Medicare beneficiaries have lots of options when it comes to Medicare plans. One of the most popular choices is Medigap Plan G. It’s known for its comprehensive coverage and predictable costs. One question we often get asked is, “Does Plan G pay doctor visits?” We’ll answer that question today.

What Is Medicare Plan G?

Let’s start with the basics. What exactly is Plan G? Plan G is one of several Medicare Supplements, also known as Medigap plans. These plans exist to fill in the gaps left by Original Medicare coverage. Original Medicare consists of Parts A and B. It offers great coverage but leaves you with many out-of-pocket costs. Without a Medigap plan, those costs could lead to financial hardship.

Plan G is often compared to other popular options like Plan F and Plan N. Before 2020, Plan F was the go-to choice for many beneficiaries because it picked up every out-of-pocket cost, including the Part B deductible. However, it’s no longer available to new enrollees. This shift has helped push Plan G into the limelight as the most comprehensive plan available to all Medicare beneficiaries. Unlike Plan F, Plan G does not cover the Part B deductible. However, it often compensates with lower premiums, making it a more cost-effective choice.

The coverage offered by Plan G includes:

  • Medicare Part A coinsurance and hospital costs
  • Medicare Part B coinsurance or copayments
  • Blood (first three pints)
  • Part A hospice care coinsurance or copayments
  • Part B excess charges
  • Skilled nursing facility care coinsurance
  • Medicare Part A deductible
  • Foreign travel emergency (up to plan limits)

Given this array of coverage, you can see why Plan G stands out as a robust choice for those seeking full coverage with predictable costs.

Plan G and Doctor Visits

Even those of us who are relatively healthy will likely see a doctor several times each year. For this reason, it’s important for beneficiaries to know if those visits will be covered by Original Medicare and Plan G. Good news – they are! But to prepare you even more, let’s talk about these visits in more detail.

Types of Doctor Visits

Not all visits to your doctor are coded the same way. Each service or procedure you have gets assigned a specific medical code. Here are just a few types of doctor visits Plan G covers.

  • Primary Care Visits: Routine visits to your primary care physician for general health check-ups, illness, and health management are covered.
  • Specialist Consultations: Visits to specialists, whether referred by your primary doctor or not, are covered under Plan G. This includes consultations with cardiologists, endocrinologists, orthopedists, and other specialists.
  • Preventive Services: Preventive healthcare services, such as annual wellness visits, screenings for various conditions, and vaccinations, are covered. Medicare often covers these services at 100%, meaning there may be no additional cost even before the Part B deductible is met.
  • Outpatient Services: Plan G covers outpatient services that are typically provided in a doctor’s office. This includes certain therapies, diagnostic tests, and minor surgical procedures.

It’s important to note that while Plan G covers the financial aspect of the doctor visits, it does not dictate which doctors you can see. As long as the doctor accepts Medicare, Plan G will provide coverage. This freedom to choose your healthcare provider is a significant advantage, offering flexibility and comfort in knowing that you can continue seeing your preferred doctors.

Costs Associated with Plan G Doctor Visits

One of the main advantages of Medicare Plan G is its clear and predictable cost structure, especially concerning doctor visits. Understanding these costs is essential for effectively budgeting and maximizing your healthcare plan. Let’s talk about the costs you’ll be responsible for under Plan G.

First, you’ll need to take care of the Medicare Part B deductible. As we mentioned earlier, there may be some preventive care visits that won’t apply to the deductible, but everything else will. The Part B deductible must be met each year before your full benefits begin. As of 2024, that amount is $240.

Once you’ve paid your deductible, Plan G picks up 100% of all covered services. This means you won’t owe anything for doctor visits or other outpatient services. Without Plan G, you’d be responsible for a 20% coinsurance for every outpatient service. There is no limit or cap to that 20% responsibility, so your costs could be significant.

Remember, Plan G will only pay for services that have been approved by Medicare. As long as Part B approves a service, it will also be covered by Plan G. If Part B denies something, Plan G will also deny it. Another cost to be aware of is Part B excess charges. In some cases, doctors who do not accept Medicare assignment may charge up to 15% more than the Medicare-approved amount. Plan G does cover these excess charges, which means you have an additional layer of financial protection.

Advantages of Choosing Plan G for Doctor Visits

Choosing the right Medicare Supplement plan is a decision that impacts both your health and finances. With its comprehensive coverage, Plan G offers several advantages, particularly when it comes to doctor visits. Understanding these benefits will help you decide if Plan G aligns with your healthcare needs and priorities.

Unlike some Medicare Advantage (Part C) plans, you won’t need to choose a primary care physician under Plan G. If you want to see several doctors, you don’t have to alert your plan or get permission. This same is true for specialists. Some Medicare Advantage plans require you to get a referral from your primary care doctor before seeing a specialist. You won’t have to jump through that hoop with Plan G. This will save time and streamline your access to necessary medical care.

In addition, there are no network restrictions with Medigap plans. Plan G allows you to see any doctor who accepts Medicare, regardless of which insurance company you purchase the plan from. This freedom is especially beneficial for those who travel or live in different parts of the country throughout the year.

Get Medigap Plan G Help

Plan G offers a nice blend of comprehensive coverage, financial predictability, and flexibility, making it an appealing choice for many Medicare beneficiaries.

If you’re considering Medicare Plan G or have questions about how it compares to other options, we are here to assist. Our expertise lies in helping you navigate these important decisions, ensuring that you choose a plan that perfectly aligns with your healthcare needs and lifestyle.

Don’t navigate the complexities of Medicare alone.