What Does Medicare Plan G Pay For?

Medicare Supplement Plan G, also called Medigap Plan G, helps pay certain out-of-pocket costs left by Original Medicare (Part A and Part B). For people eligible to buy it, Plan G generally covers all Medicare-approved Part A and Part B cost-sharing except the Part B deductible; it does not cover prescription drugs or replace Original Medicare.

What Plan G covers

Medicare sets standardized benefits for Medigap plans, so Plan G’s covered benefits are generally the same across insurers within a state. The insurer’s price, service and availability may differ. Plan G can help pay the following costs when the service is covered by Original Medicare and the claim meets Medicare rules:

Part A coinsurance and hospital costs: This includes Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are used, subject to the policy’s terms.
Part A deductible: Plan G pays the Part A deductible for a covered inpatient hospital stay.
Part A hospice care coinsurance or copayment: It helps with the applicable cost-sharing for covered hospice care.
Skilled nursing facility care coinsurance: It covers the applicable Part A coinsurance for qualifying skilled nursing facility care. It does not turn non-covered custodial care into a covered benefit.
Blood: It covers the first three pints of blood used in a covered medical procedure each year.
Part B coinsurance or copayment: After the Part B deductible is met, Plan G generally pays the beneficiary’s share of Medicare-approved Part B services, such as covered physician services, subject to Medicare’s coverage and payment rules.
Part B excess charges: Plan G covers eligible excess charges when a provider who does not accept Medicare assignment charges more than Medicare’s approved amount, within applicable limits.
Foreign travel emergency care: Plan G includes a limited foreign-travel emergency benefit. It is subject to a deductible, a lifetime limit and other conditions; it is not comprehensive travel insurance.

The Part B deductible is not covered

The central exception is the Medicare Part B deductible. A Plan G policy does not pay it, so you pay eligible Part B expenses yourself until you have met that year’s deductible. After that, Plan G generally pays the covered Part B coinsurance or copayment for Medicare-approved services. The deductible amount can change, so check the current Medicare figure rather than relying on an old example.

For example, suppose a Medicare-approved outpatient service is subject to Part B cost-sharing. If you have not yet met the Part B deductible, you are responsible for the deductible amount that applies. Once it is met, Plan G may pay the covered coinsurance. The exact result depends on the service, Medicare’s coverage decision, and whether the provider accepts assignment.

Plan G is not the same as Medicare Advantage. It supplements Original Medicare rather than providing a separate way to receive Medicare benefits. You generally remain enrolled in Part A and Part B, and Medicare processes covered claims before the Medigap policy pays its share.

What Plan G does not pay for

Plan G supplements Medicare; it does not expand Medicare’s basic coverage to every service or expense. If Original Medicare does not cover a service, Plan G generally will not cover it simply because you have the policy. Common gaps include:

The Part B deductible.
Outpatient prescription drugs. Medicare Part D is separate coverage for many retail prescriptions.
Routine dental care, routine eye exams, eyeglasses and hearing aids when these are not covered by Medicare.
Long-term custodial care, such as ongoing help with bathing or dressing, when it is not covered by Medicare.
Care outside the United States beyond the limited foreign-travel emergency benefit and its conditions.
Services Medicare determines are not medically necessary or otherwise does not cover.

Coverage details can depend on the particular service and Medicare’s rules. A Medigap policy generally pays only after Medicare has paid its share for a covered claim; it is not a promise that every bill will be paid in full.

How Plan G works with Original Medicare

With Original Medicare, Medicare Part A and Part B process a claim first. The provider’s claim information is then generally sent to the Medigap insurer, which determines whether the policy covers the remaining eligible cost-sharing. You pay the Plan G premium whether or not you use medical services, and you remain responsible for costs the policy excludes.

For a Part B service, the sequence is especially important: Medicare applies the Part B deductible if it has not yet been met, then calculates its share of the approved amount. Plan G can generally cover the remaining Part B coinsurance after the deductible. If a service is not Medicare-approved or not covered, the usual Medigap payment process may not apply.

Providers who accept Medicare assignment agree to accept the Medicare-approved amount for covered services as full payment, apart from applicable cost-sharing. If a provider does not accept assignment, a Part B excess charge may arise where permitted; Plan G covers eligible excess charges. Asking whether a provider accepts assignment can help you understand how a bill may be handled.

Plan G compared with other Medigap choices

Plan G is often compared with Plan N and, for people eligible under applicable rules, Plan F. The plans have different standardized benefit designs. Plan N may involve certain office-visit or emergency-room copayments and does not cover Part B excess charges. Plan F covers the Part B deductible, but it is not available to everyone: federal rules generally limit eligibility to people who were eligible for Medicare before January 1, 2020. Plan G leaves the Part B deductible with the beneficiary but covers Part B excess charges.

These comparisons describe benefit structure, not which policy will cost less overall. Premiums vary by insurer, location, age-rating method and other factors. A lower premium can come with more out-of-pocket exposure, while a higher premium does not mean every service is covered. Compare the policy premium and the benefits you expect to use, and verify the insurer’s current quote and policy documents.

Eligibility, premiums and choosing a policy

Medigap policies are sold by private insurers, and availability and enrollment protections can depend on circumstances and location. The federal Medigap open enrollment period generally lasts six months, starts when a person is 65 or older and enrolled in Part B, and offers important protections against medical underwriting. Outside that window, an insurer may be able to use medical underwriting or refuse an application, subject to guaranteed-issue rights and applicable state rules. Contact Medicare or your State Health Insurance Assistance Program (SHIP) for guidance about your situation.

Before enrolling, check these practical details:

Confirm that you have or will have Original Medicare, rather than assuming a Medigap policy works with Medicare Advantage.
Compare Plan G benefits separately from premiums; standardized benefits do not mean identical prices.
Ask how the insurer sets premiums and whether the rate may change over time.
Check the policy’s effective date and enrollment requirements before ending other coverage.
Review separate needs, such as prescription coverage, dental coverage or travel insurance, because Plan G does not provide comprehensive coverage for them.

Frequently Asked Questions

Does Plan G pay the Medicare Part B deductible?
No. You pay the Part B deductible yourself. After it is met, Plan G generally covers eligible Part B coinsurance or copayments for Medicare-approved services.

Does Plan G cover prescription drugs?
No. Plan G does not provide outpatient prescription drug coverage. A separate Medicare Part D plan may cover eligible prescriptions, subject to that plan’s terms.

Does Plan G cover dental, vision or hearing care?
It generally does not cover routine dental care, routine vision services, eyeglasses or hearing aids that Original Medicare does not cover. Check Medicare’s coverage for a specific service before assuming it is excluded.

Does Plan G cover foreign travel?
It provides a limited foreign-travel emergency benefit, subject to conditions, a deductible and a lifetime limit. It is not comprehensive medical or travel insurance.

Is Plan G the same as Medicare Advantage?
No. Plan G is a Medigap policy that supplements Original Medicare. Medicare Advantage is a different way to receive Medicare benefits, and Medigap generally does not supplement Medicare Advantage coverage.

Can anyone enroll in Plan G?
Not necessarily. Availability and enrollment rights depend on factors such as Medicare eligibility, timing and state rules. Medicare or SHIP can explain the options and protections that may apply to you.

General steps for current mainstream versions; menus can differ by device and version. See the disclaimer or report an error.

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