As I write this article in mid-2022, Medicare supplement Plan G is the most popular Medicare supplement for people new to Medicare. It is the Medicare supplement with the most benefits and offers complete piece-of-mind to those with the forethought to have purchased a Medicare supplement Plan G for their healthcare.
There are twelve standardized Medicare supplement plans available in the United States. Nine of those plans are available to people who were first eligible for Medicare on or after January 2020.
In this article, we will start with what you need to know about Medicare supplement plans in general. Then we will review the pros and cons of Medicare supplement Plan G and how to tell if the Medicare supplement Plan G is right for you.
If you prefer an article designed to help you understand Medicare, please see my article and video Medicare Explained.
Follow this link for a detailed discussion of How to sign-up for Medicare and When.
Medigap or Supplement, Terminology
There is more than one way to refer to Medicare Plan G. You will read the terms Medigap Plan G, Medicare Plan G, Medicare supplement Plan G or Supplemental Plan G. Each of these terms refers to the exact same thing, Medicare supplement Plan G.
It seems that Medicare publications prefer to refer to supplement plans as Medigap Plans. However, the insurance industry prefers the term Medicare supplement. Please do not confuse the term “Part” for “Plan”. “Part” refers to a part of Medicare, Like Medicare Part A or Medicare Part D. The term “Plan” is used when referring to supplemental insurance or other private insurance.
What is Medicare Supplement Plan G?
A Medicare supplement plan is an insurance policy designed to work with your Original Medicare. It pays the deductibles and copays that are the patients’ responsibility when you have Medicare Part A and Part B.
For example, after a small deductible, Medicare Part B pays 80% of your outpatient Medicare bill. You are responsible for the remaining 20%. When you have a Medicare supplement Plan G, your supplement will pay the 20% for you.
Medicare supplement Plan G is the supplement with the most benefits. With a Medigap Plan G your only responsibility will be the annual Medicare Part B deductible. That deductible is currently under $250 a year.
What Are Standardized Medigap Plans?
A standardized Medigap insurance policy is designed specifically to work with Medicare Part A and Part B to limit your out-of-pocket expenses.
The Medigap policy is secondary to Original Medicare. That means Medicare pays first, then your Medigap policy pays their portion.
The term “standardized” is very important. It means that the benefits of all Medicare supplement (aka Medigap) Plans are identical regardless of which insurance company you use. For example, all Medigap Plan G’s have the same benefits. All Medigap Plan N’s have the same benefit, and so on.
The benefits of these standardized policies are written into Social Security Law. They cannot be changed except by an act of Congress, signed by the President. This is the exact opposite of a Medicare Advantage Plan. Medicare Advantage Plan benefits change every year.
Guaranteed Renewable Contracts
Medicare supplement policies are also Guaranteed Renewable contracts. Guaranteed renewable means that the benefits are guaranteed to remain the same for as long as you own the policy. No one can change your benefits or cancel your plan. Even if Congress were to change the benefits of the plan type you have, they can’t change your plan. They can only change plans for people in the future.
Once you have a Medicare supplement no one can change your benefits. No one but you can cancel your plan. The only feature that can change from year to year is the price.
Keep in mind, it is the benefits that are standardized, not the price. Current and future prices can vary by more than 100%.
Medigap in Massachusetts, Minnesota, Wisconsin
There are three states that have opted out of standardized Medicare supplement plans. Those states are Massachusetts, Minnesota and Wisconsin. These states were able to opt-out of standardized plans because they were ahead of Medicare in improving health coverage. when Medicare upgraded (Modernized) their Medicare supplement plans in 2010, these three states already had options that were equal of better than the new plans.
If you live in one of these states, look at the Guide to Choosing a Medigap Policy in the Resources Tab of our website. Of course, we can help except in Massachusetts, the only state we do not offer insurance in. Their cost for out-of-state health insurance licenses makes working in that state cost prohibitive.
