Are you looking for help with certain costs that Original Medicare doesn’t cover? There are 10 standardized Medicare Supplement (Medigap) plans available in most states, and Plan G could be an option if you’re looking for broader coverage.
When it comes to covered benefits, Medicare Supplement Plan G is nearly identical to Medicare Supplement Plan F. These two plans offer the most comprehensive coverage of the 10 Medigap plan types available in most states. The main difference between the two plans is that Plan G doesn’t cover the Medicare Part B deductible. If you have this plan, you’ll need to pay this cost out of pocket. Something Carla (My Wife) always like to tell clients is to take the Medicare deductible and divide by 12 if the total is less than the difference in cost between plan F then go with plan G. Because even when you pay the deductible you still are saving money each year with plan G. If the deductible is more than the extra cost of plan F then go with plan F.
The Medicare Part B deductible may vary from year to year; you’ll need to pay for all medical costs until your out-of-pocket costs reach this amount. After you reach the yearly Medicare Part B deductible, you’ll generally pay 20% of the Medicare-approved cost for Part B-covered services (such as doctor visits and durable medical equipment).
Like other Medigap plans, Medicare Supplement Plan G helps Original Medicare beneficiaries with certain out-of-pocket costs (such as cost sharing). Plan G also includes the following benefits:
- Medicare Part A inpatient hospital coinsurance and hospital costs up to 365 days after Original Medicare benefits are exhausted
- Medicare Part A hospice care coinsurance or copayment
- Medicare Part A deductible
- Medicare Part B coinsurance or copayment
- Medicare Part B excess charges
- First three pints of blood for a medical procedure used in a year
- Skilled nursing facility care coinsurance coverage
- Foreign travel emergency coverage (80%, up to plan limits)
Medicare Supplement Plan G and Medicare Part B excess charges
It’s worth noting that Medigap Plan G covers Part B excess charges, which the majority of Medicare Supplement Plans do not cover. Medigap Plan F is the only other Medicare Supplement plan that covers this benefit. Excess charges are additional expenses you may have to pay for health care beyond what Original Medicare covers; it’s the difference between what Medicare pays for a particular medical service and what your doctor or provider charges for it. Normally, the Medicare program has set up approved payment rates (known as the Medicare fee schedule) for covered medical services; this regulates what doctors and providers are allowed to charge you for Medicare-covered services.
You may have to pay excess charges if you use a doctor or provider that doesn’t accept assignment, meaning the provider does not accept the Medicare-approved amount as the full payment. Excess charges occur when the doctor charges you above this amount. By law, providers who don’t accept assignment can only charge up to 15% in excess charges above the Medicare-approved amount (state law may impose further limitations).
For example, if Medicare’s allowed charge for a doctor appointment is $100, a non-participating physician may choose not to accept that amount as the full cost and charge an additional 15% for the appointment. In this instance, Medicare would pay 80% of the allowed charge, sending the physician $80. The beneficiary would then be responsible for paying not only the remaining $20 but also the excess 15% charge, another $15, making the total out-of-pocket cost $35. Because Plan G covers 100% of Medicare Part B excess charges, all of the out-of-pocket costs in this example would be covered by this policy.
Finding Medicare Supplement Plan G coverage
Remember, like other Medicare Supplement plans, benefits are standardized across each letter category. So Plan G benefits are exactly the same, no matter which insurance company you purchase the policy from.So it is important to meet with an agent in your area and discuss what Medicare Supplemental coverage is best for you.
If you would like to make an appointment or have a question please call Stephen or Carla Fowler at 205-417-5027. They are representatives with Prosurity and are Medicare Supplement advisors.