What is the Difference Between Medicare Part C and Part G?

Medicare is a federal health insurance program that provides coverage for people aged 65 and older as well as some younger individuals with disabilities. The various parts of Medicare help cover specific healthcare costs and services. Two components that often cause confusion are Medicare Part C and Part G.

This guide will explain:

• What Part C (Medicare Advantage) and Part G (Medigap) plans cover
• Key differences between the two options
• How to decide if Part C or Part G is better for your needs

Knowing the distinctions can help you choose the right supplemental Medicare coverage.

Overview of Medicare Part C (Medicare Advantage)

Medicare Part C, also known as Medicare Advantage, offers an alternative way to receive your Medicare benefits compared to Original Medicare. Here’s an introduction to Part C:

• Part C plans are offered by private insurance companies approved by Medicare.

• Plans must cover everything included in Original Medicare (Part A and Part B).

• Most plans include prescription drug coverage (Part D).

• Many plans offer extra benefits like vision, dental, and hearing care.

• You generally must use in-network providers except in emergencies.

• Out-of-pocket costs are often lower than with Original Medicare.

• Monthly premiums vary by plan but are often $0-$100 range.

• You must continue paying your Part B premium if you enroll in Part C.

Medicare Advantage plans combine Part A, Part B, and usually Part D into a single plan. They can be a convenient, affordable option with built-in drug coverage and extras like dental cleanings or gym memberships.

What Medicare Supplement Plan G (Part G) Covers

Medigap Plan G is one of several standardized Medicare Supplement Insurance policies sold by private insurers. Here’s what defines a Plan G:

• It works alongside Original Medicare.

• Helps fill gaps in Parts A and B like deductibles and coinsurance.

• Does not cover drugs (you need to enroll in a separate Part D plan).

• Lets you see any provider who accepts Medicare nationwide.

• Average monthly premiums range from $100-$300 depending on your location.

• You must keep paying your Part B premium in addition to the Plan G premium.

• Offers standardized benefits no matter which insurer you buy from.

Plan G provides extensive supplemental coverage but lacks the prescription drug benefits of a Part C plan.

Key Differences Between Medicare Part C and Part G

While Parts C and G both offer additional coverage for Medicare costs, there are important differences:

• Part C offers bundled coverage including drugs and extras often for lower premiums, while Part G strictly supplements Parts A and B.

• Part G allows complete provider choice while Part C has network restrictions.

• Part G covers gaps in Original Medicare while Part C has generally lower out-of-pocket costs.

Should You Get Medicare Advantage (Part C) or Medigap Plan G?

There are advantages and disadvantages to both Medicare Part C and Plan G coverage:

Benefits of Medicare Advantage (Part C)

• Lower out-of-pocket costs for medical services
• Built-in prescription drug coverage
• Extra benefits like dental and vision
• $0 premium options available
• Single plan covers all Medicare benefits

Drawbacks of Medicare Advantage

• Provider networks limit doctor choice
• Plan rules and costs change yearly
• Services usually require prior authorization
• Most plans don’t cover care outside the U.S.

Benefits of Medigap Plan G

• Use any provider accepting Medicare nationwide
• Peace of mind from comprehensive coverage
• No networks or pre-approvals for services
• Standardized benefits don’t change annually
• Provides coverage for care outside the U.S.

Drawbacks of Medigap Plan G

• Does not cover prescription medications
• Must pay premium plus Part B monthly premium
• No coverage for routine dental, vision, or hearing care
• Out-of-pocket costs higher than Medicare Advantage

Which option is best depends on your personal situation:

• Medicare Advantage works well if you’re satisfied using network providers and appreciate the extra benefits and lower medical costs.

• Plan G is ideal if you want complete provider choice and standardized coverage that supplements Original Medicare.

Some important notes:

• You cannot enroll in Medigap and Medicare Advantage at the same time.

• Your out-of-pocket costs are generally higher with Plan G versus Advantage plans.

• It’s crucial to compare premiums, benefits, and network rules when choosing coverage.

Can You Have Both Part C and Part G?

Unfortunately, you cannot use Medigap and Medicare Advantage plans together because they serve the same purpose. Some key points:

• If you join a Medicare Advantage Plan (Part C), you cannot also get a Medigap policy.

• If you have a Medigap plan and join an Advantage Plan, you must drop the Medigap coverage.

• The plans cannot coordinate benefits since both are designed as primary coverage.

• You can switch freely between Medigap and Medicare Advantage only at certain designated times.

However, you can use other forms of supplemental coverage with either Part C or Part G, such as:

• Separate Medicare Part D plan
• Employer group health plan
• Medicaid benefits
• Military insurance (TRICARE)

So you can have additional coverage but just not two policies that both pay primary claims for Medicare costs.

When Can You Enroll in Part C or Part G?

Medicare has specific enrollment periods for signing up for Part C and Part G plans:

Medicare Advantage (Part C)

• Initial Enrollment Period – When you first enroll in Medicare at age 65.

• Medicare Open Enrollment Period – January 1 to March 31 each year.

• Medicare Advantage Open Enrollment Period – January 1 to March 31 each year.

Medigap (Plan G)

• Initial Enrollment Period – The 6 months around your Part B effective date when you turn 65.

• Annual Enrollment Period – January 1 to March 31 each year if you meet your state’s Medigap requirements.

It’s crucial to enroll at the earliest opportunity to avoid paying lifelong penalties or being denied certain Medigap plans later on due to underwriting requirements.

Frequently Asked Questions

Can I switch between Medicare Advantage and Medigap plans?

You can only change between Medicare Advantage and Medigap at certain designated times of year without underwriting or penalties. These include your Initial Enrollment Period when first eligible and Medicare’s Annual Enrollment Period from January 1 to March 31 each year.

Which offers better coverage – Medicare Advantage or Medigap Plan G?

Medicare Advantage typically has lower out-of-pocket costs when getting medical services, while Plan G has higher premiums but covers more gaps in Original Medicare. Choose Advantage for lower costs and extras like dental or Plan G for network flexibility.

Does Medicare Advantage or Plan G cover more?

Medicare Advantage covers everything that Original Medicare does, plus usually prescription drugs and extra benefits like limited dental and vision. Plan G strictly supplements Original Medicare costs only.

Can I enroll in Medicare Advantage with End Stage Renal Disease (ESRD)?

End Stage Renal Disease (ESRD) used to prohibit enrolling in Medicare Advantage but now there is generally no restriction. The main exception is you cannot join an Advantage Special Needs Plan designed specifically for people with ESRD.

Choose the Right Plan for Your Needs

While both Medicare Part C and Plan G provide supplemental coverage, they have key differences in their benefits, costs, and how they coordinate with Original Medicare. Carefully comparing all features allows you to select the type of Medicare plan that works best for your healthcare and budget needs.