Medigap Plan G Out-of-Pocket Costs

What You Pay With Plan G

Medigap Plan G has become the standard supplement for anyone who enrolled in Medicare Part B after January 1, 2020. Its appeal is simplicity: Plan G covers essentially all of Medicare's cost-sharing gaps except one line item—the annual Part B deductible.

In 2026, your parent's out-of-pocket medical costs under Plan G break down to:

• $283/year — the Part B deductible (the only gap Plan G doesn't cover)
• $0 — Part A hospital deductible ($1,736 per benefit period, fully covered by Plan G)
• $0 — Part B coinsurance (the 20% on outpatient services, fully covered)
• $0 — SNF coinsurance ($217/day for days 21–100, fully covered)
• $0 — Part A hospital coinsurance for extended stays (days 61–90 and lifetime reserve days, fully covered)
• $0 — Part B excess charges (covered by Plan G but not by Plan N)
• $0 — Foreign travel emergency care (covered up to $50,000 lifetime, with a $250 deductible and 80/20 split)

That's it. After the $283 Part B deductible, your parent pays nothing further for any Medicare-covered medical service, regardless of how many hospitalizations, specialist visits, surgeries, or emergency room trips they have in a year. No copays at the point of care. No coinsurance. No maximum out-of-pocket threshold to worry about because the exposure is already capped at $283.

The Premium Is the Remaining Variable

Plan G premiums vary by carrier, state, age, gender, tobacco use, and pricing model. National averages in 2026 range from roughly $120–$250/month depending on these factors, but specific quotes in your parent's zip code can fall outside that range.

The pricing model matters enormously over time. Community-rated plans charge the same premium regardless of age—mandated in eight states (AR, CT, MA, ME, MN, NY, VT, WA). Issue-age-rated plans set the premium at purchase age and only increase with inflation. Attained-age-rated plans start low and automatically increase as your parent ages, compounding into significantly higher premiums at 80 and beyond.

For a parent buying at 65, the initial premium difference between pricing models can be modest. Over 20 years, attained-age rating can cost tens of thousands more than community or issue-age rating for the exact same coverage.

The Full Annual Cost Calculation

To get the true annual cost of the Plan G path, add all three components:

The worst-case scenario for Plan G—a year with heavy medical use and maximum drug costs—is roughly $7,000. That's fixed and predictable, regardless of whether your parent has zero hospitalizations or five.

How That Compares to Medicare Advantage

Medicare Advantage plans advertise $0 monthly premiums and bundled drug coverage. The total cost looks lower—until a health event drives up cost-sharing.

Under Medicare Advantage, the maximum out-of-pocket limit is $9,250 in-network in 2026 (individual plans often set lower caps between $4,000–$6,000). Add the Part B premium ($2,434.80 annually—everyone pays this regardless of plan type) and any Part D drug costs, and the worst-case annual cost under MA can exceed $11,000 depending on the plan's specific cost-sharing schedule.

For a healthy year with minimal utilization, Medicare Advantage costs less—possibly just the Part B premium and small copays. For a year with a hospitalization, skilled nursing stay, or cancer treatment, Plan G's fixed cost structure becomes substantially cheaper.

The break-even point depends on your parent's expected utilization. Families managing chronic conditions, facing likely hospitalizations, or prioritizing cost predictability almost always come out ahead with Plan G. Families with healthy parents who tolerate network restrictions and prior authorization may pay less with Medicare Advantage—until their health changes.

Our Medigap vs Medicare Advantage guide includes a cost comparison worksheet that calculates the break-even point for your parent's specific situation, factoring in local Plan G premiums, Part D costs, and projected healthcare utilization.

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