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What is Medicare Part G?

Sarah Fuhrmann

Sarah Fuhrmann

Sarah Fuhrmann is an agent of Ashford Insurance an independent health insurance agency specializing in Texas Medicare insurance.

What is Medicare Part G?

There is no Medicare Part G, there is a Medicare Supplement Plan G, or Medigap, that fills the holes and pays for health services that regular Medicare does not.

What is Medicare Part G?

If you’re 65 or soon to be, it’s time for you to sign up for Medicare. Medicare is not mandatory, but if you don’t want to face higher premiums later on, signing up around age 65 is a must.

Medicare is government-sponsored health insurance for those who otherwise may not qualify or cannot afford private insurance. 

Medicare comes in different parts:

  • Part A: Hospitalization – Covers everything from in facility to hospice and home care
  • Part B: Medical services – Covers doctor visits, emergencies, specialty treatments, medical equipment, occupational and physical therapy
  • Part C: Medicare Advantage plan – All-inclusive plan similar to preferred provider organization (PPO) or health maintenance organization (HMO) 
  • Part D: Prescription medication – Covers basic and generic medications

Medicare doesn’t cover everything. There is no Medicare Part G, there is a Medicare Supplement Plan G, or Medigap, that fills the holes and pays for health services that regular Medicare does not.

What Does Plan G Cover?

If you don’t have all the coverage you need, you’ll want the best Medicare supplemental insurance you can get. Medicare Plan G fills in the gaps. Remember, Medicare isn’t free. You’ll need supplemental coverage to pay for many of the services regular Medicare does not. To qualify for Plan G, you’ll need to have parts A and B as well.

Medicare Plan G is sold through private insurance companies. What does it cover? 

For Medicare Part A, Medigap covers:

  • 100% of coinsurance and hospital costs after you exhaust your regular Medicare benefits. Coverage lasts up to 365 days. Remember — Medigap does have a deductible.
  • 100% of Part A deductible
  • 100% of hospice-care copayment and coinsurance

It does not pay for outpatient deductibles.

For Medicare Part B, Medigap covers:

  • 100% of copayment and coinsurance
  • 100% of excess charges
  • 100% of blood — up to the 1st 3 pints
  • 100% skilled-nursing facility (SNF) coinsurance 

Medicare Part G covers the $1,484 hospital deductible for SNFs, once per benefit period. Coinsurance pays at a rate of $185.50 per day from days 21 through 100.

What Does Plan G NOT Cover?

While Medigap is a helpful supplement to Medicare bills, it doesn’t pay for everything. Medicare Plan G doesn’t cover:

  • Dental
  • Vision
  • Long-term care
  • Hearing aids
  • Private-duty nursing

Most plans don’t cover prescription medication, either.

While premiums vary from company to company, the benefits remain the same. 

What About Plan F?

Medicare Part F, also known as the “Cadillac plan,” covers everything Parts A and B do not. It ensures you never receive a bill for anything. As long as Medicare covers the service or item, Part F covers it as well. With Medicare Part F, there are:

  • No deductibles
  • No copays
  • No coinsurance

That’s why it’s called the Cadillac plan.

How is Part F different from parts B and G? It has no deductible. You pay nothing even though Part B deductibles are not very high, only around $200. However, if you can’t stand receiving bills in the mail for anything, then Part F is for you.

Like Part G, you purchase Part F through private insurance companies, only there’s a catch: As of Jan. 1, 2020, Part F is no longer available to first-time Medicare recipients.

The good news is if you already have a Part F, you get to keep it. Those already signed up for Part F get to keep their coverage. Even better, if you were eligible for Part F before Jan. 1, 2020, but not yet enrolled, you may still purchase Medicare Part F coverage.

When is the Best Time to buy a Medigap Policy?

Now that you know what Medicare Plan G is, the next question is when do you buy it? Let’s say you turn 65 in January. The best time for you to purchase a Medigap policy is from January to July, during your initial 6-month enrollment period. If you miss your initial enrollment period, premiums may be higher.

Moreover, if you miss your initial enrollment period, you may not be able to purchase a Medigap policy at all. During that time, all preexisting health conditions get waived. If you wait until later, you could be denied coverage because of preexisting health conditions. Remember, private insurance companies sell Medigap policies. As such, they reserve the right to deny you coverage after your initial enrollment period.

The Decision is Yours

 

The decision is up to you. While some like minimizing their potential out-of-pocket expenses, others prefer a pay-as-you-go system. For those in better health, the added cost of a supplemental plan like Medigap doesn’t make good financial sense. For those in need of more frequent medical services, it can make a big difference.

Remember, if you decide to get Medigap coverage, you MUST sign up during your initial enrollment period. If you don’t, you can face higher premiums and worse — you may not qualify for Plan G. If you have preexisting conditions and wait too long, you may not be able to get coverage at all.

If you decide not to purchase a Medigap policy right away, make sure you’ve done your homework. You cannot have both Medigap and a Medicare Advantage plan at the same time.

If you’d like more information on how to buy a Medigap policy, the federal government has some helpful information at Medicare.gov. Medicare.gov is the official and unbiased source when it comes to all your Medicare needs.

Please call Ashford Insurance for assistance or for more information at 817-952-3153.

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Sarah Fuhrmann

Sarah Fuhrmann

Sarah Fuhrmann has been helping Medicare eligibles in Texas with their Medicare Insurance since 2018.