Is Medigap Plan G worth it?
Work out the two totals and the answer stops being a matter of opinion. Here is the comparison and the risk it removes.
Plan G costs a real monthly premium in exchange for near elimination of medical bills. Whether that is worth it is a question you can actually calculate, and then a judgment about risk.
What you get
After you pay the annual Part B deductible once, Plan G covers essentially everything else Medicare leaves you for covered services.
- The Part A hospital deductible, per benefit period, which can occur more than once a year
- All Part B coinsurance, the 20 percent, with no cap
- 365 additional hospital days after Medicare's run out
- Skilled nursing coinsurance
- Part B excess charges
- Foreign travel emergency care, up to a limit
Any doctor in the country that accepts Medicare. No network, no referrals, no prior authorization on most services.
The calculation
Compare two annual totals honestly.
- Plan G path: twelve months of Plan G premium, plus twelve months of a Part D plan, plus the annual Part B deductible. This is close to both your best case and your worst case, because it barely moves with usage.
- Advantage path: twelve months of any plan premium, plus the plan's annual out of pocket maximum. That is your worst case. In a healthy year you might pay almost nothing.
Now the real question: in a bad year, which number would you rather face? And how much are you willing to pay in good years to never face the other one?
When Plan G is clearly worth it
- You travel, spend part of the year elsewhere, or split time between states
- You have a chronic condition requiring frequent specialist care
- You want a specific doctor or hospital regardless of any network
- You would find a large unexpected medical bill genuinely difficult
- You would rather pay a known amount than manage authorizations and referrals
When it may not be
- You are healthy, your doctors are all in a good local network, and you rarely leave the area
- The dental, vision and hearing benefits on Advantage plans are worth real money to you
- The premium would strain your budget every month, which is a legitimate reason on its own
- You qualify for Medicaid or a savings program, where a dual eligible plan may leave you paying almost nothing. See D-SNP plans.
The argument people miss
Buying Plan G during your six month open enrollment is also buying an option. Once you hold a supplement you can generally keep it for life regardless of what happens to your health, because Medigap policies are guaranteed renewable. Starting on Advantage and trying to move to a supplement later means passing underwriting, which a diagnosis can make impossible. That optionality is part of what the premium buys.
Cheaper ways to get most of it
- Plan N: same coverage with small office and emergency room copays and no excess charge coverage, at a lower premium. See G versus N.
- High deductible Plan G: much lower premium, you pay a set annual amount first. See high deductible Plan G.
- Shop carriers. Coverage is identical by law, so a lower price is purely a lower price. See comparing rates.
Common follow-up questions
Is Plan G cheaper than a Medicare Advantage plan?
Month to month, almost never. Across a year with significant medical costs, frequently yes. It depends on your health, not on the plans.
Can I drop Plan G later if it gets expensive?
Yes, you can drop it any time. Getting it back later would require passing underwriting, so think of dropping as one directional.
Does Plan G cover prescriptions?
No. You need a separate Part D plan. Budget for both when comparing against an Advantage plan.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
What is Medigap (Medicare Supplement insurance)?
Medigap