Medicare Plan G in Wake County costs between $150 and $220 per month for a 65-year-old in 2026, depending on carrier, gender, and tobacco status. On top of that you pay the $202.90 Part B premium and a $283 annual Part B deductible — the only gap Plan G does not cover. Your total monthly cost for Original Medicare + Plan G + a standalone Part D plan typically runs $380–$470. Whether that beats a $0-premium Medicare Advantage plan depends entirely on your Wake County doctors, your medications, and how much out-of-pocket risk you can tolerate. For your specific situation in Wake County, call Rob Simm at (828) 761-3326 — free, no obligation.

What Wake County families ask

What are Wake County residents getting wrong about Plan G?

These are the four questions I hear most from Raleigh, Cary, Apex, and Wake Forest residents comparing Plan G to Medicare Advantage.

Why does Plan G cost $150 from one carrier and $220 from another?

Every Plan G covers the same benefits — the difference is the carrier’s pricing model (attained-age vs. issue-age), their claims experience in Wake County, and household discounts. Comparing at least three carriers can save $40–$60/month for identical coverage.

Do I still need a Part D drug plan with Plan G?

Yes. Plan G covers Medicare cost-sharing gaps, not prescriptions. You need a separate Part D plan. Skipping Part D means a 1% penalty on the $37.20 national base premium for every month you delay — and that penalty is permanent.

Can I switch to Plan G later if I pick Medicare Advantage now?

You can apply, but outside your 6-month Medigap open enrollment window, NC carriers can medically underwrite you. A new health condition can mean denial or premiums 30–50% higher. This is the single most expensive mistake I prevent in Wake County.

Is Plan G worth it if I’m healthy and rarely see a doctor?

If you’re healthy, a $0-premium MA plan may cost less month-to-month. But one ER visit or surgery can cost up to $9,350 on MA vs. $283 on Plan G. The right answer depends on whether you want predictable bills or lower premiums while healthy.

⚠️ Your Medigap window closes 6 months after you turn 65

Once you turn 65 and enroll in Part B, you have exactly 6 months to buy any Medigap plan — including Plan G — with no medical underwriting. Miss that window and NC insurers can deny you coverage or charge dramatically more based on health conditions you develop later. Even if you choose Medicare Advantage now, understand that the Plan G door closes on a fixed date.

The difference

What does a broker add when comparing Plan G in Wake County?

What do you need to know?	Medicare.gov	Rob Simm — NC #10447418
Plan G quotes	Lists carriers and estimated premiums — no side-by-side comparison by your age, zip, and tobacco status	Run quotes from every NC Medigap carrier for your exact profile in one call
Wake County network context	Not applicable — Plan G works with any provider who takes Medicare	I verify which Wake County specialists accept Medicare assignment, avoiding excess charges Plan G doesn’t cover
Part D pairing	Separate tool — you compare drug plans on your own after choosing Medigap	I match your medications to the lowest-cost Part D plan alongside your Plan G quote
Medigap vs. MA comparison	Two separate systems — no unified comparison	I run both paths side by side with your actual doctors and drugs to show total annual cost
Underwriting guidance	No guidance on health questions or timing strategy	I know which NC carriers are most favorable for specific conditions and when to apply
Cost	$0 (just your time and risk of choosing wrong)	$0 — paid by the carrier, same premium either way

2026 Medicare numbers

What are the key 2026 numbers Wake County residents need to know?

$202.90

Part B premium per month

2026 standard rate. Higher with IRMAA surcharge based on income above $106,000.

$283

Part B annual deductible

The only gap Plan G does not cover. You pay this once per year before Medicare covers 80% of outpatient care.

$9,350

MA in-network out-of-pocket max

2026 cap on in-network Medicare Advantage spending. Plan G has no equivalent cap because cost-sharing is already covered.

$2,100

Part D out-of-pocket cap

No catastrophic Rx costs in 2026. Insulin capped at $35/month. You need a standalone Part D plan with Plan G.

