Gap Insurance Plan G

Medigap Plan G

Updated September 3rd, 2016

Medicare Supplement Plan G, also known as Medigap Plan G is the second most popular of the Standardized Plans. The most popular is Plan F. Since Plan F will be phased out in 2020, Plan G is likely to become the top choice.

There are nine benefits that can be covered by Supplemental Insurance, Medigap Plan G covers all of them but one, the Medicare Part B Deductible. In 2016, the annual deductible is $166.

Medigap Plan G Compared to Medigap Plan F

The only difference between Medicare Supplements Plan G and Plan F is coverage for the Part B Deductible. Not having coverage for the deductible has a larger impact on price than you would think. Because Medigap G does not have first-dollar coverage, it’s utilization is much lower. This means individuals are less likely to see a doctor for minor conditions or illnesses knowing they will have out-of-pocket expenses.

To be clear, the $166 Part B Deductible is paid once a year. Not having this benefit is what makes a Plan G such a tremendous value.

Historically Medigap Plan G has Lower Rate Increases

Because of the lower utilization with Plan G compared to Plan F, it has significantly lower rate increases over time.

What Does a Medigap Plan G Cover

Medicare Part A Coinsurance (Hospital)
Medicare Part B Coinsurance (Medical)
Blood (First 3 Pints)
Part A Hospice Care Coinsurance and Copay
Skilled Nursing Facility Care Coinsurance
Part A Deductible
Part B Excess Charges
Foreign Travel Emergency

What a Medigap Plan G Does NOT Cover

Part B Deductible

Medigap Plan G and Your Covered Medicare Part A Costs (Hospital) Per *Benefit Period

The following chart shows your coverage under Medicare Part A, along with your gap coverage with a Medicare Supplement Plan G and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Hospitalization

This includes semi-private room and board, general nursing, and miscellaneous services and supplies.

	Medicare Pays	Medigap Plan G Pays	You Pay
First 60 days	All but $1,288	$1,288 Deductible	$0
61st through 90th day	All but $322 a Day	$322 a Day	$0
During your 60 lifetime reserve days	All but $644 a Day	$644 a Day	$0
Once lifetime reserve days are used, during your additional 365 days	$0	100% of Approved Expenses	$0
Beyond the additional 365 days	$0	$0	All Costs

Skilled Nursing Care

You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days of leaving the hospital.

	Medicare Pays	Medigap Plan G Pays	You Pay
First 20 days	All Approved Amounts	$0	$0
21st Through 100th day	All but $161 a Day	Up to $161 a Day	$0
101st Day and after	$0	$0	All Costs

Blood

	Medicare Pays	Medigap Plan G Pays	You Pay
First Three Pints	$0	100%	$0
Additional Amounts	100%	$0	$0

Hospice Care

You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

	Medicare Pays	Medigap Plan G Pays	You Pay
Hospice Care	All but very limited coinsurance for outpatient drugs and inpatient respite care.	100%	$0

* A benefit period begins when you receive services as an inpatient in a hospital. It ends after you have been out of the hospital and have not received skilled care in another facility for 60 consecutive days. All Part A copayments and deductibles start new with the beginning of each new benefit period.

Medigap Plan G and Your Covered Medicare Part B Costs (Medical)

The following chart shows your coverage under Medicare Part B, along with your gap coverage with a Medicare Supplement Plan G and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Medical Expenses in the Hospital or While Receiving Outpatient Treatment

This includes physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.

	Medicare Pays	Medigap Plan G Pays	You Pay
First $166 of Approved Amounts	$0	$0	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$0
Part B Excess Charges	$0	All Costs	$0

Blood

	Medicare Pays	Medigap Plan G Pays	You Pay
First Three Pints	$0	100%	$0
Next $166 of Approved Amounts	$0	$0	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$0

Clinical Laboratory Services – Tests for Diagnostic Services

	Medicare Pays	Medigap Plan G Pays	You Pay
Lab Services and Tests	100%	$0	$0

*You will only be billed the $166 Part B Deductible once per calendar year regardless of the service.

Medigap Plan G and Your Covered Costs for Approved Home Health Care Service Under Both Medicare Part A and B

The following chart shows your coverage under Medicare Part A and Part B, along with your gap coverage with a Medicare Supplement Plan G and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.

Medicare Approved Home Health Care Services

	Medicare Pays	Medigap Plan G Pays	You Pay
Medically Necessary skilled care services and medical supplies	100%	$0	$0
Durable Medical Equipment First $166	$0	$0	$166 Part B Deductible
Remainder of Approved Amounts	80%	20%	$0

Supplemental Plan G Benefit Comparison

Medigap Plan G Benefit Chart

*Plans K-N provide for different cost sharing.

*Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% for Plan K, and 75% for Plan L. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The annual out-of-pocket limit does NOT include costs from your provider that exceed Medicare-approved amounts (excess charges).

*Plan F is also offered as a high-deductible plan. With a high-deductible Plan F, you must pay for Medicare-covered expenses such as copays and deductibles up to $2,180 in 2016 before the policy pays anything.

*Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.