Medigap High-Deductible Plan G: Balancing Premiums and Out-of-Pocket Costs
With the high-deductible version of Medigap Plan G, you must pay an annual deductible of $2,800 in 2024 before the plan’s full coverage kicks in.
Anything that is approved by Medicare Part A or Part B but not paid counts toward your annual deductible.
The high-deductible Plan G is an excellent choice for individuals in good health who don’t anticipate significant healthcare expenses. By agreeing to shoulder a higher upfront deductible, you can enjoy substantial savings on monthly premiums while still benefiting from the comprehensive coverage of Plan G once your deductible is met.
Benefits of Medigap Plan G and High-Deductible Plan G
Both the standard and high-deductible versions of Medigap Plan G offer the following benefits:
- Coverage for Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted
- Payment of the Medicare Part A deductible
- Coverage for Medicare Part A hospice care coinsurance or copayments
- Payment of Medicare Part B coinsurance or copayments (but not the initial $240 Medicare Part B deductible)
- Coverage for Medicare Part B excess charges
- Coverage for the first three pints of blood for a transfusion
- Payment of skilled nursing facility care coinsurance (post hospitalization only, for up to 100 days)
- Coverage for medically necessary emergency healthcare services for the first 60 days when traveling outside the United States (deductible and limitations apply)
The primary difference between the standard and high-deductible versions of Plan G is the annual deductible amount you must pay before the plan’s coverage begins.
Weighing Potential Disadvantages of Medigap Plan G
The high-deductible Plan G isn’t the right option for everybody.
Here are some reasons why a high-deductible Medigap Plan G may not make financial sense:
- You can’t afford the deductible: Those with limited income or savings may struggle to pay the $2,800 deductible upfront, even though premiums are lower. If the deductible causes you to delay or skip needed care because you can’t afford to see your doctor, a high-deductible may not be the best thing for you, in the long run.
- Preference for predictable costs: Some may prefer the higher but stable monthly premiums of standard Plan G over the high deductible version’s initially lower premiums but unpredictable out-of-pocket exposure.
- Transition to standard Plan G is difficult: Once on high-deductible Plan G, switching to the standard version later requires medical underwriting. If your health changes, you might not be able to switch to the standard Plan G.
You should anticipate potentially having a high deductible for many years.
Comparing the High-Deductible Medigap Plan G to Other Options
Medigap Plan N
Medigap Plan N is another popular option for new Medicare beneficiaries.
The most important thing about Plan N is that it’s nearly identical to Plan G, but doesn’t pay for physician’s excess charges. That’s a good thing if you live in one of the states that prohibits excess charges.
While it offers slightly less coverage than the standard Plan G, it typically comes with lower premiums.
Plan N requires copayments and coinsurance for all office visits and emergency room visits, which can add up if you frequently utilize these services.
If you have multiple Medicare-covered office visits in one day you will only be charged one copayment. Your labs, x-rays, and any durable medical equipment (DME) needed during your visits will not be charged copayments or coinsurance.
Also, telehealth services are not billed as office visits by providers, so you won’t be charged a copayment for those.
Medi-Share 65+ (Christian Healthcare Sharing Ministry)
Medi-Share 65+ is a non-insurance healthcare sharing ministry designed for individuals aged 65 and older.
While it operates differently from traditional insurance, it can provide an alternative way to share healthcare costs among members with similar beliefs and values. However, it’s important to carefully evaluate the coverage and limitations of such programs to ensure they align with your needs and preferences.
If you are excited about this Christian health sharing ministry and want to join a like-minded community who help each other with medical expenses you can easily self-enroll.
Comparing Medigap Plan G High-Deductible and Medi-Share 65+
When it comes to healthcare coverage options for Medicare beneficiaries, Medigap Plan G High-Deductible and Medi-Share 65+ offer distinct approaches.
Here’s a comprehensive comparison to help you understand the key differences and similarities:
| Feature | Medigap Plan G High-Deductible | Medi-Share 65+ |
|---|---|---|
| Type | Medicare Supplement Insurance | Healthcare Sharing Ministry |
| Eligibility | Enrolled in Medicare Parts A and B | Age 65 or older, Christian faith, also enrolled in Medicare Parts A and B |
| Coverage | Comprehensive Medicare supplement benefits after meeting the annual deductible ($2,800 in 2024) | Eligible medical bills are shared among members based on Biblical principles. |
| Deductible | Annual deductible of $2,800 in 2024 | $500 Annual Household Portion (similar to a deductible) |
| Out-of-Pocket Costs | No copays or coinsurance after the deductible is met | No copays or coinsurance after AHP is met |
| Provider Network | No network restrictions; any provider that accepts Medicare | No network restrictions, but providers must be willing to accept Medi-Share, or you can pay upfront and get reimbursed |
| Guaranteed Issue | Available during the Medigap initial eligibility period. Medically underwritten after that. | No guaranteed issue; medical history review required |
| Premiums | Set by private insurance companies, varies by location and age | Currently $99/month for ages 65-74, and $150/month for ages 75 and up. Rate lock-in through age 74. |
| Accountability | Regulated by federal and state governments | Member-voted guidelines and accountability |
| Biblical Principles | Secular insurance product | Based on Biblical principles of sharing burdens |
| Community Support | No community aspect | Members support and pray for each other |
| Pre-existing conditions | Covered from enrollment | Subject to a 6-month waiting period. |
Excess Charges and State Regulations
One unique feature of Medigap Plan G is its coverage for Medicare Part B excess charges, which occur when healthcare providers charge more than the Medicare-approved amount for a service.
However, it’s important to note that excess charges are relatively rare, as most providers who accept Medicare are not permitted to impose them.
Additionally, eight states (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont) prohibit excess charges altogether, making the excess charge coverage benefit of Plan G less relevant for beneficiaries residing in these states.
If you live in one of these states, you should consider Plan N, or the high-deductible Plan N.
