Home Health 5 Important Facts to Know About Medicare Plan G

5 Important Facts to Know About Medicare Plan G

by Gareth Mark

The U.S. government created Medicare to give seniors ease of access to healthcare. Did you know that Medicare Plan G is one of the most popular Medicare supplements? Plus, Plan G is gaining even more momentum with Medicare beneficiaries. 

So, what exactly is Plan G? Medicare Plan G covers everything you would pay for except your Medicare Part B deductible. It is an excellent plan for Medicare beneficiaries looking to cover the gaps in Medicare with competitively priced premiums. This article will share information on five important facts to know about Medicare Plan G!

#1: Plan G’s Coverage

Medigap Plan G is highly comparable to Medigap Plan F. The policy is sold by private insurance companies. It covers all the coverage gaps in Medicare except for your Part B deductible and typically offers a better premium. The Part B deductible in 2022 is $233. It pays for your copays amount, Medicare Part A hospital stay and deductibles, and coinsurance charges. 

What is covered with Plan G is inpatient hospital costs and copayments, three pints of blood, hospice care coinsurance, and skilled nursing facility care. In addition, Medicare supplement Plan G covers outpatient care like lab work services, doctor visits, cancer treatment, diabetes supplies, durable medical equipment, ambulance, surgery, x-rays, and more. Plan G is loved by Medicare enrollees who love the Medigap plans’ budget benefits. 

Medigap Plan G is typically more expensive than Medigap Plan N. However, people seem to like the stability more. They have peace of mind knowing that they are covered with gaps in their Original Medicare policies. 

#2: Medicare Supplement Insurance in the Different States

Health insurance companies have standardized plans across the states for Medigap policies. A standard Medigap policy offers the same basic benefits, and some offer additional benefits. You can choose between the options which one meets your needs. 

However, in Massachusetts, Minnesota, and Wisconsin, Medigap policies for residents in these states are standardized differently. The difference is that while each insurance company decides which policy to sell. 

#3: Underwriting

Perhaps you’re on another plan like a Medicare Advantage plan and want to switch to a Medigap plan. You will most likely have to answer some health questions to determine your enrollment eligibility. 

Small amounts of health conditions will leave you likely to get approved for a Medigap plan. Any pending surgeries or treatments will hold you back. Recent changes can be used against you. For example, suppose you have a major surgery coming up. In that case, you should get it done with your old insurer before applying for a new one. 

Also, any prescriptions or medications you’re taking will be in your record for review. A big reason why people want to change to Plan G is because of a lower price rate they would pay for the supplement compared to other supplemental Medicare plans. The peace of mind of knowing that service and its expenses will be covered is pretty nice. If you do not pass underwriting, you have a few plan options. You will have to make a choice to stick with your existing policy or look into Medicare Advantage plans. 

#4: Medigap Open Enrollment Windows

There are specific open enrollment windows where you can change your Medigap policy like Plan G. In states like Oregon and California, you can change your Medigap plan during your birthday month with no underwriting. Missouri has a similar rule that you can change 30 days before your Medigap anniversary, and it ends 30 days after. Illinois, Idaho, and Nevada also are open enrollment states.

Connecticut, New York, Maine, Washington, and some carriers in Vermont have open enrollment year-round. Some states will have specific rules with year-round enrollment. However, not all states have these special enrollment rules. Suppose you are a Medicare beneficiary in one of the states listed above. In that case, it is easier to get enrolled into a Medigap plan.

#5: How Billing Works

Here’s an example of how billing works. John goes to his first doctors office visit of the year. The specialist sends a bill to Medicare. Medicare pays 80% of the cost except for the $233 outpatient deductible charge. This is billed to John for payment. His supplement plan pays the rest. As you can see, this is a tremendous value and benefit to John because after he pays the $233 deductible, he will owe no out-of-pocket costs for the remainder of the year. 

Final point

It’s important to know the facts about Plan G before you make the decision to enroll in a plan. For more Medigap information, you can visit Medicare.gov or speak directly to a Medicare broker that represents multiple carriers. 

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