Author

Sharon O'Day

When you choose your Medicare coverage, you’ll either opt for the federal government’s Original Medicare with Part A (Hospital Insurance) and Part B (Medical Insurance), or its private-insurer replacement: Medicare Advantage. 
Original Medicare has some significant advantages over Medicare Advantage, such as the ability to see any doctor, specialist, or health professional who accepts Medicare nationwide with no referral requirements. However, it also has a major downside: it only covers 80% of the Medicare-approved cost of services after you meet your annual deductible. The remaining 20% — in the form of deductibles, coinsurance, and copayments — remains your responsibility, which could be financially devastating in the case of a severe illness or injury since it has no upper limit.
The solution is Medicare Supplement Insurance, or Medigap, which about <a href="https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries-in-2018/" target="_blank" rel="noreferrer noopener">one in three Original Medicare beneficiaries opt into</a>. Medigap fills some or all of the payment “gaps” — especially a plan referred to as Medigap Plan G. So, what is it exactly?

Plan G is one of 10 major Medicare supplement plans currently offered to new Medicare enrollees. Plans are standardized and are named by letter — <a href="https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies" target="_blank" rel="noreferrer noopener">ranging from A to N</a> — with each lettered plan offering different coverage of out-of-pocket costs. However, you’ll receive the same coverage for any Plan G, for example, no matter what insurance company sells you that plan. Only the insurance company’s quoted price will vary.
For many years, Plan F was the most popular plan because it covers 100% of out-of-pocket costs for all Medicare-approved services, including the Medicare Part B annual deductible of $226. But as of 2020, Plan F became unavailable to new Medicare beneficiaries because, by law, Part B deductibles can no longer be covered. So, does Plan G cover Part B deductible? 
 
Medigap Plan G is still available because it doesn't cover the Part B deductible. It is now the most popular plan choice for those turning 65, representing <a href="https://medicaresupp.org/information/medigap/most-popular-medigap/" target="_blank" rel="noreferrer noopener">51% of the plans sold</a> because, similar to Plan F, it covers all cost-sharing left over by Original Medicare.
Once you’ve purchased a Medigap policy and incurred a medical expense, Medicare first pays its share of the Medicare-approved amount for covered costs. Then, your Medigap plan automatically pays its share. With Medigap Plan G, after you have met the annual Medicare Part B deductible of $226, all out-of-pocket costs will be paid. With some less-comprehensive Medigap plans, you may still owe something and be billed.
Whereas Original Medicare is the foundational insurance for state Medicare beneficiaries administered by the government to cover hospital care, doctor’s visits, and other medical expenses, it’s not a blanket policy that covers everything. You will have deductibles, coinsurance fees, and copayments to pay. Medigap is optional insurance offered by Medicare-approved private insurance companies to fill part or all of the costs left unpaid by Original Medicare coverage.

Medigap Plan G covers every Medicare-approved cost that Original Medicare does not pay — except for the Part B deductible. Here, in detail, is what the plan covers: 
<ul>
<li>Part A coinsurance</li>
<li>Hospital costs up to an additional 365 days after Medicare benefits are used up</li>
<li>Part A deductible</li>
<li>Part A hospice care coinsurance or copayment</li>
<li>Part B coinsurance or copayment</li>
<li>Part B excess charges, which include the differential if a provider is legally allowed to charge more than the Medicare-approved amount</li>
<li>The first three pints of blood for a blood transfusion</li>
<li>Skilled nursing facility care coinsurance</li>
<li>Foreign travel coverage up to 80% of billed charges for certain medically necessary emergency care abroad after a $250 deductible</li>
</ul>
However, as comprehensive as Plan G’s coverage is, the following benefits are not included: 
<ul>
<li>Part B deductible</li>
<li>Long-term care, such as the non-skilled custodial care received in a nursing home</li>
<li>Private duty nursing</li>
<li>Cosmetic procedures</li>
<li>Dental, vision, or hearing care</li>
<li>Prescription glasses</li>
<li>Hearing aids</li>
<li>Prescription drugs</li>
</ul>
Original Medicare doesn’t cover prescription drugs, so many members purchase optional Part D prescription drug plans from private insurance companies. However, Medigap — including Plan G — does not cover any out-of-pocket expenses related to prescription drugs.

The role of Medigap is to minimize or avoid unpleasant surprises from the cost of health care in retirement. At 65, you may be on a fixed income, in which case open-ended medical bills could disrupt your planned retirement. With Plan G — except for $226 for the annual Part B deductible — 100% of your out-of-pocket costs are covered. 
Plan G is ideal for someone who prefers the certainty of budgeting for an extra monthly premium but wants to know that there will never be another medical bill as long as they only choose providers who agree to work with Medicare. They’ll never have a financial reason to hesitate to visit a specialist or a specialized facility. And, for international travelers, some emergency help is available.
Your Medicare coverage is for life, and so is your Medigap coverage, as long as you pay the premiums. With age, doctor visits and hospitalizations will likely increase, but your Plan G will limit your exposure to unexpected out-of-pocket medical costs.
If you’re wondering, “Should I get Medigap Plan G?” your decision may be better informed by knowing the advantages of Medigap plans. Plan G's advantages include the following: 
<ul>
<li>The predictability of medical costs. Besides monthly premiums, there are no further expenses once the Part B deductible is met.</li>
<li>Being one of only two Medicare Supplement plans that cover Part B excess charges (up to 15% more than standard Medicare rates from doctors who don't participate in Medicare).</li>
<li>The reliability of coverage, regardless of the insurer, since all Medigap policies offer the same benefits.</li>
<li>Being able to go to any doctor or hospital nationwide that accepts Medicare.</li>
<li>The ease of processing claims that go through Medicare first and, once approved by Medicare, are automatically paid by Medigap.</li>
</ul>

