Idaho Hi-Deductible Medigap Plan G
Idaho High Deductible Medigap Plan G premiums:
As of 7/19/2026:
G Hi-deductible premium: less than $78/month.
G less than $225/month.
N: less than $170/month.
Medigap Plan F Hi-deductible is also available at less than $78/month.
High Deductible Medigap plan G is ideal for Idaho residents who:
- Want long-term flexibility and a lower monthly premium (than Medigap Plan F, G, or N). Flexibility means all providers (physicians, hospitals, skilled nursing facilities, physical therapists, other medical professionals, etc.) in the US that ‘accept Medicare Insurance’ (98% non-pediatric do) are available to you.
- Referrals from your primary care physician are seldom needed.
- Prior authorizations are minimal AND you do not have an insurance company standing between you and your Medicare providers.
- This resource (on the Medicare.gov site) helps you find these resources anywhere in the US.
Additional information to consider!
- Read this report (Kaiser Family Foundation) to see how the author determined about 48% of the providers in the US are in the network of Medicare Advantage plans. This means 52% of providers that ‘accept Medicare’ (in the US) do not participate in Medicare Advantage plans. These are national averages and are not applicable to local markets.
- Are frustrated with the rules of Medicare Advantage networks, prior authorizations, or annual plan changes.
- Are tired of being included in the pool of Idaho Medicare Advantage plan members whose plan is either cancelled, merged into a different plan, or has noticeably premium and/or cost sharing increases.
- Want lower financial exposure than the MOOP found in Idaho Medicare Advantage plans. The2026 figures range between $3000 (the plan with this MOOP does not cover prescription medications) and $13,900.
- IF you were eligible before or enrolled in Medicare prior to 1/1/2020, Hi Deductible Medigap Plan F is your option. HD F operates in the same manner as HD G and often has the same premium (or slightly higher).
While most Original Medicare services covered by Part A and B have cost sharing these same services can vary by each Medicare Advantage plan and can change annually.
Medigap HD G may appeal to those who value certainty.
High-Deductible Medigap Plan G (HD G)— Simply Explained.
HD‑G is a Medigap plan that works with Original Medicare (Parts A and B).
- You pay Medicare cost-sharing until you reach the annual HD‑G deductible ($2,950 for 2026)…this figure is controlled by Medicare (not an insurance company) and goes up a bit annually.
- After the deductible is met, HD‑G pays 100% of covered Medicare costs for the rest of the year.
- All providers (doctors/hospitals/others) working in the USA AND ‘accept Medicare insurance’ is your network.
- Some specialists (Neurologists for example) may want a referral from the patients primary care physician.
- There are few prior authorizations when you stay with Original Medicare (are enrolled in Part A and B and do not enroll in a Medicare Advantage plan).
- Medicare’s cost sharing is defined here and apply to all choosing to remain with Original Medicare (enrolled in Part A and B and not enrolled in a Medicare Advantage plan); each Medicare Advantage plan contains their plan specific costs/rules/network parameters.
Think of HD‑G as a safety net. It has a clear limit on your annual costs for Medicare covered services (the plan’s deductible) and offers you the flexibility to use all providers in the USA that ‘accept Medicare insurance’.
How HD-G Works With the Deductible.
Each year, HD‑G has a single, defined deductible (set by Medicare).
- Once your cost sharing for Medicare covered services hits the deductible for the calendar year, all additional covered care is fully paid by the plan for the remainder of the year.
Coverage After the Deductible is met.
HD‑G covers exactly what standard Plan G cover. This includes:
- Medicare Part A hospital deductible.
- Hospital coinsurance and extended stays.
- Skilled nursing facility coinsurance.
- Medicare Part B coinsurance (20%).
- Excess charges (providers billing above Medicare rates).
- Foreign travel emergency coverage.
Coverage is nationwide, anywhere Medicare is accepted.
