Medigap Plan G: Understanding and Its Coverage

Medigap Plan G: Understanding and Its Coverage

Medicare Supplement Plan G covers your share of medical costs (with exemptions for an outpatient’s deductible) as your initial Medicare includes. It’s also known as Medigap Plan G.

Original Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Medigap Plan G is one of the most well-known available plans due to its broad coverage, including coverage for Part B’s extra costs.

Find out the specifics about Medicare Part G and what benefits it provides.

Understanding Medigap

Medigap policies, including Medicare Supplemental Plan G, assist in covering the costs of healthcare that are not covered by Medicare. 

These policies are:

  • Offered by private insurance companies
  • Standardized and complies with the federal and state laws
  • Covers the most common expenses.

A Medigap policy is just for one person. Thus, everyone needs an individual plan.

If you’re trying to buy the Medigap insurance plan, the following steps can help you-

What Original Medicare Covers

Medicare Part A Cover:

  • Hospitalization in a semi-private room
  • Skilled nursing facility in the event of hospitalization for three or more days
  • Inpatient care at a qualified nursing home but not long-term or custodial care.
  • Occupational speech therapy, physical therapy, and illness counseling
  • Hospice care
  • Blood transfusions following at least three pints

Part A Does Not Include:

  • A deductible of $1,556 when you are admitted for hospitalization
  • Hospital inpatient days 61-90. You pay $389 per day.
  • Hospital inpatient days beyond 90 days. *You pay $778 per day.
  • Nursing facilities with skilled staff are open for between 21 and 100. You pay $233.per day.

There are Lifetime Reserve days that you can utilize across various benefit periods (each moment you’re at the hospital or in a skilled nursing center). 

*You must have a minimum of 60 days between visits to be eligible to use Lifetime Reserve days.

These sums are added to the following “benefit period” when you visit the hospital or skilled-nursing establishment (SNF) and expire when you’ve not received treatment in these settings for 60 consecutive days.

Medicare doesn’t pay for Part A and B-related items or services outside the U.S. and U.S. territories. However, Medicare could cover inpatient hospitalization outside of the U.S. under rare circumstances.

Medicare Part B

Medicare Part B is primarily focused on outpatient treatments. After you have paid your first Part B deductible of $233, your coinsurance must be set at 20 percent.

Medicare Part B Covers What?

Part B covers 80% of the cost including outpatient services in the emergency room or a hospital and diagnostic tests like X-rays. In the case of many preventive treatments, the coinsurance and the deductible will not be applied to routine mammograms, flu shots, osteoporosis tests, glaucoma testing, and various cancer screenings. 

However, certain preventive services have specific criteria to meet before taking advantage of the preventive services without coinsurance or deductible. 

Part B can also cover doctor’s appointments, ambulances, mental health outpatient surgeries, and home health care. DME, durable medical devices (DME), including glucose monitors, test strips, and lancet devices, wheelchairs, and walkers. Home health care is provided under Medicare Part A if specific requirements can be met.

What Does Medicare Part B Not Cover?

Medicare Part B generally does not cover medical care that is not in the U.S.

Medicare Part B does not cover:

  • Long-term care (also known as custodial care)
  • Most dental care
  • Eye exams that are related to the prescription of glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and tests to determine if they are suitable
  • Routine foot treatment

What Does Medicare Supplement Plan G Cover?

Besides your deductible, most Medigap policies cover coinsurance. In addition, the particular Medigap policy also covers the cost of the premium.

Coverage offered by Medicare Supplement Plan G includes:

  • Part A deductible: 100 percent.
  • Copayment or Part B coinsurance 
  • Part B Extra Charges: 100 percent
  • Specialist nursing facilities Care and coinsurance up to 100 percent
  • The blood (first 3 pints): 100 percent
  • Foreign travel exchange: 80 percent

Why Consider Plan G?

Plan G can be described as the best Medigap choice if you’re recently eligible to receive Medicare. Depending on where you reside in the United States, it could cost between $99 and $476 monthly for the plan’s premium, which is $1,188 up to $5,712. 

However, in terms of the higher cost than similar Medigap plans, it will be able to get more excellent coverage.

Plan G covers most expenses out of pocket for medical treatments and services once you have paid your Medicare Part B deductible of $233. That means you do not have to pay the cost of coinsurance, copays, or other copays.

If you don’t require this level of protection, you might consider an insurance plan with lesser coverage.

Deciding on the Best Medigap Plan

A method to find the Medicare supplement insurance policy that meets your requirements is using one of the internet search engines. These search tools online are developed in CMS. U.S. Centers for Medicare and Medicaid Services (CMS).

Takeaway

Medicare Supplement Plan G is a Medigap policy that covers the costs of healthcare that are not covered under Original Medicare. The most extensive Medigap plan also covers Medicare Part B additional costs.

Medigap policies are different across Massachusetts, Minnesota, and Wisconsin. Therefore, if you reside in any of these states, it is necessary to examine the Medigap policies to obtain an insurance plan similar to Medicare Supplemental Plan G.

If you have any additional questions on nursing home care regarding Medicare, you can contact our licensed agents specializing in Medicare. 

Also, visit our website for more info!

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