So what does Medigap Plan G cost? Although the government regulates Medigap plans, private insurance companies are free to decide what plans to offer in each state (if any) and what rates to charge. While many states must approve rate increases for individual Medigap premiums, insurance companies decide how competitive to be in their pricing strategies.
Because Plan G’s coverage is the most comprehensive, its monthly premiums will be slightly higher than other plans. However, to lower premiums, the plan is available in some states as a high-deductible. You must pay a deductible amount of $2,700 in 2023 before your policy kicks in for the rest of the year.
For example, premiums for a 65-year-old, nonsmoking man in <a href="https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=19153&amp;zip=50314&amp;year=2023&amp;lang=en" target="_blank" rel="noreferrer noopener">Des Moines, IA</a>, range from $89 to $398 for Medigap Plan G and $32 to $131 for Plan G High Deductible. The same man in <a href="https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=06075&amp;zip=94110&amp;year=2023&amp;lang=en" target="_blank" rel="noreferrer noopener">San Francisco, CA</a>, will pay from $122 to $208 for Plan G and $32 to $70 for Plan G High Deductible. Yet, premiums for that man in <a href="https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=12086&amp;zip=33156&amp;year=2023&amp;lang=en" target="_blank" rel="noreferrer noopener">Miami, FL</a>, will run $241 to $443 for Plan G and $70 to $156 for Plan G High Deductible.
With Plan G, some insurers may charge an application fee, but there should be no fees to be paid beyond the monthly premium, which may see a rate increase yearly according to the pricing mechanism your provider has agreed to with your state. You will, however, still be paying Medicare’s premium for Part B. 
Your premium is not affected by your income, current health, or pre-existing conditions as long as you enroll during your six-month <a href="https://www.openmedicare.com/guide/medicare-101/enrollment-periods-dates-deadlines" target="_blank" rel="noreferrer noopener">Medigap Open Enrollment Period</a>. Instead, several other factors can influence the initial price you pay, such as: 
<ul>
<li>The type of plan you select</li>
<li>Age</li>
<li>Gender</li>
<li>Marital status</li>
<li>Where you live</li>
<li>Tobacco use</li>
</ul>
Future premium increases may reflect your current age, inflation, and how long you’ve been enrolled.

To be eligible for Medigap Plan G, you must already have Medicare Part A and Part B provided under Original Medicare. The plan cannot be sold to Medicare Advantage members who receive Part A and Part B through private insurers. Also, a Medigap plan only covers one person and does not cover the expenses incurred by your spouse. Your spouse will have to meet eligibility requirements independently. Additionally, your Medicare Supplement Plan G is automatically renewed each year and can’t be canceled as long as you pay your premiums.
Several government programs are available to help lower-income seniors with different aspects of Medicare Part A, Part B, and even private Part D prescription drug plans. However, the same types of programs do not extend to Medigap plans. In fact, there is no income component — maximum or minimum — related to eligibility for Medigap plans, including Plan G.
Medigap plan eligibility also has some exceptions. A small number of Medigap plans are offered in some states to <a href="https://www.openmedicare.com/guide/medicare-101/medicare-prior-to-65" target="_blank" rel="noreferrer noopener">people under 65</a> who are eligible for Medicare because of a disability. Some states have laws or regulations that offer additional opportunities to apply for or switch Medigap policies without medical underwriting. Also, Massachusetts, Minnesota, and Wisconsin have their own plan standards regarding coverage, out-of-pocket limits, and premiums. Your <a href="https://www.shiphelp.org/" target="_blank" rel="noreferrer noopener">State Health Insurance Assistance Program (SHIP)</a> can help with the rules in your state.

Your six-month Medigap Open Enrollment Period starts the first month you have Medicare Part B and are 65 or older. During that period, you’re guaranteed access to any plan offered in your area, and your premium cannot be affected by your health status or pre-existing conditions. This access is unique to this period. After that window, except under special circumstances, any new enrollments or changes in policy require underwriting by the insurance company. You may be denied a policy, face delayed coverage of existing conditions, or pay higher premiums based on your current health.
Medigap plans are available from any insurer licensed to sell them in your state. By working with <a href="https://www.openmedicare.com/" target="_blank" rel="noreferrer noopener">OpenMedicare</a>, a licensed agent can help you decide what plan you want and what policies are available in your area. It’s important to compare Medigap policies because their costs can vary significantly.
Once you've chosen a policy, the agent who is working with you will handle the rest of the transaction, including the interaction with your selected insurance company.
Selecting a Medigap policy and completing the enrollment process with an insurance company appears very straightforward. However, as you first try to understand your options, the differences between plans and how they impact you in the long term may seem overwhelming. And, as explained earlier, your broadest selection and best pricing come when you are first enrolling — during your Medigap Open Enrollment Period. You don’t want to make a mistake.
For additional assistance, here are your options: 
<ul>

<li>Visit <a href="https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap" target="_blank" rel="noreferrer noopener">Medicare.gov</a> or call 800-633-4227</li>
<li>Contact your local <a href="https://www.shiphelp.org/" target="_blank" rel="noreferrer noopener">SHIP</a> for help with plans, coverages, and costs</li>
</ul>
However, for more detailed assistance, you can browse plans in your area on the <a href="http://www.openmedicare.com" target="_blank" rel="noreferrer noopener">OpenMedicare website</a> or call OpenMedicare at (844) 910-2061 directly to be connected with a licensed agent who will walk you through the process of finding the best lifelong Medigap plan* for you.
<hr />
 
* OpenMedicare is a non-government website operated by a licensed Medicare insurance agency. OpenMedicare is not affiliated with or connected with Medicare.gov or any other government program or agency.
Any information we provide is limited to those plans we offer in your area, as we do not always offer every plan available in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.