Plan G is a Medigap policy that covers most of what Original Medicare leaves you to pay

Plan G is a standardized Medigap insurance policy sold by private insurers. It pays many of the costs that Original Medicare (Parts A and B) does not — copayments, coinsurance, and deductibles. Plan G is one of the most popular Medigap choices for people over 65 because it covers nearly everything except the Part B deductible, which you pay once per year.

Medigap policies are designed to work alongside Original Medicare, not replace it. You keep your Medicare card and use it at doctors and hospitals. Plan G straightforward steps in to cover the gaps. The trade-off is that you pay a monthly premium to the insurance company selling the plan, in addition to your Medicare Part B premium.

Key Takeaways

  • Plan G covers coinsurance and copayments for hospital stays, doctor visits, and emergency care, but you still pay the Part B deductible once per year.
  • You must have Original Medicare Part A and Part B to buy Plan G; it does not work with Medicare Advantage.
  • Plan G premiums vary by age, location, and insurance company, and can change each year.
  • You can buy Plan G during your initial enrollment window or during the annual open enrollment period, though some states allow year-round sales.

What Plan G actually covers

Plan G covers the coinsurance you owe after Medicare pays its share. For example, after a hospital stay, Medicare Part A covers the first 60 days fully. Days 61 through 90, you owe coinsurance; Plan G pays it. For doctor visits and outpatient care, Medicare Part B covers 80 percent after you meet the deductible; Plan G covers the remaining 20 percent coinsurance.

Plan G also covers the Part A deductible (the amount you owe before Medicare hospital coverage begins) and emergency care outside the United States, up to the plan's limits. It does not cover the Part B deductible, which is a set amount you pay once per calendar year before Part B coverage starts. As of 2024, that deductible is $240, though it changes yearly.

Plan G does not cover dental, vision, hearing aids, or long-term care. Those services are not covered by Original Medicare either, so no Medigap plan covers them. If you need those services, you would buy separate insurance or pay out of pocket.

How Plan G premiums work

Insurance companies set their own Plan G premiums, so the cost varies widely depending on which company you choose and where you live. Premiums also depend on your age when you enroll. If you buy Plan G during your initial enrollment window (the six months starting the month you turn 65 and enroll in Medicare Part B), insurers cannot charge you more based on your health history — this is called may provide issue.

If you buy Plan G outside that window, some insurers may require you to answer health questions or undergo medical underwriting, and they can charge you more if you have pre-existing conditions. Premiums also increase as you age and typically rise each year due to inflation and claims costs.

You pay the Plan G premium directly to the insurance company, separate from your Medicare Part B premium. Your Part B premium goes to Medicare; your Plan G premium goes to the private insurer. Some people pay both by automatic bank withdrawal, others by check or credit card.

When you can buy Plan G

The best time to buy Plan G is during your initial enrollment period, which is the six-month window that starts the month you turn 65 and enroll in Medicare Part B. During this window, you have may provide issue rights — insurers must sell you the plan at their standard rate regardless of your health.

If you miss that window, you can still buy Plan G during the annual open enrollment period, which runs from October 15 through December 7 each year. Coverage begins January 1 of the following year. Outside these windows, availability depends on your state and the insurance company. Some states allow year-round sales; others restrict them. Contact insurers in your area to ask whether they are currently selling Plan G.

If you enroll outside your initial window and an insurer requires medical underwriting, they may deny your process or charge you more. For this reason, buying during your initial enrollment period is strongly recommended.

Plan G versus other Medigap plans

Medigap offers ten standardized plans: A, B, C, D, F, G, K, L, M, and N. Each plan covers a different combination of costs. Plan F covers everything Plan G covers, plus the Part B deductible, but Plan F is no longer sold to people who became may be able to access for Medicare on or after January 1, 2020. For those people, Plan G is the most comprehensive option available.

Plan N is less expensive than Plan G but covers less. With Plan N, you pay copayments at the doctor's office ($20 for most visits) and at the emergency room ($50, waived if admitted). Plan G has no copayments for these services. Plan A and Plan B are cheaper but cover fewer costs overall. The right plan depends on how much you use healthcare and how much premium you want to pay.

Plan G and prescription drug coverage

Plan G does not include prescription drug coverage. If you take medications, you need to enroll in a separate Medicare Part D plan (a prescription drug plan) or a Medicare Advantage plan that includes drug coverage. Part D plans are sold by private insurers and have their own premiums, deductibles, and formularies (lists of covered drugs).

You can enroll in Part D when you first become may be able to access for Medicare, or during the annual open enrollment period. If you delay enrolling in Part D without having other creditable drug coverage, you may pay a penalty when you do enroll. The penalty is calculated based on how many months you were without coverage.

Questions to ask your doctor or insurance agent

Before you buy Plan G, ask your current doctors whether they accept Original Medicare and Medigap. Most do, but some practices have opted out of Medicare entirely. If your doctor has opted out, you may face higher costs or need to find a new provider.

Ask your insurance agent to show you quotes from at least three companies for Plan G in your area. Premiums can differ by hundreds of dollars per year for the same coverage. Also ask whether the company uses age-based pricing (your premium goes up each year as you age) or issue-age pricing (your premium is locked based on your age when you buy the plan, then rises only due to inflation and claims costs).

Frequently Asked Questions

Can I switch from Plan G to a different Medigap plan later?

Yes, you can switch to another Medigap plan at any time, though you may face medical underwriting and higher premiums if you switch outside your initial enrollment window. Some states have limited switching rights. Contact your state's insurance commissioner's office to learn the rules in your state.

Does Plan G work with Medicare Advantage?

No. Plan G is only for people with Original Medicare (Parts A and B). If you have a Medicare Advantage plan, you cannot buy Medigap. If you switch from Medicare Advantage to Original Medicare, you may have a limited time to buy Medigap without medical underwriting.

What happens to my Plan G if I move to a different state?

Your Plan G coverage ends when you move. You must buy a new Plan G from an insurer in your new state. You may have may provide issue rights during the move, depending on your state's rules. Contact your state insurance commissioner's office before you move to learn what protections explore.

Will Plan G cover me if I travel outside the United States?

Plan G covers emergency care outside the United States up to a limit (typically $250 deductible and 80 percent coinsurance after that). For planned care or extended travel, you may want to buy a separate travel insurance policy. Medicare itself does not cover care outside the U.S. except in limited situations.

How do I know if Plan G is better than Plan N for me?

Plan G costs more but has no copayments for doctor visits or emergency room care. Plan N costs less but requires you to pay copayments. If you see doctors frequently or use the emergency room, Plan G may save you money overall. If you rarely see doctors, Plan N's lower premium may be the better choice. Compare the total cost (premium plus expected copayments) for your situation.