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Medicare Plan G: Pros and Cons

When Plan F became unavailable to those who are new to Medicare after January 1, 2020, Medicare Supplement Plan G stepped into the spotlight. It has been gaining popularity among seniors as a reliable option for enhancing their Medicare coverage. But is it the right option for you? 

In this article, we’ll delve into the details of Medicare Plan G pros and cons and how to make an informed decision about your healthcare coverage.

What is Medicare Plan G?

Medicare Plan G, like other Medigap plans, works alongside your Original Medicare coverage. It helps cover the out-of-pocket expenses that Medicare alone may not fully address. This means that after Medicare pays its approved portion of your medical costs, Plan G will help cover the remaining expenses. 

It’s important to note that you must pay a separate monthly premium for your Medigap coverage.

What Does Medicare Plan G Cover?

Medicare Plan G offers comprehensive coverage, similar to Plan F, with one key difference. Plan G does not cover the Medicare Part B deductible, while Plan F does. Here’s a breakdown of what Medicare Plan G covers:

  • Basic Doctor Visits
  • Medicare Part A Deductible, Coinsurance, & Hospital Costs (including hospice care co-payment)
  • Medicare Part B Coinsurance, Co-Payment, & Excess Charges
  • Foreign Travel Emergency (80% of foreign travel emergency expenses up to a lifetime limit of $50,000, but this may vary by plan)
  • Preventative Care Part B Coinsurance
  • Skilled Nursing Facility Coinsurance
  • Various medical services, such as outpatient therapy, durable medical equipment (DME), lab work, and X-rays

What does Medicare Part G Not Cover?

medicare plan G pros and cons - Figuring the cost of healthcare

All Medigap plans, including Plan G, do not cover the following:

  • Part B deductible. (However, those who had Plan F before 2020 still have it covered as they are grandfathered into Plan F.)
  • Prescription medications 
  • Long-Term Care 
  • Dental & Vision Care
  • Private-Duty Nursing.

Some Medicare Advantage policies may offer coverage for these services, but you should review the specific details of that Medicare Advantage Plan.

Variations in State Coverage

Some states have slight variations in Medicare supplement insurance benefits. If you are in Minnesota, Wisconsin, or Massachusetts, the uniform medical plan may differ in terms of what it covers, out-of-pocket limits, and premiums. 

Medicare Plan G Premiums: What to Expect

The cost of Medicare Supplement Plan G premiums depends on several factors, including your age, location, tobacco use, and other personal considerations. Private health insurance companies set the premiums, even though the government regulates the plans.

One notable aspect of Medicare Plan G is its premiums are lower than Plan F. The primary difference in coverage between these two plans is the $226 Medicare Part B deductible (2023 cost), which Plan G does not cover. After you meet this deductible, you typically pay 20% of the Medicare-approved portion of most doctor services.

Pros and Cons of Medicare Plan G

It was nothing to worry about. Shot of a young doctor sharing information from his digital tablet with an older patient.

Pros

Comprehensive Coverage: Medicare Plan G offers robust coverage, including hospitalization, doctor visits, and various medical services. It provides peace of mind by covering most of your healthcare expenses.

Lower Premiums: Plan G premiums are often significantly lower than Plan F premiums, so you can save money while enjoying extensive coverage.

Stable Rates: Plan G rates tend to be more stable than Plan F, largely because Plan F is no longer available to new enrollees, which can lead to increasing costs as its pool of beneficiaries age. The stability of Plan G rates can help you budget your healthcare expenses more effectively.

Freedom to Choose Doctors: With Plan G, you can visit any doctor without needing referrals to specialists. This flexibility can be valuable for those who want to maintain control over their healthcare choices.

Cons

Medicare Part B Deductible: Plan G does not cover the Medicare Part B deductible, which is $226 annually. However, this deductible is relatively modest compared to the potential savings on premiums.

In summary, Medicare Plan G offers comprehensive coverage with lower premiums and greater flexibility in choosing your healthcare providers. The only trade-off is the Medicare Part B deductible, which you must pay out of pocket.

Is Medicare Plan G Right for You?

Enrolling in Medicare Plan G depends on your specific healthcare needs and preferences. Consider the following factors:

Budget: Assess your budget and determine if the lower premiums of Plan G align with your financial goals.

Healthcare Flexibility: Think about whether you prioritize the flexibility to choose any doctor without referrals or if you’re comfortable staying within a network.

Prescription Drug Costs: If you require prescription medications, factor in the cost of Part D coverage since Plan G does not include it.

Stability: Plan G rates are typically more stable over time, offering consistency in your healthcare expenses.

Making an Informed Decision with The Medicare Family

When it comes to healthcare coverage, making an informed decision is crucial. By weighing the pros and cons of Medicare Plan G and considering your specific needs, you can select the plan that best aligns with your goals and financial situation. 

Schedule an appointment with The Medicare Family today if you’re ready to explore your Medicare Plan G options or have questions about your Medicare coverage. With over 40 years of experience, we are dedicated to helping you find the right Medicare plan to meet your needs. Choose the healthcare coverage that works for you with the trusted assistance of The Medicare Family.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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