Medicare Plan G is often hailed as the “gold standard” of Medicare Supplement (Medigap) plans for new enrollees, and for good reason. It covers most of the out-of-pocket costs that Original Medicare (Parts A & B) leaves behind, providing a significant financial safety net. However, it’s crucial to understand that even the most comprehensive Medigap plan has its limitations and does not cover every single healthcare expense.
Here’s a clear breakdown of what is plan g medicare,what it does not cover:
1. The Medicare Part B Annual Deductible
This is the most notable and often discussed exclusion for Medicare Plan G.
- The Gap: For 2025, the Medicare Part B annual deductible is $257. You are responsible for paying this amount out-of-pocket each calendar year before Original Medicare Part B (and subsequently Plan G) begins to cover your Part B services.
- Why it’s excluded: Due to a federal law (MACRA) effective January 1, 2020, Medigap plans sold to new Medicare beneficiaries are no longer allowed to cover the Part B deductible. Plans F and C, which did cover it, are no longer available for new enrollees.
2. Outpatient Prescription Drugs (Retail Pharmacy Drugs)
This is a common misconception, but a critical one.
- The Gap: Original Medicare (Parts A and B) does not cover most outpatient prescription medications that you pick up at a pharmacy.
- Plan G’s Role: Medicare Plan G, and all other Medigap plans sold today, do not cover these retail prescription drugs.
- Solution: To get coverage for your prescriptions, you must enroll in a separate Medicare Part D Prescription Drug Plan (PDP). These plans are offered by private insurance companies.
3. Services Not Covered by Original Medicare
Medicare Supplement plans like Plan G are designed to cover the gaps in Original Medicare, not to expand upon what Medicare itself covers. Therefore, if Original Medicare (Parts A or B) doesn’t cover a service, Plan G won’t either. This includes many common services:
- Routine Dental Care: This includes cleanings, fillings, extractions, crowns, dentures, and other general dental procedures. Original Medicare only covers very limited dental services that are medically necessary as part of another covered procedure (e.g., a dental exam before a heart valve replacement).
- Routine Eye Exams and Eyeglasses/Contact Lenses: Medicare Part B covers certain medical eye conditions (like glaucoma or macular degeneration) and a new pair of eyeglasses or contacts after cataract surgery. However, routine eye exams for vision correction and the cost of eyeglasses or contact lenses are not covered.
- Routine Hearing Aids and Hearing Exams (for fitting): Medicare covers diagnostic hearing and balance exams if ordered by a doctor to determine if medical treatment is needed. However, it does not cover routine hearing tests or the cost of hearing aids.
- Long-Term Custodial Care: This refers to care that assists with Activities of Daily Living (ADLs) like bathing, dressing, eating, and personal hygiene, typically provided in nursing homes, assisted living facilities, or at home. Original Medicare (and therefore Plan G) only covers skilled nursing care for a limited period after a qualifying hospital stay, not ongoing custodial care.
- Acupuncture (with limited exceptions): While Medicare has recently expanded coverage for acupuncture for chronic lower back pain, most other forms of acupuncture are not covered by Original Medicare.
- Chiropractic Care (with limited exceptions): Original Medicare only covers manual manipulation of the spine by a chiropractor if medically necessary to correct a subluxation (a partial dislocation of a vertebra). Other chiropractic services like X-rays or massage therapy are generally not covered.
- Cosmetic Surgery: Unless it’s medically necessary due to an accidental injury or to improve the function of a malformed body part (e.g., breast reconstruction after a mastectomy), purely cosmetic procedures are not covered.
- Private Duty Nursing: If you require a private nurse in a hospital or at home beyond what Medicare deems medically necessary or a facility provides.
- Concierge Care: Services from doctors or providers who have “opted out” of Medicare (except in emergency situations).
4. Services Covered by Medicare Advantage Plans (Part C)
It’s crucial to remember that you cannot have both a Medicare Plan G (or any Medigap plan) and a Medicare Advantage (Part C) plan at the same time. If you enroll in a Medicare Advantage plan, you automatically disenroll from Original Medicare, and your Medigap policy would be canceled. Medicare Advantage plans often include prescription drug coverage and may offer additional benefits like routine dental, vision, and hearing, but they operate under different rules, typically with network restrictions and annual out-of-pocket maximums.
Summary of Exclusions
In essence, Medicare Plan G is designed to fill almost all the financial gaps within Original Medicare’s coverage. It does an exceptional job of protecting you from the high costs of deductibles, coinsurance, and excess charges for services that Original Medicare does cover. However, it does not:
- Cover the Medicare Part B annual deductible.
- Cover outpatient prescription drugs.
- Cover services that Original Medicare itself does not deem medically necessary or does not cover at all (like routine vision, dental, or long-term care).
To achieve truly comprehensive healthcare coverage, individuals with Medicare Plan G often pair it with a Medicare Part D Prescription Drug Plan and may choose to purchase separate dental and vision insurance policies.
