Medigap, also known as Medicare Supplement insurance, is a type of private insurance policy that can help fill the gaps in coverage that Original Medicare (Part A and Part B) doesn’t cover. There are ten standardized Medigap plans available, labeled A through N, with each plan providing a different set of benefits.
Medigap Plan G and Medigap Plan N are two of the most popular plans. Plan G provides comprehensive coverage for Medicare beneficiaries who want a plan that covers most of their out-of-pocket costs. Medigap Plan N is a more affordable option than Plan G but also provides less coverage. Both plans have their pros and cons and we will go through them below.
Medigap Plan G
Medigap Plan G is a type of Medicare Supplement insurance plan that helps cover some of the out-of-pocket costs that are not covered by Original Medicare. It is a popular Medigap plan among beneficiaries who want comprehensive coverage, but also want to save on premiums. This plan is a cost-sharing plan and the only cost-sharing that you have to pay with Plan G is the Medicare Part B deductible, which is $226 in 2023. Once you pay the deductible, Plan G covers the rest of your out-of-pocket costs. There is also a high-deductible version of Plan G, which is the same in coverage as regular Plan G but has a higher annual deductible amount to fulfill, after which the insurance kicks in.
Here are some key features of Medigap Plan G:
- Coverage: Plan G covers all of the benefits of Medicare Supplement Plan F except for the Medicare Part B deductible. This means that it covers:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayment
- Blood (first 3 pints)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B excess charges (the difference between what a doctor or provider charges and the Medicare-approved amount)
- No network restrictions: Like all Medicare Supplement plans, Plan G works with any doctor or hospital that accepts Medicare.
- Standardized benefits: Plan G is a standardized Medigap plan, which means that the benefits are the same no matter which insurance company you buy it from. However, premiums may vary between insurance companies.
- Guaranteed issue: You have a guaranteed issue right to buy a Medigap Plan G if you enroll in Medicare Part B for the first time or lose certain types of health coverage. You can also apply for a Plan G during the annual Medicare Open Enrollment Period (October 15 – December 7).
Is Plan G being phased out?
While some changes to Medigap plans have been made in recent years, including the phasing out of some plans for newly eligible Medicare beneficiaries, Plan G is not among them. It remains a popular choice among Medicare beneficiaries who want comprehensive coverage for their healthcare expenses.
On the other hand, Medigap Plan F is being phased out, which is why some confusion around Medigap Plan G arises. As of January 1, 2020, new enrollees in Medicare are no longer able to purchase Plan F or Plan C. However, if you were eligible for Medicare or Medigap before January 1, 2020, you are still able to enroll in Plan F.
The phase-out of Plan F was part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The goal was to reduce Medicare costs and encourage beneficiaries to be more conscious of their healthcare spending. Plan F was one of the most comprehensive Medigap plans, covering all out-of-pocket costs for Medicare-covered services. This meant that beneficiaries with Plan F had no financial incentive to limit unnecessary healthcare spending.
As a result, starting in 2020, new Medicare beneficiaries are no longer able to purchase Plan F. Instead, they can choose from other Medigap plans that offer similar coverage, such as Plan G or Plan N. These plans do not cover the Medicare Part B deductible, but they have lower premiums than Plan F and still provide comprehensive coverage for most out-of-pocket costs.
Medigap Plan N
Medigap Plan N is one of the standardized Medicare Supplement plans available to beneficiaries in most states. It provides coverage for some of the out-of-pocket costs that Original Medicare (Part A and Part B) does not cover, such as deductibles, copayments, and coinsurance.
Some key features of Medigap Plan N include:
- Coverage for coinsurance and hospital costs associated with Part A, up to an additional 1 year after Medicare benefits are exhausted.
- Coverage for Part B coinsurance or copayment, with the exception of a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission.
- Blood coverage, which pays for the first three pints of blood per year.
- Coverage for hospice care coinsurance or copayment.
- No coverage for the Medicare Part B deductible or excess charges.
It’s important to note that Medigap Plan N may offer lower premiums compared to other Medigap plans, but it also requires beneficiaries to pay certain out-of-pocket costs such as copayments for some office and emergency room visits.
Does Plan G and Plan N Cover Physical Therapy?
Yes, both Medigap Plan N and Medigap Plan G can provide coverage for physical therapy, which is a type of rehabilitative service that aims to help people recover from physical injuries or illnesses.
Under original Medicare (Part A and Part B), physical therapy is covered, but there are some out-of-pocket costs such as coinsurance and deductibles that you need to pay. Medigap plans can help fill in the gaps by covering some or all of these costs.
Medigap Plan N covers 100% of the Medicare Part B coinsurance for outpatient physical therapy services, but you may have to pay a copayment of up to $20 for each office visit and up to $50 for emergency room visits that do not result in an inpatient admission.
Medigap Plan G covers the same benefits as Plan N but does not have the copayments for office visits or emergency room visits.
It’s important to note that the coverage and costs of Medigap plans can vary depending on the insurance provider and the state you live in. Therefore, it’s important to review and compare the details of each plan before choosing one that suits your needs.
Is Medigap Plan G Better than Medigap Plan N?
Both Medigap Plan G and Medigap Plan N offer similar coverage for Medicare beneficiaries. However, there are some differences between the two plans that may make one more beneficial for some individuals.
Medigap Plan G offers more comprehensive coverage than Plan N. Plan G covers all of the same benefits as Plan N, with the addition of coverage for Medicare Part B excess charges, which are the difference between what a healthcare provider charges for a service and what Medicare pays for that service.
On the other hand, Medigap Plan N offers lower monthly premiums than Plan G but requires you to pay a copay for some services such as doctor visits and emergency room visits. Additionally, Plan N does not cover excess charges for Medicare Part B services. Have in mind that you always can switch Medigap plans, if you are not satisfied with its coverage.
Ultimately, the decision between Medigap Plan G and Plan N depends on your personal needs and financial situation. If you want more comprehensive coverage and are willing to pay a higher monthly premium, Medigap Plan G may be a better choice. If you want lower monthly premiums and are comfortable with copays for some services, Medigap Plan N may be a better fit. It’s always a good idea to review the details of each plan and compare costs and benefits before making a decision.