If you’re 65 or just about to turn 65, 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 required. Medicare is government-sponsored health insurance for those who otherwise may not qualify or cannot afford private insurance. However, some may need supplemental coverage, also known as Medicare Supplemental Plans, Medigap orMedicare Part G.
What is Medicare Part G?
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. Medicare Part G, or Medigap, fills the holes and pays for health services Original Medicare does not.
What Does Medicare Part G Cover?
If you don’t have all the coverage you need, you’ll want the best Medicare supplemental insurance you can get. Medicare Part 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 Part G, you’ll need to have parts A and B as well.
Medicare Part 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 Part G NOT Cover?
While Medigap is a helpful supplement to Medicare bills, it doesn’t pay for everything. Medicare Part G doesn’t cover:
- 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. One drawback — Part B deductibles are not very high, only around $200. But if you’re the type who 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 caveat: As of Jan. 1, 2020, Part F is no longer available to first-time Medicare recipients. It seems the small deductibles of Part B made many in Congress rethink the need for Part F. The quandary is: If going to the doctor is free, won’t people abuse it? Hard to say, but it led to tightening restrictions on access to Part F.
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 Medigap 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.
If you’re still on the fence over whether or not to buy a Medigap policy, you can buy a Medicare SELECT policy. This gives you the right to change your mind within 12 months and switch to a standard Medigap policy.
Best Medicare Part G Plan Providers
If you’ve decided that a Medigap policy is for you, the next question is where do you buy it? Have no fear — Benzinga is here.
Do You Need a Medigap Plan?
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 Part 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. If you’re still not sure, remember, you can still purchase a Medicare SELECT policy. This buys you time, as much as 12 months to decide whether a Medigap policy is for you. 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.
Frequently Asked Questions
Is Medicare Part G worth the additional premiums?
It really is up to you and your personal situation. Are you healthy? Unhealthy? Do you make frequent visits to the doctor, or is the only doctor you see usually on TV. Every situation is unique.
If you do make frequent use of your Medicare insurance, then Part G is for you. Keep those pesky copays and in-hospital deductibles in their place. Remember, even if you don’t want it now, you may need it later on down the line. Don’t deny yourself the opportunity of getting Medigap at some later date because you decided not to get it now.
Is Medigap really the best Medicare supplement for you?
Again, that depends upon your personal situation. If you have chronic illnesses and make more use of your healthcare, then a Medicare Advantage plan may be better for you. Medicare Advantage has caps on its out-of-pocket expenses that work better for more frequent users.
Medigap policies allow you more freedom of choice and saves you money if you do not use medical services as much. If you’re a senior who loves traveling, Medigap also offers coverage while traveling abroad where regular Medicare does not. Medicare Advantage offers similar coverage, but every plan is different and some may have limitations.
Does Medicare Part G include prescriptions?
Medicare Part G does not include outpatient retail prescriptions.