When you near Medicare eligibility, you might feel like you just entered a maze. There are Medicare parts, Medicare plans, enrollment periods, and much more. One thing about Medicare that surprises seniors is the out-of-pocket costs for their medical services. That’s right; Medicare is not full coverage for all healthcare services. But luckily, there are Medigap plans, such as Part G (also known as Medigap Plan G), to help cover your out-of-pocket costs. To learn more about Plan G, visit Boomer Benefits – Plan G. But be sure to keep reading to learn the most important facts about Medicare Part G.
How does Medicare Part G work?
Original Medicare Part A and Part B will leave you with out-of-pocket costs, such as deductibles, copays, and coinsurance. Private insurance companies sell Medigap plans to help cover those costs. Medigap plans work as secondary coverage to Original Medicare. If a doctor or facility accepts Original Medicare as insurance, they will also accept Part G, no matter the carrier you purchased the plan through. Therefore, you can travel to any zip code in the United States and have secondary coverage.
Here is what Part G covers:
∙€€€€€€€Part A deductible
∙€€€€€€€Part A coinsurance and hospital costs
∙€€€€€€€First 3 pints of blood
∙€€€€€€€Part A hospice care coinsurance/copay
∙€€€€€€€Skilled nursing facility coinsurance
∙€€€€€€€Part B coinsurance/copay
∙€€€€€€€Part B excess charges
∙€€€€€€€Foreign travel emergency ($50,000-lifetime limit)
When you have Part G, your only out-of-pocket cost for Medicare-approved services for the year is the Part B deductible ($233 in 2022). After you pay the Part B deductible, Part G covers the remainder of your approved costs for the remainder of the year.
How Part G covers excess charges
When beneficiaries visit the doctor, they ask, “Do you accept Medicare Assignment?” If your doctor does not accept Medicare Assignment, then your doctor can bill you up to 15% more than the Medicare allowable amount; this 15% charge is called a Part B excess charge. Doctors who accept Assignment cannot charge you more for your healthcare services.
Beneficiaries who purchase Part G will never have to worry about excess charges since the plan covers Part B excess charges in full at 100%!
When do I enroll in Part G?
If you don’t want to miss your chance to enroll in Part G, you will want to sign up for a plan during your six-month Medigap Open Enrollment. The Medigap Open Enrollment is a one-time enrollment period based around your Part B effective date. When you apply for Part G during those six months, you will not have to answer any health questions. But, if you apply for a plan outside your Open Enrollment, you will likely have to answer health questions in most states. If you cannot answer “no” to most of the health questions, you can be denied Part G or be charged a higher premium due to your pre-existing health conditions.
How much does Part G cost?
One thing to remember is that Part G is standardized, meaning no matter who you purchase Part G from, it will have the same benefits. The one thing that separates Part G from carrier to carrier is the monthly premium. There is no set price for Medicare Part G, as premiums vary from person to person since they depend on multiple factors.
For example, a Medigap premium depends on your age, gender, tobacco use, zip code, and, again, the insurance carrier. When you work with a Medicare broker representing multiple companies, they can compare plans in your area and find the most cost-effective option! So, even if your friend has a Part G with a premium of $100, that does not mean you will pay the same monthly price.
Medicare Part G is an excellent option for beneficiaries who want predictable annual healthcare costs and comprehensive coverage. Contact a reputable broker to shop and compare Part G in your area!