Key takeaways:
Any U.S. citizen or permanent resident who was eligible for Medicare prior to 2020 is eligible to apply for a Medicare Supplement Plan F, Plan F-HD or Plan C.
Medicare beneficiaries new to Medicare as of January 01, 2020 cannot apply for Medicare supplement Plans F, Plan F-HD or Plan C.
In most states, an applicant for Medigap Plan F must qualify medically to be accepted unless the applicant qualifies for a guarantee issue.
The most popular Medicare supplement for people new to Medicare is currently Plan G, followed by Medicare Plan N in second place.
What is Medicare Supplement Insurance?
Medicare Supplement insurance, also known as Medigap, is health insurance offered by private insurance companies and designed to work hand-in-glove with Medicare to offset your medical expenses.
A Medicare supplement insurance plan helps fill in the coverage gaps left by Original Medicare (Medicare Part A and Medicare Part B). Medicare Supplement insurance plans are designed to cover out-of-pocket costs such as deductibles, coinsurance and hospital costs, and copayments that beneficiaries would otherwise have to pay with Original Medicare.
You must have original Medicare coverage, Medicare Part A and Medicare Part B to be eligible for a Medicare Supplement policy. When you have a Medigap Plan, Medicare pays its share of the approved amount for covered health care costs and Medicare-covered services. Then Medicare instructs the Medigap policy to pay its share.
With most insurance companies, a Medigap policy will pay 85% or more of claims within 48-hours, without human intervention.
Medicare Supplement insurance plans provide standardized benefits and are labeled with letters (Plan A, Plan B, Plan C, etc.). Each Medicare plan of the same letter offers the same basic benefits, regardless of the insurance company administering the plan.
None of the Medicare supplement plans include a Part D prescription drug plan. The Medicare beneficiary must purchase a separate stand-alone Part D prescription drug plan. Stand-alone prescription drug plans have additional monthly premiums.
With Medicare Supplement, you have the freedom to choose any healthcare provider who accepts Medicare patients. There are no network restrictions, allowing you to receive care from any doctor or hospital that accepts Medicare, for services Medicare covers.
With this Medicare plan, no prior authorizations for non-urgent medical services or procedures are required. As such, there will be no delays or complications when you need to see a doctor fast.
Why should I purchase Medicare Plan F?
Medigap Plan F is widely regarded as the most comprehensive coverage option among other Medicare Supplement plans. With a Medicare supplement Plan F, a Medicare beneficiary will have zero cost for Medicare inpatient and outpatient care. Between Medicare and Plan F, everything is paid for.
Who Can Get a Medicare Supplement Plan F?
Effective January 1, 2020, individuals who are newly eligible for Medicare are not able to enroll in Medicare Supplement Plan F, Plan F-HD or Plan C. Existing Medicare beneficiaries who already have Plan F can keep their coverage and continue to receive its benefits. This change was made as part of the Medicare Access and CHIP Reauthorization Act (MACRA).
However, if you were eligible for Medicare before January 1, 2020, you will still be able to apply for these Medicare supplement plans. This is true even if you have never has a Medicare supplement or did not enroll in Medicare until 2020 or after.
Unless you qualify for a guarantee issue Medicare supplement, the Medicare beneficiary would be required to qualify medically to be approved for a supplement plan.
Is Plan F Still A Guarantee Issue Medigap Plan?
Medicare supplement Plan F, F-HD and Plan C are the guarantee issue
plans only for Medicare beneficiaries who qualified for Medicare plans prior to January 2020 and also qualify for a guarantee issue supplement plan.
Medigap guaranteed issue rights are situations where insurance companies that offer Medicare Supplement plans are required to offer you a policy regardless of your health status, and they cannot charge you higher premiums based on your health conditions.
Losing Medicare Advantage Plan coverage is one way to qualify for a guarantee issue supplement. You can take a look at pages 22 and 23 of Choosing a Medigap Policy for further details on guarantee issue rights.
Why Was Medicare Supplement Plan F Discontinued?
All Medigap plans that pay the Medicare Part B deductible were phased out as part of the Medicare Access and CHIP Reauthorization Act (MACRA) passed by Congress in 2015.
Medicare Plan F and Plan C both pay the annual Medicare Part B deductible. Because of this, Medicare beneficiaries with either of these supplement plans have “first dollar coverage”. It means they can see a doctor with no out-of-pocket expense for Medicare approved services. There is no annual deductible for them to overcome.
In a study done for Congress in 2012, it was found that when a person can see a doctor with no out-of-pocket costs, they tend to have multiple unnecessary visits during the year and abuse their Medicare benefits and health care services. This was a financial burden on Medicare, easily relieved by phasing out these plans.
All Medicare supplement plans currently available to those who are new to Medicare do not cover the annual Medicare Part B deductible.
