Key takeaways:
Any U.S. citizen or permanent resident who was eligible for Medicare prior to 2020 is eligible to apply for a 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.
Medigap Seminars Insurance Agency Reviews.
What is Medicare Supplement Insurance?
Consulting a licensed insurance agent about Medicare Supplement insurance, commonly referred to as Medigap, is a valuable step, as it is a form of private health insurance that complements the federal Medicare program by addressing the gaps left by Original Medicare (Part A and Part B). This type of insurance is specifically designed to help cover various costs that Medicare beneficiaries would otherwise have to pay out of pocket, such as deductibles, copayments, and coinsurance. By reducing these out-of-pocket expenses, Medigap policies provide financial relief to those enrolled in Medicare.
Medicare Supplement insurance are offered by private insurance companies and are standardized in most states, meaning that the benefits for each plan type are consistent regardless of the insurer. However, the cost of these plans can vary based on factors such as age, location, and tobacco use, which should be evaluated in relation to available medicare benefits . It’s important to note that while Medigap plans offer substantial coverage for many Medicare-covered services, they do not include prescription drug coverage. Beneficiaries seeking prescription drug benefits will need to enroll in a separate Medicare Part D plan.
In addition to helping with hospital costs and other Medicare-approved expenses, In addition to helping with hospital costs and other Medicare-approved expenses, Medicare Supplement policies can also offer benefits that Original Medicare doesn’t cover, such as emergency care during foreign travel and coverage for durable medical equipment. This makes Medigap a valuable option for individuals seeking comprehensive coverage and peace of mind when it comes to managing their healthcare costs. To enroll in a Medigap plan, individuals must be eligible for Medicare and typically apply during their initial enrollment period to avoid medical underwriting.
What is Medicare Supplement Plan F?
Often referred to as Medigap Plan F, is recognized as the most comprehensive Medigap plan available to Medicare beneficiaries. It is designed to cover nearly all out-of-pocket costs associated with Medicare-approved services, providing extensive financial protection and peace of mind. Plan F includes core benefits that cover hospital stays and protect against unexpected costs when Medicare benefits are exhausted. Plan F covers a wide range of expenses, including:
Medicare Part A Deductible: This deductible can be a significant cost for hospital stays, but Plan F ensures that beneficiaries do not have to worry about this expense.
Medicare Part B Deductible: By covering this deductible, Plan F eliminates the need for beneficiaries to pay out-of-pocket before Part B services are covered.
Part A and B Coinsurance and Copayments: Plan F takes care of coinsurance and copayments for both hospital and medical services, ensuring that beneficiaries have minimal out-of-pocket costs.
Excess Charges: Some healthcare providers charge more than the Medicare-approved amount, resulting in excess charges. Plan F covers these additional costs, providing broad protection.
Skilled Nursing Facility Care Coinsurance: Beneficiaries who require skilled nursing care can rely on Plan F to cover the coinsurance costs, easing the financial burden.
Foreign Travel Emergency Coverage: For those who travel abroad, Plan F offers emergency coverage for medical services needed during foreign travel, adding an extra layer of security.
With Plan F, many Medicare beneficiaries experience zero out-of-pocket costs for services approved by Medicare. Plan F covers Medicare cost-sharing aspects such as deductibles, copays, and coinsurance, providing comprehensive coverage for eligible individuals. This extensive coverage makes it an attractive option for those seeking the most comprehensive Medigap plan available, ensuring that they are protected against unexpected health care costs and can focus on their health and well-being without financial stress.
Who is Eligible for Plan F?
Plan F is an option available exclusively to individuals who were eligible for Medicare before January 1, 2020. This means that if you became eligible for Medicare on or after that date, you will not be able to enroll in Plan F. However, those who were eligible before 2020 but did not initially enroll may still have the opportunity to apply for Plan F. To do so, they must either meet specific medical underwriting requirements or qualify for guaranteed issue rights.
Changing to a different Medigap policy typically requires answering health questions, which can influence the premium amount based on the beneficiary’s specific health status.
