With the exit of the popular Medicare Supplement Plans C and F as part of the government implementation of MACRA, those eligible for Medicare after January 1, 2021, are looking to the next best option. For most, that option is Plan G.
The only difference is with Plan G beneficiaries are responsible for paying the Part B deductible ($203 in 2021). It offers great value for beneficiaries after paying the small annual Part B deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays your hospital deductible, copays and coinsurance. It also covers the 20 percent that Part B does not cover.
It helps pay for inpatient hospital costs, such as blood transfusions, skilled nursing and hospice care. It also covers outpatient medical services like doctor visits, lab work, diabetes supplies, x-rays, ambulance and surgeries.
Original Medicare Part A and Part B pay first, then Plan G pays the remaining amount after you pay the Part B deductible.
For many, the appeal of Plan G is the benefits you receive. The benefits include:
- Part B excess charges
- Foreign travel emergency coverage (up to plan limits)
- Part B coinsurance or copayment
- Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
- The first 3 pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Durable Medical Equipment like wheelchairs and walkers
See the Medicare Supplement Outline of Coverage for a full explanation, 2021 premiums and exclusions.
High Deductible Health Plan G
High Deductible Health Plan G is an option for current and new Medicare beneficiaries. Plan G HDHP has the same coverage as Plan G, but the beneficiary must pay a $2,370 (2021) deductible –which includes the Medicare Part B deductible – before the plan begins to pay. The appeal of the Plan G HDHP is the monthly premium is generally lower.
Meet Stan! Stan has Original Medicare with Medigap Plan G
Stan was diagnosed with diabetes which requires him to visit his primary care doctor annually and his endocrinologist three or four times a year. Stan has Original Medicare Part A and Part B and added Medicare Supplement Plan G to help cover the gaps. Stan visits his doctor in February. The doctor sends the bills to Medicare which pays the 80 percent share of the bill except for the Part B outpatient deductible of $203 which is billed to Stan. The remainder of the bill is covered by Stan’s Medicare Supplement Plan G. For the rest of the year, Stan will not owe any out of pocket costs for covered Part A and Part B services as his supplement plan covers the rest. If Stan needed to have surgery, Medicare would cover 80 percent and his Plan G would cover 20%.
|Doctor charges: $12,500 Medicare pays: $10,000 Medicare Supplement pays: $2,500||Stan pays: $203 Medicare Part B deductible||Total Stan pays: $203 *Stan’s deductible for Medicare Part B is met for the year|
Meet Kate! Kate has Original Medicare with Medigap Plan G HDHP
In February Kate was diagnosed with an illness that required hospitalization for seven days. Her Medicare Part A covered all but $1,484 dollars. After she was released, she needed a walker and physical therapy for six weeks. Her Medicare Part B paid 80% of her physical therapy bill and 80% of her walker cost. That’s when her Medicare Supplement Plan G HDHP kicked in. She paid the $2,370 Plan G HDHP deductible which includes the Part B deductible and her Plan G paid the $1,484 uncovered hospital cost, the 20% remainder of the physical therapy bill and the 20% remainder of the walker cost. Her deductible was met for the remainder of the year so when she was hospitalized for a short time in March, she paid $0 out-of-pocket for her stay and follow up doctor visit.
|Hospital Charge: $25,000 Medicare pays: $23,516 Medicare Supplement pays: $1,484||Kate pays: Medicare Supplement Plan G HDHP deductible: $2,370||Doctor/physical therapy charge plus walker cost: $12,500 Medicare pays: $10,000 Medicare Supplement pays: $2,500||Total Kate pays: $2,370 *Kate’s deductibles for both Medicare Part B and her MedSup Plan G HDHP are met for the year|
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