Medicare Supplement Plan G

What is Medicare Supplement Plan G?

Medicare Supplement Plan G, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare.

You may choose to purchase a Medicare supplement Plan G from a private insurance company or enroll in the Premera Blue Cross Medicare Supplement Plan G that the PEBB Program offers, if eligible for PEBB retiree coverage.

In Medicare Supplement Plan G, benefits such as vision, hearing exams, and routine physical exams may have limited coverage or may not be covered at all.

If you select Medicare Supplement Plan G, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic.

Medicare Supplement Plan G does not include prescription drug coverage. If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage (e.g., VA benefits).

How do I enroll?

You will be able to enroll in Plan G during the PEBB Program's annual open enrollment November 1 through 30, 2019. Forms and other enrollment information will be available on November 1.

How do I find a provider?

Visit Premera's online provider directory. Medicare Supplement Plan G allows the use of any Medicare contracted physician or hospital nationwide.

Is there a quick way to see benefits and costs?

Outline of coverage

2020

Summaries of benefits and coverage are not available for Medicare supplement plans. For PEBB Program Medicare plan summaries, see the medical benefits comparison tool.

What are the monthly plan costs?

2020

Note: The Medicare premiums listed below are reduced by the state-funded contribution, up to the lesser of $183 or 50 percent of the plan rate per retiree per month.

 

Plan G Retired
(age 65 or older, eligible by age)

Plan G
(Under age 65, eligible by disability)

Subscriber only

$97.56

$162.31

Subscriber and spouse1
(1 Medicare eligible)2

$722.22

$836.97

Subscriber and spouse1
(2 Medicare eligible - 1 retired, 1 disabled)

$254.81

$254.81

Subscriber and spouse1
(2 Medicare eligible)

$190.06

$319.56

Subscriber and child(ren)
(1 Medicare eligible)2

$603.55

$668.30

Subscriber, spouse1, and child(ren)
(1 Medicare eligible)2

$1,278.21

$1,342.96

Subscriber, spouse1, and child(ren)
(2 Medicare eligible - 1 retired, 1 disabled)2

$761.55

$761.55

Subscriber, spouse1, and child(ren)
(2 Medicare eligible)2

$696.05

$825.55

 

Plan G Retired
(age 65 or older, eligible by age)

Plan G
(Under age 65, eligible by disability)

Subscriber only

$185.00

 

$314.50

 

Subscriber and spouse1
(1 Medicare eligible)2

 

$864.72

 

$994.22

 

Subscriber and spouse1
(2 Medicare eligible - 1 retired, 1 disabled)

$499.50

 

$499.50

 

Subscriber and spouse1
(2 Medicare eligible)

$370.00

 

$629.00

 

Subscriber and child(ren)
(1 Medicare eligible)2

$696.05

 

$825.55

 

Subscriber, spouse1, and child(ren)
(1 Medicare eligible)2

$1,370.71

 

$1,500.21

 

Subscriber, spouse1, and child(ren)
(2 Medicare eligible - 1 retired, 1 disabled)2

$1,010.55

 

$1,010.55

 

Subscriber, spouse1, and child(ren)
(2 Medicare eligible)2

$881.05

 

$1,140.05

 

1Or state-registered domestic partner

2If a Medicare supplement plan is selected, non-Medicare enrollees are enrolled in UMP Classic. The rates show reflect the total due, including premiums for both plans. 

Do I live in the medical plan's service area?

Medicare Supplement Plan G is available in all Washington State counties and nationwide.

Contact

Premera Blue Cross
Online: Premera website (general information, not PEBB specific)
Phone: 1-800-817-3049
TTY: 1-800-842-5357