Guaranteed issue rights are typically granted in certain situations, such as when a beneficiary loses other health coverage or if their Medicare Advantage plan ceases to operate in their area.
Why Was Plan F Discontinued for New Enrollees?
The discontinuation of Plan F for new enrollees was a result of legislative changes under the Medicare Access and CHIP Reauthorization Act (MACRA), which took effect in January 2020. The primary goal of phasing out Plan F (along with Plan C) was to address concerns about “first dollar” coverage. These plans were known for covering the Medicare Part B deductible, which meant beneficiaries had no out-of-pocket expenses from the start.
This comprehensive coverage led to concerns about increased utilization of healthcare services, as beneficiaries had no initial costs to consider. By eliminating this aspect of coverage for new enrollees, policymakers aimed to encourage more prudent use of healthcare services and help control overall healthcare spending. Despite its phase-out, Plan F remains a popular choice among those who are grandfathered in, due to its extensive coverage and the financial peace of mind it offers.
What Does Medigap Plan F Cover?
Medicare Plan F offers the same benefits and 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, including medicare deductibles. A benefit period starts upon inpatient admission and concludes after a 60-day period of absence from the hospital or skilled care facilities.
These benefits are the same no matter which insurance company administers the supplement plan.
Compare Medigap Plans
Footnotes & Legend
- ✓ Covered. ✕ Not covered. Percentages show how much the plan pays.
- * High-deductible versions may be available for Plans F and G.
- ** Out-of-pocket limits apply only to Plans K and L.
- *** Plan N pays Part B coinsurance except: up to $20 office visit & up to $50 ER if not admitted.
NA – Not Applicable
= 100% payment for Medicare services.
X = Not Included.
*Plans F & G offer a high-deductible plan option.
**Plans K & L show how much they pay for approved services before you meet your out-of-pocket yearly limit. After you meet the maximum out of pocket limit, the plan will pay 100% of your costs for approved services for the remainder of the calendar year.
***Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits. Copayments are up to $20 per office visit and up to $50 for an emergency room visit when not admitted as an inpatient.
Note: Plan C & Plan F are only available if you were eligible for Medicare prior to January 01, 2020. You can apply for Plan F or Plan C if you were eligible for Medicare prior to January 1, 2020, even if not yet enrolled.
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, which could lead to denied coverage.
Plan F works alongside Medicare coverage by covering additional costs for services Medicare approves, ensuring minimal out-of-pocket expenses for beneficiaries. This includes financial responsibilities such as copayments, coinsurance, and deductibles, providing comprehensive coverage.
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, but it does provide valuable hospital benefits .
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 Plan F Cost?
Monthly premiums range from $115 to $250 depending on age, location, tobacco use, gender, and insurer. Plan F premiums may increase faster than other plans due to the lack of new enrollees joining the risk pool.
Some insurance companies offer premium discounts to attract potential customers, which can help reduce the overall cost of Plan F.
Will Plan F Premiums Increase?
Yes, because Plan F is closed to new enrollees, the average age of beneficiaries is rising, which typically leads to higher claims and higher premiums over time. It’s wise to compare the annual cost with other Medigap plans.
High-Deductible Plan F (Plan F-HD)
High-Deductible Plan F, often referred to as Plan F-HD, offers the same comprehensive benefits as the standard Plan F but requires beneficiaries to meet a higher annual deductible before coverage begins. For 2025, the deductible is $2,800. Once this amount is met, Plan F-HD covers the full range of Medigap benefits, including Medicare Part A and B deductibles, coinsurance, and excess charges. Beneficiaries must pay the full cost of Medicare-approved services out-of-pocket until they reach the deductible, making it essential to understand the potential financial responsibility involved.