Please read the Medicare published document which describes Medigap plans. This is available here (Medicare.gov website).
High Deductible Medigap Plan G vs Standard Plan G.
|
Feature |
Standard Plan G |
HD‑G |
| Monthly premium | Higher ($200+) | Lower…less than $85/month |
| Out-of-pocket costs | Minimal (Medicare Part B Annual deductible) | Deductible is defined by Medicare, not an insurance company. |
| Risk management | First-dollar coverage (after Part B annual deductible is met). | Defined maximum exposure (HD-G deductible for the year). |
| Coverage | Medicare pays its share; Plan G pays your share. | Same as standard G once deductible met. |
If you think in terms of risk ceilings, not just monthly cash flow, we recommend HD-G.
HD‑G vs Medicare Advantage: Key Differences.
| Feature |
Medicare Advantage |
HD‑G |
| Premiums | Range from $0–$150+ (Depending on which Idaho County a person resides). | Moderate (less than $85 for residents in all Idaho Counties). Premium is set at the State (not County) level. |
| Deductible / MOOP | MOOP applies only after plan approves care. | One annual deductible; 100% coverage for Medicare covered services after deductible is met. |
| Networks | Restricted to providers insurance company invited and accepted their network offer; prior authorization often required for some services. Exceptions can apply for emergencies. | Any provider accepting Medicare. Prior authorizations minimal. |
| Benefit changes | Annual redesign possible | Medicare sets the foundation. Benefits stay stable year-to-year |
| Maximum cost to you. | HMO Medicare maximum plan limit: $9,250 limits; 2026 Idaho HMO plans range from: $3,000–$9,250; PPO Medicare limits: member limit use to ‘in-network providers’ maximum figure: $9,250; 2) if you use ‘out of network providers’ the maximum figure is; $13,900. | Defined deductible ($2,950 for 2026…defined by Medicare….not an insurance company); no surprises |
| Provider choice | Limited to defined network; if you have a PPO plan, your plan’s ‘Evidence of Coverage’ document is a must read for additional rules. Some hospitals do not accept Medicare Advantage plans unless they are defined as being in the plan’s network. | Full nationwide access, including top hospitals that ‘accept Medicare’. Think Mayo Clinics, Johns Hopkins Hospital, Stanford Health Care, top Cancer and Cardiology care, etc. |
Key takeaway: Medicare Advantage limits cost-sharing to the plan’s MOOP but can limit provider access; HD‑G limits total financial risk to the annual deductible (often noticeably lower than the MOOP of most Medicare Advantage plans, and does includes all providers in the US that accept Medicare insurance (98% of the non-pediatric physicians do).
Understanding the Deductible vs MA MOOP
The Medicare Advantage (MA) maximum out-of-pocket (MOOP) and the HD‑G deductible are different:
- MA MOOP: Only counts after the plan approves services and they are completed; when using an HMO plan, services are typically limited to the plan’s network; when using a PPO plan, ‘out of network’ services often cost more when compared to using ‘in-network providers’.
- HD‑G deductible: Automatically accumulates as Medicare covers delivered services; applies anywhere Medicare is accepted; very few prior approvals needed. When the deductible is met, the policy holder does not pay for anymore for Medicare covered services for the rest of the calendar year.
In practice:
- MOOP = “Maximum you could pay if the insurance company offering your plan agrees to cover all your care”.
- HD‑G deductible = “Maximum you will pay as long as Medicare covers the care”.
HD‑G offers unrestricted access to any provider that accepts Medicare.
This opens the door to:
- Mayo Clinic
- Cleveland Clinic
- Johns Hopkins Medicine
- Mass General Hospital
- Stanford Health Care
- and other top hospitals in the US.
Why this matters:
- Many MA plans restrict access (by having defined networks the plan member can use) and/or require prior authorization.
- The top 250 hospitals in the US may not be available to the Medicare Advantage member because of network rules or the reluctance of these facilities to ‘accept Medicare Advantage plans’. An example of this is here.