Why Buy a Medicare Supplement Plan?
One of my favorite questions to answer is “Why buy a Medicare supplement plan instead of a Medicare Advantage plan?”
There are two reasons why. First is because the benefits are standardized and will remain as is for as long as you own the policy. For your benefits never change. Second is that with a Medicare supplement plan you get to keep all the benefits of Original Medicare. Let me elaborate.
There is a certain sense of security you feel when the benefits of your health insurance policy remain the same from year to year.
Image for a minute the year-to-year experience of those who chose a Medicare Advantage Plan instead of a Medicare supplement. With an Advantage Plan any feature of your plan can change from year to year. The doctors and medical facilities that accept your specific Medicare Advantage Plan can change not only from year-to-year, but at any time during the year. That is why the Medicare Advantage policy holder must re-shop their Medicare policy every year during the Annual Election Period (AEP). AEP is that period between October 15 through December 07 when people on Medicare Advantage Plans must check the changes in their plan and decide if they want to keep it or change plans. They never know from year-to-year how their costs and benefits can change.
The person who chose a Medicare supplement completely avoids those issues. Your benefits never change. They will continue for as long as you own your policy. Add to this the second benefit, below, and you have the best health insurance available in the United States.
Benefits of Original Medicare
Medicare Part A and Part B is also called Original Medicare. When you receive your red, white and blue Medicare card, you have original Medicare. With Original Medicare you can see any medical provider or facility in the country as long as they accept Original Medicare. That is over 95% of all doctors and medical facilities. You have national insurance coverage. In fact, if you develop a medical issue and wish to see a specialist 1,000 miles away, you can. As long as they accept that red, white and blue Medicare card your Medicare bills are covered.
There is no limiting network of providers you are restricted to. You do not have to ask permission or approval from a Primary Care Physician to see a specialist or anyone else.
The second great benefit of Original Medicare is that there is no insurance company between you and your doctor’s decisions. Your doctor does not need to get preapproval to perform a recommended treatment. No insurance company can deny or delay treatment. Your medical decisions are between you and your doctor.
With a Medicare supplement Plan you keep the above two benefits of original Medicare.
You can see any medical provider or facility that accepts original Medicare. Your medical decisions are guided by you and your doctor. The Medicare supplement has no say in what is or is not covered by your Medicare.
What is a Medicare Replacement Policy?
Contrast the above with a Medicare Advantage Plan. A Medicare Advantage Plan replaces your Original Medicare. You no longer use your red, white and blue card. You no longer have original Medicare. The Medicare Advantage plan then gets to set their own rules as long as they are close to what original Medicare offers.
With a Medicare Advantage Plan, you are restricted to the network of doctors contracted with that specific plan. Some plans allow you to use a medical provider out-of-network, but only if that medical provider agrees to accept your insurance. Most will not.
In addition, when a doctor advises you to have a treatment or procedure, they must first get approval by the insurance company. In a recent report by the Inspector General for Health & Human Services, more than half the recommended procedures are denied or delayed.
Perhaps this is why only 45% of medical providers will accept a Medicare Advantage Plan. Even then, they may not accept yours.
How does a Medicare Supplements Work?
Your Medicare supplement is secondary to Medicare. When you have a Medicare service with a Participating Medicare Provider your medical provider bills Medicare. They want to have your supplement information on record in case of errors, but they only bill Medicare.
Medicare will pay its portion and at the same time electronically communicate with your Medicare supplement insurance company instructing them on what to pay and to whom. Yes, Medicare will know with whom you have your supplement.
Most of medical bills are paid by the supplement company in just a few days. Almost all bills are paid within two weeks. A couple of the largest insurance companies I work with routinely note to me that over 85% of medical claims are paid within 48-hours.
The bottom line is that the Medicare supplement simply follows Medicare’s direction. They pay what they are told to pay and when. They have no say in what is or is not covered by Medicare. Your healthcare is between you and your doctor.