💡 Broker Tip — Wake County

Many Wake County residents fixate on Plan G’s monthly premium and forget the total cost picture. Add your Part B premium ($202.90), your Plan G premium ($150–$220), and a Part D plan ($0–$50) — then compare that total to a $0-premium MA plan plus its copays, coinsurance, and $9,350 worst-case. For a healthy 65-year-old in Raleigh who sees 2–3 specialists at UNC REX or WakeMed, I often find Plan G costs $1,200–$2,400 more per year in premiums but eliminates $5,000–$9,000 in potential out-of-pocket exposure. The math changes for every person — which is why I run both paths side by side before you choose.

— Rob Simm, Licensed Medicare Broker, NC #10447418

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Rob Simm · Licensed NC Medicare Broker · NPN #10447418

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Real scenario · Wake County

What does a Wake County retiree actually pay in a bad year?

Medicare Advantage — worst case

$9,350

$0/month premium sounds great — until a hip replacement at WakeMed triggers copays, coinsurance, and the full $9,350 in-network out-of-pocket max. Plus you need a referral for every specialist on an HMO.

Plan G — worst case

$283

Same hip replacement, same hospital. Your out-of-pocket cost is the $283 Part B deductible — and nothing else. Plan G covers the remaining 20% coinsurance, the $1,736 Part A deductible, and skilled nursing. No referrals, no network restrictions.

It pays to talk to the right broker

Does it matter which carrier I buy Plan G from?

It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.

Common questions

Frequently asked questions

Does Plan G cost the same in every part of Wake County?

Plan G benefits are identical everywhere, but premiums vary by zip code, carrier, age, gender, and tobacco status. A 65-year-old in Cary and a 65-year-old in Wake Forest will see different quotes from the same carrier. Always compare at least three carriers using your actual zip code.

How do I verify a Medicare agent is licensed in North Carolina?

Go to sbs.naic.org/solar-external-lookup, select North Carolina, and search by name. Robert Simm’s NC license number is #10447418.

Is there a fee to talk to a Medicare broker about Plan G?

No. Brokers are paid by the insurance carrier when you enroll, and the commission is the same whether you enroll directly, through Medicare.gov, or through a broker. There is no markup on your premium.

Can I switch from Medicare Advantage to Plan G later?

You can apply, but outside your 6-month Medigap open enrollment window, NC carriers can medically underwrite you. That means they can deny coverage or charge higher premiums based on health conditions. This is why the timing of your initial decision matters so much. Call (828) 761-3326 before your window closes.

What happens after I call?

A 10-minute conversation to understand your doctors, medications, and budget. No pressure, no SSN required, no commitment to enroll. You can call (828) 761-3326 or book at calendly.com/robert-generationhealth/new-meeting.

Related Medicare guides

Medicare Enrollment in NC – 2026 Guide Extra Help/LIS Eligibility NC 2026 Compare Medicare Advantage Plans in NC Extra Help / LIS in NC – 2026 Eligibility Guide Working Past 65 – Medicare Enrollment Special Enrollment Periods in NC Cheap Health Insurance Without Employer Coverage Free Medicare Quotes Online

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Robert Simm

Licensed Independent Medicare Broker

Helping NC families navigate Medicare since 2014. Independent — I work with all carriers and get paid the same regardless of which plan you choose. I verify provider networks with Duke Health and WakeMed directly and answer my own phone the next year when something changes.

📞 (828) 761-3326 📋 NC #10447418 🏥 AHIP Certified ⭐ 5.0 · 20+ reviews 📍 2731 Meridian Pkwy, Durham NC 27713 🕐 Mon–Fri 9am–7pm ET

Last Updated: 2026-05-03 | Reviewed By: Robert Simm, Licensed Medicare Broker, NC #10447418 | Next Review: October 2026

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for information on all of your options. GenerationHealth.me and Robert Simm are independent agents not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent may contact you. Information on this page is for educational purposes only and should not be considered legal or financial advice. Plan availability, premiums, and benefits vary by location and carrier. © 2026 GenerationHealth.me