Plan F-HD is especially appealing to healthy individuals who anticipate minimal medical expenses and are looking to lower their monthly premiums while maintaining robust coverage. The key advantage is its significantly lower premium compared to standard Plan F, which can result in substantial savings for those who rarely need care. However, since the deductible is tied to the Consumer Price Index for Urban Consumers (CPI-U), it may increase annually with inflation, potentially impacting long-term affordability. It’s also important to note that Plan F and its high-deductible version are not available to individuals who became eligible for Medicare on or after January 1, 2020. Additionally, availability of Plan F-HD varies by insurer and location, so checking with local providers is essential when evaluating your options.
When Can You Enroll in Plan F?
Enrollment in a Medicare Supplement insurance Plan, including Plan F, is open throughout the year. However, applying outside your initial enrollment period or without guaranteed issue rights may result in medical underwriting. During this process, insurers assess your health status, which could affect your eligibility and premium rates. Guaranteed issue rights protect you from underwriting in specific scenarios, such as losing employer-sponsored coverage or if your Medicare Advantage plan exits your service area. This ensures you can secure a Medigap plan without facing potential coverage denials or inflated premiums due to pre-existing conditions.
Plan F vs Plan G
Plan G stands as the closest alternative to Plan F, offering nearly identical benefits except for the Medicare Part B deductible, which Plan G does not cover. For 2024, this deductible is set at $240. Despite this difference, Plan G often presents a more economical choice due to its generally lower premiums and the additional consideration of the calendar year deductible . For instance, if the annual premium for Plan F is $1,800 and for Plan G is $1,500, you’d pay a total of $1,740 with Plan G (including the Part B deductible), compared to $1,800 with Plan F. This makes Plan G a financially savvy option for those willing to pay the Part B deductible out-of-pocket in exchange for lower monthly premiums.
Plan F vs Plan N
Plan N is another viable alternative to Plan F, featuring lower premiums but introducing copayments for certain services. Beneficiaries under Plan N are responsible for a $20 copay for office visits and a $50 copay for emergency room visits, which is waived if the patient is admitted. Unlike Plan F, Plan N does not cover excess charges, which are additional fees some healthcare providers may charge beyond the Medicare-approved amount. This plan is ideal for individuals who prioritize lower monthly premiums and do not mind occasional copays, but it may not be suitable for those who frequently visit doctors that impose excess fees.
Plan F vs Plan C
Plan C shares similarities with Plan F but lacks coverage for excess charges. Like Plan F, Plan C has been discontinued for new Medicare enrollees post-2020. For those eligible, Plan F is generally preferred due to its broader coverage, encompassing excess charges that Plan C does not address. The insurer stands to cover costs for an additional 365 days after Medicare benefits are exhausted, ensuring that patients are not billed for any excess charges. This makes Plan F the more comprehensive choice for individuals who qualify for both options, ensuring maximum protection against out-of-pocket costs.
Benefits of Medicare Supplement Plan F
Medicare Supplement Plan F stands out as the most comprehensive Medigap plan available, offering the broadest coverage for Medicare-approved amounts. Here are the key benefits of Plan F:
Comprehensive Coverage for Hospital Costs: Plan F covers Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted, providing extensive protection against high hospital bills.
Medicare Part B Coinsurance or Copayment: This plan covers the Part B coinsurance or copayment, including any excess charges, ensuring that beneficiaries have minimal out-of-pocket costs for medical services.
Hospice Care Coinsurance: Plan F includes coverage for hospice care coinsurance, offering financial relief during difficult times.
Skilled Nursing Facility Care Coinsurance: Beneficiaries can rely on Plan F to cover the coinsurance costs for skilled nursing facility care, reducing the financial burden of extended care.
Emergency Health Care Services Abroad: For those who travel outside the U.S., Plan F provides coverage for emergency health care services for the first 60 days, adding an extra layer of security.
No Out-of-Pocket Costs for Medicare-Approved Services: With Plan F, beneficiaries enjoy predictable health care costs, as there are no out-of-pocket expenses for Medicare-approved services.
Freedom to Choose Providers: Plan F allows beneficiaries to choose any doctor or hospital that accepts Medicare patients, offering flexibility and peace of mind.
Guaranteed Renewable: As long as premiums are paid, the insurance company cannot cancel the policy, ensuring continuous coverage.
