The Medicare landscape changes from year to year. Usually, these changes are relatively minor; the Part B premium increases each year, as do the Part A and B deductibles. Various test programs are launched aimed at improving the Medicare experience for Americans. Sometimes, though, the changes are more drastic and impactful. This is the case with Medicare Supplement Plans F, and G. Plan F has traditionally been the go-to plan for people entering Medicare. But, a recent law change has caused Plan G to overtake it as the most popular plan. In this guide, we’ll review the changes in the law that lead to this development and dive into the details on Medigap Plan G.
What Is Medigap Plan G?
Plan G is one of the ten standardized Medicare Supplement Insurance plans, also referred to as Medigap plans. These are some of the most comprehensive programs available, and Plan G is the most-comprehensive Medigap plan open to newly eligible Medicare Beneficiaries.
These plans work in tandem with Original Medicare. This is entirely unlike Medicare Advantage, a replacement for Original Medicare.
Medicare Supplement plans function as secondary coverage to Original Medicare. So, when you go to the doctor, you present both your Medicare card and your Medicare Supplement card. Your doctor or other providers then bill both Medicare and your Medicare Supplement plan. Depending on which Medigap plan you’ve chosen, you may or may not have to pay out of pocket as well.
So, what is Medigap Plan G paying for when you visit the doctor or other provider? They’re paying for almost all of the amounts that you would typically have to cover out of pocket under the terms of Original Medicare. These are the so-called “gaps” in Medicare. Specifically, Plan G covers these gaps:
- Part A hospitalization costs, plus 365 extra hospital stay days (above and beyond what Original Medicare covers typically)
- Your first three pints of blood (Medicare covers anything beyond this)
- Part A hospice care costs
- Part B co-insurance (you would typically pay 20% of the cost of Part B services and procedures)
- Skilled nursing costs under Part A
- Part A deductible
- Part B excess charges
- Emergency coverage outside the United States
There is only one gap that Plan G doesn’t cover – the Part B deductible. With Plan G, you must meet the Part B deductible each year before the plan will pay benefits. This deductible is minimal; it is currently less than three hundred dollars. This means that your total out-of-pocket costs – on Medicare-covered services and procedures – are limited to the Part B deductible each year. Medigap Plan G will cover all of your other expenses.
What Happened To Medigap Plan F?
We mentioned that Plan G is now the most comprehensive Medigap plan available, but that Plan F used to occupy this position; what happened to Plan F? There was a change in the law that prevented new Medicare Beneficiaries from purchasing Medigap plans that covered the Part B deductible. It was decided that if people have to pay some money out of pocket, it will cut down on the over-use of medical care. Because of this change, anyone who becomes eligible for Medicare (even if they don’t actively enter Medicare) on or after January 1, 2020, cannot enroll in a Medigap plan that covers the Part B deductible. This means that Plans C, F, and High Deductible F are not available for newly-eligible Medicare Beneficiaries. This has left Plan G as the “replacement” for Plan F as the most comprehensive Medicare Supplement Insurance plan available.
What Are The Eligibility Rules For Medigap Plan G?
The eligibility rules are pretty simple. You must be covered by both Medicare Part A and B, for starters. You must always continue to pay your Part B premium; otherwise, you will lose your Part B coverage. Since Plan G is the secondary payer, it only pays after your primary (Medicare Part B) pays. In other words, if you don’t have primary coverage because you stopped paying your Part B premium, then your secondary coverage won’t pay, either.
Besides this basic eligibility, you also need to know that you may not be able to get Medigap Plan G if you’re younger than 65. This will happen if you enter Medicare at an early age. This would be due to one of these circumstances:
- Receiving disability payments from Social Security or the Railroad Retirement Board for 24 consecutive months
- Diagnosis of End-Stage Renal Disease (ESRD)
- Diagnosis of ALS, or Lou Gehrig’s Disease
In these cases, you will enter Medicare Parts A and B, but you might not be able to choose Medigap. This is a state-by-state rule; some states will allow you to get Plan G (or any other Supplement plan available) before turning 65. If you enter Medicare early and can’t get Medigap coverage, you might want to consider your choices for Medicare Advantage in your area until you turn 65.
If you do enter Medicare before age 65, you should know that you will have the opportunity to choose Plan G whenever you do turn 65. This brings us to the enrollment periods for Medigap Plan G.
Assuming that you enter Medicare at the average age of 65, or later if you delay taking Part B because you’re still working or covered by your spouse’s health plan, you’ll have an opportunity to enroll in Medigap Plan G when you first enter Part B.
Specifically, you’ll have the chance to enroll in Plan G, or any other Medigap plan available to you, during your Medigap Open Enrollment Period. This open enrollment period will begin when you are both 65 or older and enrolled in Part B. The enrollment window lasts for six months. You have a guaranteed right to enroll in the Medicare Supplement Insurance plan of your choice during this period, including Plan G.
Your open enrollment period is the best time to enroll in Medigap Plan G. However; you may be able to choose this plan at a later date if you’re willing to go through Medical Underwriting. If you go this route, you might not qualify for coverage or be charged more for range based on your specific health status.
I Have Plan F – Should I Move To Plan G?
Now that Plan F isn’t available to new Medicare Beneficiaries, many people want to know if they should move to Medigap Plan G from Plan F. This is an excellent question and one that you should think carefully about. One line of thinking is that comparatively few people will be entering Plan F now; that means that the insured pool is fixed to some extent. This pool is getting older every year and possibly sicker. This could cause premiums for Plan F to increase faster than for Plan G. This is a possibility, although so far, this doesn’t seem to have happened since 2019.
However, even if Plan F doesn’t see significant premium increases, you probably will still save money with Plan G. This is because you have to pay the Part B deductible with Medigap Plan G. Even though this deductible is relatively tiny, the premium savings with Plan G over Plan F is usually more significant than the deductible amount.
Save Money On Medigap Plan G
Many insurance companies offer Medigap Plan G, and they all have different price points. If you could help find the plan that’s best for you, ask for a free consultation today. We can help you compare quotes on Medigap Plans in your area and help you easily enroll in the plan of your choice. Give us a call today to get started.