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Medigap Plan F vs Medigap Plan G

Summary: Medigap Plan G is virtually identical to Medigap Plan F, except Plan G does not pay your Part B deductible. Each plan may also charge a different premium or copayment/coinsurance.

Medicare Supplement insurance plans, also called Medigap plans, are designed to help pay your out-of-pocket costs with Original Medicare (Part A and Part B). If you choose to get your Medicare benefits with a Medicare Advantage plan, you can’t buy any of the Medigap plans to supplement your coverage. Medigap plans also can’t be used to help pay your out-of-pocket costs with a Medicare Part D Prescription Drug Plan. They only pay for covered services under Part A and Part B.

Medigap plans are private insurance policies, but they are heavily regulated at the state and federal level. For example, benefits are established by the federal government, while state governments regulate the insurance companies licensed to sell Medicare Supplement Insurance plans to their residents. Three states (Minnesota, Massachusetts, and Wisconsin) have their own standard benefits for Medigap plans.

Recently, Congress passed laws affecting which benefits could be offered with Medigap plans effective January 1, 2020. After that time, insurers will no longer be allowed to offer plans that cover the Part B deductible. Currently, only two plans, Medigap Plan F and Plan C, offer this coverage; these plans will be phased out for new Medicare enrollees at the end of 2019. However, if you already have one of these plans, you’ll be allowed to keep it after the new law goes into effect.

All Medicare Supplement insurance plans offer a basic set of benefits including:

  • 100% of your Part A inpatient coinsurance including an additional 365 days of coverage once your Medicare benefits are exhausted
  • Between 50% and 100% of your Part B coinsurance or copayment amounts
  • Between 50% and 100% of your first three pints of blood
  • Between 50% and 100% of your Part A hospice coinsurance

From there, the plans add in extra benefits such as covering the Part A deductible, skilled nursing care coinsurance, and Part B excess charges.

Two plans, Medigap Plan F and Medigap Plan G, offer the most comprehensive coverage allowable under Medicare law. If you are eligible to enroll in Medicare, or will be soon, it’s important to understand your coverage options to help you decide if you want to buy a Medigap plan. If you do want extra protection with a Medicare Supplement insurance plan, you should buy one as soon as you are eligible during your Medigap Open Enrollment Period. During this time, you have guaranteed issue rights—you can buy any plan sold in your state for the same premium as any other Medicare beneficiary regardless of your health status.

If you wait to buy a plan, the insurer usually requires medical underwriting. You will be asked about your health history and may need to sign a medical records release so the insurance company can determine your risk. If you have serious or chronic health conditions, you may not be able to buy a plan.

Here’s what you need to know about the benefits available with Medigap Plan F and Medigap Plan G so you can make the best decision for your financial situation.

What is covered under Medigap Plan F?

Plan F pays 100% of the standard benefits mentioned above: Your Part A hospice coinsurance, your Part B coinsurance, and your first three pints of blood.

Medigap Plan F then adds the following benefits:

  • 100% of your skilled nursing facility coinsurance amount
  • 100% of your Part A deductible
  • 100% of your Part B deductible
  • 100% of your Part B excess charges (the 15% premium you are billed when you see non-participating providers)
  • 80% of your emergency health care costs if you travel outside the country (up to lifetime plan limits currently set at $50,000)

Plan F generally has among the highest monthly premium; however, you pay very little in out-of-pocket costs. If you need predictable health care costs to manage your budget, Medigap Plan F is an excellent choice. Keep in mind, this plan will no longer be sold after December 2019, so if you want this level of coverage, you need to buy it before the deadline.

What is covered under Medigap Plan G?

Medigap Plan G is virtually identical to Medigap Plan F, except it does not pay your Part B deductible. This plan will still be available when the new law goes into effect in 2020, which means people who reach Medicare eligibility after that time will still be able to get the same comprehensive coverage available under Plan F minus the Part B deductible ($185 in 2019).

This plan also has higher monthly premiums compared to more basic plans, but you can rate shop with different insurers to get the best price. If you have serious or ongoing medical conditions requiring regular supervision and treatment, Medigap Plan G will keep your out-of-pocket costs low and predictable.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. The product and service descriptions, if any, provided on these web pages are not intended to constitute offers to sell or solicitations in connection with any product.

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