These benefits make Medicare Supplement Plan F an attractive option for those seeking the most comprehensive Medigap plan available, providing extensive financial protection and peace of mind.
Drawbacks of Medicare Supplement Plan F
While Medicare Supplement Plan F offers comprehensive coverage, there are some drawbacks to consider:
Higher Premiums: Plan F generally has higher premiums compared to other Medigap plans, which can be a significant factor for those on a fixed income.
Limited Availability for New Beneficiaries: Plan F is not available to new Medicare beneficiaries who became eligible on or after January 1, 2020, limiting options for those newly eligible for Medicare.
Cost-Effectiveness: For some individuals, other Medigap plans may offer similar coverage at a lower premium, making Plan F less cost-effective.
Exclusions: Plan F does not cover long-term care, private-duty nursing, or other services not covered by Medicare, potentially leaving beneficiaries with significant out-of-pocket costs for these services.
Premium Variability: Premiums can vary significantly depending on the insurance company, location, and other factors, making it essential to shop around and compare rates.
Considering these drawbacks is crucial for making an informed decision about whether Medicare Supplement Plan F is the right choice for your healthcare needs and budget.
Changing or Canceling Medicare Supplement Plan F
If you have a Medicare supplement insurance plans F policy and want to change or cancel it, there are several important considerations:
Enrollment Periods: You can change your Medigap plan during the annual open enrollment period, which typically runs from October 15 to December 7, or during a special enrollment period if you experience a qualifying event.
Underwriting and Medical Questions: Switching to a different Medigap plan may subject you to underwriting and medical questions, which can affect your ability to get coverage.
Future Coverage: Canceling your Medigap plan may make it difficult to get another one in the future, depending on your health status and other factors.
Policy Review: It’s essential to review your current policy and compare it to other options before making any changes to ensure you have the best coverage for your needs and budget.
Consulting an Expert: Consider consulting with a licensed insurance agent who can help you navigate the process and ensure you make an informed decision.
By understanding these factors, you can make a well-informed decision about changing or canceling your Medicare Supplement Plan F policy.
Should You Choose Plan F?
For those eligible for Plan F, it remains a highly attractive option due to its comprehensive coverage that minimizes out-of-pocket expenses. This plan is particularly beneficial for individuals with frequent medical needs or those seeking peace of mind knowing nearly all Medicare-approved costs are covered. Understanding different Medicare plans, including Plan F, is crucial for making an informed decision about healthcare coverage. However, it’s essential to evaluate the total costs, including premiums and potential deductibles, against alternatives like Plan G or Plan N, to determine which plan offers the best value for your specific healthcare needs.
Looking for Expert Medicare Help?
Navigating the complexities of Medicare Supplement plans can be challenging, but our award-winning Medicare advisors are here to assist you. Whether you’re considering Plan F, Plan G, or another Medigap plan, we offer personalized guidance to help you save money and find the plan that best fits your needs. Our licensed experts provide this service at no cost to you, ensuring you receive a free Medicare Supplement quote tailored to your circumstances.
Contact us today to speak with a licensed expert and receive a free Medicare Supplement quote, empowering you to make informed decisions about your healthcare coverage.
FAQs about Medicare Supplement Plan F
These FAQs provide a quick reference for common questions about Plan F, helping you understand its features and how it fits into your healthcare coverage.
Here are some frequently asked questions about Plan F:
Plan F is a type of Medigap policy that helps cover the gaps in Original Medicare coverage, including deductibles, copays, and coinsurance.
No, Plan F is only available to those who were eligible for Medicare before January 1, 2020.
The cost of Plan F varies depending on the insurance company, location, and other factors, but it is generally more expensive than other Medigap policies.
The benefits include comprehensive coverage for hospital costs, Medicare Part B coinsurance or copayment, and hospice care coinsurance, among others.
Yes, you can change or cancel your Medigap policy during the annual open enrollment period or during a special enrollment period if you experience a qualifying event, but you may be subject to underwriting and medical questions.
