Medigap Plan G is one of the most comprehensive Medicare supplements on the market today. Because it covers just about “everything,” we often get asked if Plan G covers drugs. The short answer is no, Plan G does not cover drugs. However, let’s unpack that further to understand what is covered by Plan G and how a prescription might be included in that coverage.
What is a Medicare supplement?
A Medicare supplement is a type of insurance that is designed to pick up the expenses that Medicare Parts A and B leave behind. You can think of a Medicare supplement as your secondary coverage to Original Medicare (Parts A and B). It will only cover services and products that are also covered by Parts A and B. If the service is denied by Original Medicare, it will also be denied by your Medicare supplement. There are no additional benefits offered by supplement plans.
Medicare supplements are standardized insurance plans. Standardization means that no matter where you purchase one of the plans, the coverage remains the same. For instance, if you purchase Plan G from Company X and your friend purchases Plan G from Company Z, you both have the exact same benefits. The benefits and coverage levels of Medicare supplements remain the same year after year. The only change you will encounter is a change in your premium.
What Medicare supplements are available?
As of 2022, there are ten Medicare supplements on the market: Plans A, B, C, D, F, G, K, L, M, and N. Plus, there is a high-deductible version of both plans F and G. Once you have enrolled in Original Medicare, you can enroll in any of these Medicare supplements, with on exception.
Medicare supplement Plan F is only available to Medicare beneficiaries who turned 65 prior to January 1, 2020. The reason for this rule came from changes that were made in 2020 as part of MACRA, the Medicare Access and CHIP Reauthorization Act of 2015. One part of this act prohibits Medicare supplements from paying the Part B deductible. Plan F pays the Part B deductible; hence it is no longer available to newly eligible beneficiaries. Plan G is the next best option.
What does Plan G cover?
The only difference between Plan F and Plan G is that Plan G cannot pay the Part B deductible. In 2022, that deductible is $233. Aside from that, coverage in the two plans is identical.
Here is a breakdown of Plan G benefits:
- Part A deductible ($1556 per benefit period)
- Part A coinsurance/copays
- 365 additional days for inpatient stays under Part A
- Part B coinsurance/copays
- Part B excess charges
- Up to 3 pints of blood
- Skilled nursing facility coinsurance
- 80% coverage for foreign travel emergencies
So, what about Plan G drug coverage? Original Medicare and Medicare supplements do not cover most prescription medications. However, there are some exceptions. Medicare Part B will cover drugs that are not typically administered. This includes medications administered by a provider or in a hospital’s outpatient department. These drugs may be given as an infusion or injection. Injectable osteoporosis drugs, some antigens, blood clotting factors, and immunosuppressive drugs may all be covered by Part B.
Some drugs administered as vaccines are also included in Medicare Part B. Covered vaccines include the flu shot, COVID-19 vaccine, pneumococcal shots, hepatitis B shots, and others if they are included as part of treatment. Once Medicare Part B has paid its 80% share, Plan G will come in and take care of the remaining 20%.
How do I get prescription drug coverage?
Since Plan G isn’t going to cover your prescriptions, you’ll need a separate prescription drug plan. You can find one of these in Medicare Part D. Part D includes all of the prescription drug plans and carriers. There are many to choose from across the country.
The specific drugs covered in your Part D plan will depend on the policy you choose. You should compare your current drugs to the ones included in the plan’s drug formulary to find out if a policy may be a good fit for you.
Where can I get help enrolling in Plan G?
A qualified Medicare advisor can help you enroll in Plan G. While you could find an insurance company that sells Plan G and enroll on your own, it is beneficial to use an independent Medicare agent. An independent agent can compare the rates of Plan G across multiple carriers, ensuring you get the most competitive rate. Plus, we’ll make sure the carrier doesn’t have a history of rapidly increasing their premiums.
The best part? There is no additional cost to work with us! Our services are completely free to you. Call our office today, and we can begin your enrollment into Plan G!