own regulations for Medigap, so it is best to check with your state’s Department of Insurance for specific coverage details once you have narrowed down your Medigap options. Residents of Wisconsin, Minnesota, and Massachusetts have their own sets of Medigap plans.
Medigap plans can only be used with Original Medicare. People with Medicare Advantage are not eligible for Medigap unless they switch back to Original Medicare.
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)
Medicare Supplement Plan G Eligibility
People with Original Medicare may be eligible for Plan G if they’re enrolled in both Part A and Part B. People who get their Medicare coverage through a Medicare Advantage plan are not eligible unless they’re switching 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, but others do not. Contact your state’s Department of Insurance for more information.
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.
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 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.
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