Is Medigap G Better Than Medigap F?


I am often asked which Medigap plan is better.  My answer is that both plans are excellent.  It depends on what the insured wants to accomplish.

Medigap is standardized.  That means that a Plan F with ABC Company is the same coverage as with XYZ.  The only difference is the logo on your ID card and the premium that you are charged.  In theory, although it does not always work this way, the premium is based on customer service, the size of the insurance company you have elected, and other various factors that cause one person to purchase coverage from one company while another person purchases the same coverage from a different company at a different price.

The Centers for Medicare and Medicaid Services has written, “Choosing A Medigap Plan.”  In it you will be able to learn about Medigap plans and your options.  If you are age 63 or older, I recommend that reading this booklet be your first step when you start considering Medigap.

In this post I want to try to explain the difference between plan F and plan G.

PLAN F

Plan F is the most comprehensive Medigap plan that is currently available.  As the most comprehensive, it is also the most expensive.  If you use the services of a doctor who accepts Medicare, you should never again have to deal with Medical bills.  That hassle is a thing of the past with Plan F.

Once you show your insurance ID card to your doctor, he will file your claim with Medicare and they will then file your claim with your Medigap plan.  They in turn will pay your doctor.

If you use a doctor who does not accept Medicare, federal law limits the amount of “Excess Fees” that he can charge you to 15% of what Medicare approves.  That means that you are liable for the 20% of your doctor’s bill that Medicare approves but does not pay plus his “Excess Fees.”  In other words, you could find yourself liable for 35% of your doctor’s bill in you use a non-enrolled doctor.

If you elect to go to a doctor who does not accept Medicare, he is still obligated to file your claim with Medicare.  Medicare will forward your claim to your Medigap plan after it has finished.

The difference is that you will have to pay your non-enrolled doctor directly and  wait to be reimbursed.  You will eventually get refund checks from Medicare and Medigap.

Medigap, Plan F will pay anything and everything that Medicare does not.  Things that Medigap Plan F will pay include;

  • Medicare Part A Deductible
  • Medicare Part B Deductible
  • Medicare Part B 20% co-insurance
  • Excess Fees
  • Foreign Travel Medical Emergencies  (Coverage is limited)

PLAN G

Medigap Plan G is identical to Plan F with 2 significant differences.

  1. Plan G does not pay Medicare’s Part B Deductible.  You would have to deal with the bookkeeping for that.  The deductible for 2012 was only $140.  You will be required to pay that to your doctor out of your pocket.  As expensive as many doctor’s visits are, it is likely that you will pay your deductible after just one or two visits to your doctor.  You should not have any bookkeeping problems for the rest of the year.
  2. The difference in premium for Plan G, over the year, typically is going to be more than the annual Medicare B deductible.

CONCLUSION

As I mentioned above, both plans are excellent.  You cannot go wrong with either.  If you are value conscience and look to save every penny you can, Plan G is a better deal.

If, however, you want a plan that will eliminate every bookkeeping responsibility, Plan F is probably what you are looking for.

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