Are you nearing 65 years old? If yes, your mailbox and phone are probably bombarded by Medicare solicitations! Medicare age is 65 years old (unless you qualify earlier), and Medicare will be your insurance from here on out if you don’t have creditable coverage from an employer. But there is one thing you should know: Medicare will leave you with out-of-pocket costs throughout the year. Due to this, many beneficiaries purchase Medicare Part G (Medigap Plan G) for cost-sharing help. For detailed information on this plan, visit plan G – boomerbenefits.com, but keep reading for a quick overview of Medicare Part G coverage.
How Plan G works
As mentioned above, Medicare leaves you with out-of-pocket costs. Medigap plans, such as Plan G, help cover those gaps, such as deductibles and coinsurance costs. Plan G pays secondary to Original Medicare. If a doctor or hospital accepts Original Medicare Part A and Part B, they are required to accept your Medigap plan. You can visit any doctor in the U.S. that accepts Medicare and use Plan G.
Plan G leaves you with predictable healthcare costs for the year. Here is what Medigap Plan G covers –
∙€€€€€€€Part A deductible
∙€€€€€€€Part A coinsurance and hospital costs
∙€€€€€€€Part A hospice care coinsurance/copay
∙€€€€€€€First 3 pints of blood
∙€€€€€€€Skilled nursing facility coinsurance
∙€€€€€€€Medicare Part B coinsurance/copay
∙€€€€€€€Medicare Part B excess charges
Your only cost-sharing amount for Medicare-approved services with Plan G is the Part B deductible, which is $226 in 2023. Here’s how the process works –
You will pay nothing upfront when you have a doctor visit, and the doctor will bill Medicare. Medicare will pay its part and send the bill to your Plan G. Plan G pays its portion, then sends the remaining bill (the Part B deductible) back to the doctor. Then and only then should the doctor bill/charge you for the deductible.
After you pay the Part B deductible, Plan G will cover all your Medicare-approved services in full for the rest of the year.
Plan G and Part B excess charges
There are doctors out there that do not accept Medicare Assignment. Medicare Assignment is when your doctor accepts the Medicare-approved amount as full payment for your medical services. If your doctor does not agree to this, then they do not accept Medicare Assignment. Therefore, they can charge your service up to 15% more than the Medicare allowable amount.
Luckily, Medigap Plan G covers Part B excess charges. You do not have to worry about being charged extra for your medical services when you have Plan G!
Traveling with Plan G
As mentioned, you can travel anywhere in the U.S. with your Medigap plan. You need to ensure the doctor accepts Original Medicare for your services to be covered. But this does not apply to international travel!
Plan G has a foreign travel emergency benefit that you can use within 60 days of your international travel. If you have a medical emergency during your vacation and you visit the doctor or hospital, you will first pay a deductible of $250. After you pay this amount, Plan G will pay up to 80% of your medical care. Therefore, you will pay a 20% coinsurance.
The foreign travel emergency benefit has a limit of $50,000. Once your plan pays out $50,000, it is maxed out, so you will no longer have foreign travel coverage. Again, this is for emergencies only, so you cannot plan a surgery out of the country and expect your Medigap plan to cover it.
What Plan G doesn’t cover
Medigap Plan G will only cover the services that Original Medicare Parts A and B cover. There are some services that Medicare does not cover. For instance, Medicare does not cover routine dental, vision, and hearing services. Therefore, neither will Medigap Plan G.
Medicare also does not cover most prescriptions you pick up at the pharmacy. Therefore, you must purchase a standalone Part D drug plan for drug coverage. Many Medicare brokers sell Medigap, and Part D plans so that you can buy both simultaneously during your enrollment.
When to apply for Plan G
There is a specific time to apply for a Medigap plan so that you can secure a plan. The time to apply for Plan G is during your one-time six-month Medigap Open Enrollment; this enrollment period is based around your Part B effective date. During those six months, you can apply for a Medigap plan with no health questions asked. However, when you apply for Plan G outside your Open Enrollment, you will undergo medical underwriting, unless your state has special Medicare enrollment rules, such as New York or California.
Medical underwriting is a series of health questions the insurance carrier asks you. Every insurance carrier will ask you a different set of health questions. You must pass the health questionnaire to avoid being denied a Medigap plan or charged a higher premium. So, don’t miss your Open Enrollment if you want a Plan G.
What is the cost of Plan G?
The cost of Plan G is not set in stone. A Medigap premium varies from person to person, depending on many factors. For example, it depends on your gender, age, tobacco use, zip code, and insurance carrier. Therefore, you and your friend will likely receive different quotes for Plan G. There is one thing to note: Plan G is standardized, meaning no matter the insurance carrier you purchase Plan G from, Plan G covers the same benefits mentioned above. The only difference between carriers is the monthly premium.
Many beneficiaries work with a broker since they represent multiple carriers. When you work with a broker, they can shop Plan G rates among multiple carriers and find you the most cost-effective option.
Wrapping up
Medicare Plan G provides comprehensive coverage to its beneficiaries. If you want predictable healthcare costs throughout the year and the freedom to visit any doctor you please, consider Plan G! Contact a reputable Medicare broker today to get started on your Plan G enrollment.