With the discontinuation of Medicare Plan F, Plan G has gained popularity as a comparable alternative. Plan G offers full coverage similar to Plan F, except for the Medicare Part B deductible. Many beneficiaries find Plan G to be a cost-effective option that provides substantial coverage while requiring them to pay the Part B deductible themselves.
What Does Medicare Supplement Plan F Cover?
Medicare Plan F offers the most comprehensive coverage of any Medicare supplement plan.
Plan F pays all the deductibles, copays and coinsurance that Original Medicare leaves as your financial responsibility. Put simply, a person with Original Medicare Part A and Part B plus a Plan F will have no out-of-pocket expenses for any inpatient or outpatient Medicare services.
These benefits are the same no matter which insurance company administers the supplement plan.
What Is Not Covered by Medicare Supplement Plan F?
If a medical service or procedure is not covered by Medicare Part A or Part B, it will not be covered by a Medicare supplement.
Here are some examples of what is not covered by Medigap Plan F (or any other Medigap plan):
Medicare Part D Prescription Drugs
Medigap Plan F does not include coverage for prescription drugs. To obtain prescription drug coverage, beneficiaries need to enroll in a stand-alone Medicare Part D prescription drug plan.
Dental, Vision, and Hearing Care
Routine dental care, eye exams, eyeglasses, hearing aids, and related services are not covered by Medigap Plan F. Separate insurance plans are available for these services.
Long-Term Care
Medigap Plan F does not cover long-term care services, such as nursing home care or assisted living facility costs.
Private Duty Nursing
Medigap Plan F does not cover the cost of private-duty nursing services, which refers to round-the-clock nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN).
Foreign Travel Emergency coverage
Medigap Plan F does provide coverage for emergency medical care during foreign travel up to plan limits. However, it does not cover routine or non-emergency care received outside the United States.
How much does Medicare Supplement Plan F cost?
The monthly premium for Plan F typically ranges from $115 to $250, depending on various factors such as the insurance company, your age, gender, location, tobacco usage, and, in certain cases, height and weight. Contact us for a free quote or to talk with a Medicare expert.
Will Medicare Supplement Plan F monthly premium increase soon?
If you’re eligible for Plan F or considering enrolling in it, it’s important to be aware of potential future implications. Plan F’s limited enrollment may lead to higher premiums over time, as insurance plans depend on new, younger, and healthier members to balance costs. Similar trends have been observed with closed Medigap plans, where premiums increased over time.
While the exact outcome is uncertain, it’s generally expected that Medicare Plan F’s premium increases may be higher than other Medigap plans. See below for how to compare Plan F to Plan G.
What is a High-Deductible Plan F?
A High Deductible Plan F (Plan F-HD or Plan G-HD) is a type of Medicare Supplement (Medigap) plan with a high deductible. The deductible is an amount you must pay toward Medicare bills before the plan pays any benefits.
Once the deductible is met, a high deductible Plan F offers the same full coverage as a regular Plan F, including coinsurance, hospital costs, skilled nursing facility care, and hospice care.
High deductible Plan F is a suitable option for those seeking lower monthly premium costs but willing to pay a higher deductible before the plan coverage provides any benefit.
The availability of Plan F-HD may vary among insurance companies, so make sure to check if this Medicare plan is offered in your area.
No Inflation Protection
In addition, the deductible for these supplement plans increases each year with inflation. In most states the premium also increases each year. This means you may pay more every year for less and less coverage.
When should I enroll in Medicare Plan F?
A Medicare beneficiary can enroll in or change Medicare supplements any day of the year, 365-days per year. Of course, you may be required to qualify for the plan based on your health history (medical underwriting). Unless there is a guarantee issue situation, the private health insurance companies can deny your application. Contact Us to speak with a Medicare expert. We love advising on Medicare.
Which Supplement Is The Best Alternative to Medicare Plan F?
The best alternative to Medigap Plan F is often considered to be Medicare Supplement insurance Plan G.
Medigap Plan G is identical to Plan F except that with Plan G the Medicare beneficiary will pay the annual Part B deductible, which is currently under $250. The Part B deductible is only paid when a person receives outpatient Medicare services.
Medicare Supplement Plan F vs. Plan G
The easiest way to ascertain which Medicare supplement insurance plan is the better value is to simply subtract the annual premium cost of Plan G from the annual cost of Plan F. If the difference is greater than the Medicare Part B deductible, then Plan G is a better value of the two Medicare plans.
For example, let’s say that Plan G has a monthly premium of $125, and Plan F has a monthly premium of $150. The annual cost of Plan G would be $125 x 12 = $1,500. The annual cost of Plan F would be $150x 12 = $1,800.
The difference in cost is $1,800 – $1,500 = $300. But the difference in benefit is the Part B deductible of $226. This means that if you purchase a Plan F you will pay $300 for a $226 benefit. That is not a good decision.
Looking for a Medicare agent expert advisor? Our award-winning team is on a mission to help you save on medical expenses while having the best coverage possible. Let us help you find the best Medicare supplement plan!
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