What Does Medicare Supplement Plan G Cover?
A Medicare supplement simply pays the copays and deductibles of the procedures and services covered by Medicare. Medicare’s goal is to cover everything that is medically necessary. In order to determine medical necessity, they lean on your doctor for guidance. That doesn’t mean they do everything your doctor wants them to do. But it does mean that your doctor does not have to ask permission to perform their duty as your medical provider. There is no “pre-approval” process like there is with Medicare Advantage Plans.
Medicare Supplement Benefits Table
You can view the benefits of a the Medicare supplement plans here: https://medigapseminars.com/medigap-benefits/
On this table, the various Medicare supplement plans are listed across the top row. The broad category of all benefits are listed down the left hand column. Medicare supplement Plan G covers 100% of everything except the Medicare Part B Annual Deductible.
The Medicare Part B deductible is an annual deductible. You pay it when you first see a doctor for outpatient services during any calendar year. Once that deductible is paid, you have 100% coverage for inpatient and outpatient services for the rest of the calendar year. Or, to put it simply, your annual maximum out-of-pocket risk for inpatient and outpatient Medicare services is equal to the annual Medicare Part B deductible. The Medicare Part B deductible is $233 for 2022.
Considering you keep the benefits of Original Medicare, in my opinion there is no better insurance coverage in the United States than Original Medicare plus Medicare supplement Plan G.
Of course, with all Medicare supplement plans, you will need separate prescription drug coverage. I have created a special website to help with Part D.
Please go to PartDShopper.com for more information.
Do Medicare Supplement Plans Have Out-of-Pocket Maximum?
Yes, Medicare supplement plans have a maximum out-of-pocket limit. In fact, Medicare Supplement Plan G offers the lowest maximum out-of-pocket of any other choice you can make with Medicare.
I have an article and video specific to this subject and why there is so much confusion. Please take a look: Medicare Maximum Out-of-Pocket
The bottom line is that all the popular Medicare supplement plans have a much lower maximum out-of-pocket that any of the Medicare Advantage Plans.
When Can I Buy a Medicare Supplement Plan?
In short, you can purchase a Medicare supplement plan any day of the year, 365-days a year. However, there is a catch. First, for a Medicare supplement to provide insurance coverage, the consumer must have Medicare Part A and Medicare Part B. Without Original Medicare, you cannot have a Medicare supplement Plan. Second, your Medicare supplement Initial Enrollment Period is linked to the start date of your Medicare Part B. Not Part A, just Part B.
No matter when your Medicare Part B starts, your Medicare Supplement Initial Enrollment Period is the first six months you have Medicare Part B coverage. During that time period you can apply for any Medicare supplement that is available to you without regard to your medical history. No medical questions will be asked, and you cannot be turned down or charged more due to your medical history.
Warning: some insurance companies consider your Medicare Supplement initial Enrollment Period to be the first six calendar months of your Medicare Part B coverage. But some insurance companies use a 360-day year, which means your Medicare supplement Initial Enrollment Period is only 180-calendat days from your Medicare part B start date.
I Am Turning 65
After a person decides that a Medicare supplement Plan G is right for them, the next question is When? When can I buy a Medicare supplement plan?
As you may have heard elsewhere, there are over 10,000 people a day turning 65 in the United States. That is a huge market and there is a lot of competition for enrolling people in the various Medicare choices. Because of the competition, in most states an insurance company will allow the consumer to complete an application for a Medicare supplement up to six-months before their Medicare will start. This is even before you have a Medicare number.
Of course, you will need to apply for Original Medicare during their Medicare Initial Enrollment window and then provide the Medicare supplement insurance company with their Medicare number before benefits can start.
Here is an example: let’s say you have a birthday of October 10. That means the earliest your Original Medicare can start is October 01. If you plan on your Medicare starting October 01, you can enroll in a Medicare supplement as early as the prior April 01 for an October 01 start date.