- If you travel or live in multiple states, unrestricted access ensures you can see top specialists wherever you are. Some Medicare Advantage plans may have a similar feature. Be sure and check to see if the plan limits the amount of money you can spend on care AND how much more it will cost you when you are ‘out of network’.
HD‑G lets you choose providers based on quality and fit, not plan networks.
What this means for your decision:
- Popularity alone doesn’t equal the best choice for everyone.
- MA plans often offer lower visible premiums, but network restrictions, prior authorizations, and annual plan changes can create challenges when care is actually needed. Examples include one Idaho insurance company terminated over 70,000 policies effective 12/31/2025; other Companies offering Idaho plans are not offering all of the plans they did in 2025; residents of other Idaho Counties were left with fewer plan choices in 2026; and, 2 other insurance companies (Regence Blue Shield of Idaho and Select Health) left the Idaho Medicare Advantage plan market on 12/31/2025. Idaho residents affected by this change had to find new health insurance for 2026.
- HD‑G offers stable coverage, nationwide provider access, and a defined annual risk, which may be more valuable for people seeking autonomy and certainty.
Who Matches Up With HD‑G.
- Idaho residents who understand the benefits of staying with Original Medicare (Part A and B), the value added HD-G offers, and the financial side of this plan meets their budget.
- People who want local as well as nationwide provider access and freedom to see top hospitals
- Those frustrated with MA networks, prior authorization requirements, and plans which can change annually.
Who May Not Be Right For HD‑G.
- People preferring a $0/low monthly plan premium and are comfortable with the financial exposure which comes with the plan’s MOOP (these can be as high as $13,900).
- Residents comfortable with the skills/resources found in the MA plan’s network.
- Individuals who qualify for Medicaid or need substantial cost-sharing assistance.
- People who want bundled extras (dental, vision, OTC benefits, etc.). We encourage people interested in MA plans with dental and/or vision coverage to read their plan’s Evidence of Coverage to learn the details of the plans coverage, exclusions, exceptions, and other limitations.
Switching to HD‑G.
- New to Medicare: Enroll in this plan within 6-months of your Medicare Part B effective date to skip underwriting. Enrollment past this date means answering the health history questions on the application. Based on these answers, prescription medications a person takes, and other health history are used by the insurance company to determine if they will accept or deny the application.
- Leaving Medicare Advantage: Idaho requires underwriting unless the person has a ‘guaranteed issue’ or ‘special enrollment period. Some exceptions apply.
- Switching from another Medigap plan: Review Idaho’s rules here.
Professional guidance is recommended for transitions.
Call us if you have questions.
What about High Deductible Medigap Plan F (HD F)?
It is still available to interested Idaho residents, provided they enrolled (or was eligible for Medicare) prior to 1/1/2020.
Why the change?
The Medicare Access and CHIP Reauthorization Act of 2015 states that insurers can no longer sell Medigap Plan F, High Deductible F and Plan C to people new to Medicare on/after 1/1/2020. Individuals already enrolled in these plans could keep them.
What was the concern with these plans? They covered the Medicare Part B annual deductible.
What is the difference between High Deductible Plan G and High Deductible Plan F?
They are the same with one exception. The HD G does not cover the Part B annual deductible. This figure is $283 for 2026.
Call us if you have questions about the above.
The Long-Term Perspective.
HD G is quiet, rational, and durable.
It’s designed to:
- Stay out of your way
- Work the same way year after year
- Protect you when something serious happens
- Let you choose providers based on quality, not contracts.
Bottom Line
High Deductible Plan G is not about paying the lowest monthly premium. It’s about:
- Knowing your maximum risk
- The flexibility to access top hospitals nationwide when you need this level of service
- Avoiding network restrictions and prior authorization
- Maintaining stability over time.
Call us with your questions.
We have been helping Idaho residents with Medigap plans since 2012.
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