With your Medicare supplement application complete, you can go about planning your retirement knowing that one more “to-do” item is off your list. When you get your Medicare number, simply call your Medicare supplement insurance company and let them know so they can complete the process of linking your supplement to Medicare.
There Are Always State Exceptions
As with most Medicare rules, there are always exceptions. For people new to Medicare Part B, Connecticut, Maine, Missouri and Washington State allow Medicare supplement application up to 60-days prior to the start date of coverage. New York and Wisconsin allow applications 90-days or three months prior to the start date. Please talk to us if you have questions about this.
I Am Over 65 and Already Have Medicare
If you are over 65 and have had Medicare Part B for more than six-months, you can still enroll in a Medicare supplement Plan any day of the year. The catch is that you must qualify medically. The insurance company will look at your medical history. If you have expensive or critical / chronic medical conditions, the insurance company can decline your application.
There Are Always State Exceptions – Part 2
There are many exceptions to the above. Some states have annual open enrollment periods for Medicare supplement plans. Three states have perpetual open enrollment periods and so. There are too many exceptions to list here. Please call us. Our advice cost you nothing and can save you a lot of time and money.
How Much Does Medicare supplement Plan G Cost?
Prices on Medicare supplement plan G can vary by 100% or more from one insurance company to another and from one state to another. For example, the price of a Medicare supplement plan G for a 65-year-old in New York or Miami can cost three times more than the same plan in Virginia or the Carolinas.
The same can also be said between insurance companies. The cheapest priced plan in any state can be one third the price of the most expensive plan. There is no difference in Medicare benefits between one insurance company and another, but there is a big difference in premiums. Choosing the right insurance company is important.
At Medigap Seminars we work hard to help you find the insurance company that is most likely to provide you your lowest premiums over your lifetime. The lowest price over your lifetime is not always today’s cheapest plan.
Medigap Plan G Pros & Cons
The Pros of a Medicare supplement are detailed above section titled “Why Buy a Medicare Supplement Plan?” Simply put, it is the best health insurance available in the U.S. for those who are on Medicare.
If there is one “Con” for Medicare supplement Plan G it is the cost. Because Medicare supplement Plan G offers such robust insurance coverage, the monthly premiums are typically higher than other choices. In addition, it is more susceptible to increases in medical costs.
Keep in mind, statistics show that the choice of insurance company will have a greater impact on price over your lifetime than your choice of supplement plan. That is where we come in. We know these companies and their pricing strategies. Avoiding companies with higher expected price increases can save you thousands of dollars over your lifetime.
For a great article and video on comparing Medicare Supplement Plan G to Medicare Supplement Plan N, please see my page on the Best Medicare Supplement Plan.
Call us at 80-847-9680 for personalized assistance
Frequently Asked Questions About Medicare Plan G
You can apply for a Medicare supplement any day of the year, 365-days a year. If you are within 6-months or 180-days of your Medicare Part B start date, you can get any Medicare supplement without answering medical questions. Outside of that 6-month window, you can still apply for a policy but may need to qualify medically to be accepted. Several states have exceptions that allow for an annual open enrollment.
No. You must have Medicare Part A and Part B to receive any benefits from a Medicare supplement.
No. Medicare supplement plans pay the copays and deductibles that are the patients’ obligation under Original Medicare. Original Medicare does not cover dental, vision & hearing except for in cases of disease or injury. Medicare does cover cataracts, glaucoma and so on.
Technically, the Medicare supplement Plan G does not have a deductible. However, it does not insure against the annual Medicare Part B deductible. For the Medicare supplement policy holder, their only Medicare expense for inpatient and outpatient services is the annual Medicare Part B deductible. That deductible is $233 for 2022.
Yes. However, if you currently have a Medicare Advantage Plan, you can only make a change during the Medicare Advantage Open Enrollment Period. Otherwise, you can apply for a Medicare supplement at any time.