For those on Medicare, copays and deductibles can start to add up. Even though you might receive premium-free Part A coverage, there are many other out-of-pocket costs associated with Medicare that you will need to pay.
Many might think that services don’t cost you anything when you have Medicare coverage, but that is untrue. Plus, there are many items that Medicare does not cover. Medigap plans help cover these expenses and lower your overall healthcare expenses. If you decide to purchase Medicare supplement insurance, you might have discovered many plan options.
So, what is Plan F, and how does it work? Keep reading as we provide all the details on Medicare supplement Plan F.
What Is Medicare Supplement Plan F?
Medicare Supplement Plan F is one of the most comprehensive Medigap plans available, and it can help cover out-of-pocket expenses not covered by Original Medicare. As you likely already know, Medicare supplement insurance plans help you with expenses not covered by Medicare.
Insurance for Out-of-Pocket Expenses
Out-of-pocket expenses include copayments, coinsurance amounts, deductibles, and services that Medicare doesn’t cover. These costs can get pretty steep. Medigap Plan F will help pay for nearly every out-of-pocket expense that you may have with Original Medicare. Plan F is generally considered the most comprehensive Medigap plan available because it even covers your Medicare Part B deductible.
Standardized Policies
Medigap policies are generally standardized according to state law. They are the same across 47 states in America. Only Massachusetts, Minnesota, and Wisconsin have their own rules regarding Medigap.
No Longer Available
You should know that Plan F policies are no longer available to new Medicare enrollees as of 2020. As of 2020, the law no longer allows coverage of the Part B deductible. However, if you already had Plan F coverage before this date, you can keep it.
Medigap Plan G is now considered the most comprehensive. It provides essentially the same coverage as Plan F, except for the Part B deductible.
KEY TAKEAWAYS
- Medigap Part F is one of ten plans offered through private insurers to help cover some of the costs associated with Original Medicare.
- Medicare Supplement Plan F will pay Part A and B deductibles, coinsurance, copays, blood for transfusions, excess fees from providers, and medical services in foreign countries.
- Medicare Plan F requires a monthly premium, which varies based on certain conditions. Most plans carry a zero deductible; however, some locations have an option for a high-deductible plan with a lower premium.
What Medicare Supplement Plan F Covers
Since Medigap plans are managed and administered by private insurance companies, they get to set their own rules regarding coverage and costs. The great thing about Medigap policies is that they are standardized in most states today. So, just what does Plan F cover? Here are some of the most essential details about coverage.
Deductibles + Copays
First, Plan F covers many items associated with your Medicare Part A coverage. Remember that Medicare Part A is your hospital insurance. Part A covers inpatient services and hospital stays, requiring a deductible and copayments or coinsurance amounts. Plan F will cover your Part A deductible, copays, and coinsurance amounts.
The covered services don’t stop there. Plan F also covers many items associated with your Medicare Part B coverage. Remember that Part B is like regular health insurance. It pays for doctor visits, lab work, or preventive care services. However, Part B also has a deductible and copay amounts that must be paid out of pocket. Plan F will cover your Part B coinsurance amounts.
Medigap Plan F assists with paying almost all medical expenses for outpatient services not covered by Medicare — including your Medicare Part B deductible.
Medicare Supplement Plan F also covers copays associated with care in a skilled nursing facility or Hospice care.
Additional Hospital Stay
Medigap Plan F also covers up to 365 additional days in a hospital stay after your Medicare Part A benefits are used up.
Blood Transfusion
Plan F will cover and pay for the first three pints of blood for a transfusion. Blood transfusions after the first three pints are covered by Medicare Part A.
Fees Above Medicare Approved Amounts
Remember that Medicare only pays 80% of the services cost up to the Medicare-approved amount. If your healthcare provider charges more than this, then you might be stuck paying the difference. Medigap Plan F will pay for these Medicare Part B excess charges up to a certain amount.
Medical Services in Foreign Countries
Lastly, Medicare does not generally cover medical services outside the United States. However, what happens if you travel internationally and have a medical emergency?
If you don’t have the comprehensive coverage provided by Plan F, you might be stuck with a hefty bill. Plan F will pay up to 80% of the cost of foreign medical services incurred while traveling overseas.
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Services Not Covered By Medicare Plan F
Now that you know what Plan F will cover, let’s discuss some things it does not cover.
Prescription Drugs
Plan F does not cover prescription drug costs. You must be enrolled in a Medicare Part D plan to receive prescription drug coverage, and your Plan F will not assist with any out-of-pocket expenses associated with that coverage.
Long-Term Care
Similarly, Plan F does not provide payment assistance for long-term care. If you require a stay in an assisted living facility, you must pay for that care out of your pocket. You will also need to pay for private-duty nursing on your own. Plan F coverage does not include private-duty nursing.
Dental or Vision
Finally, Plan F does not include any dental or vision benefits. Neither Original Medicare nor Plan F will cover these costs if you need dental care or an eye exam. Some Medicare Advantage Plans provide dental and vision coverage; however, you cannot be enrolled in an Advantage plan and a Medigap Plan F.
Medicare Plan F Costs
Since most people exploring these plans receive Social Security benefits, they often want to know the associated cost. Medigap insurance costs vary based on a few factors, like your age and location. Here are some of the most common costs associated with Medigap Plan F coverage.
First, remember that you can no longer purchase a new Plan F policy. However, if you already have a policy, you will be allowed to keep it in effect.
Plan F Premiums
Just like with most insurance coverage, Plan F requires a monthly premium. Beneficiaries can expect the amount of their premium to vary based on several factors. Your insurance company will examine whether you smoke or vape, your location, gender, existing health conditions, and other items to determine the appropriate premium rate.
On the low end, you can expect Plan F to cost at least $123 per month. This is for a low-risk individual living in an area with lower health care expenses. However, the premium can go up to over $700 per month for someone with a higher health risk living in a more expensive area, like New York. On average, you can expect to pay around $189 monthly for Plan F coverage. If you enroll in the high-deductible Plan F, you can expect to pay a monthly premium of around $80.
Plan F Deductibles
Most Plan F policies have a zero deductible. This means they will start paying for items not covered by Medicare immediately. However, some states also offer Plan F in a high-deductible plan. This means you must meet your deductible before the plan starts to pay anything.
In 2024, the high deductible for Plan F is $2,800. Remember that the high-deductible plan is not available in all areas. You can expect to pay lower premiums on the high-deductible plan as a tradeoff. You can always get the help of a licensed insurance agent to assist with selecting the right plan for your situation.
Plan F Copayments
There are no copayments associated with Plan F coverage. That is one of the most significant benefits of enrolling in Plan F. It covers the copayments you usually need to pay with Original Medicare. Original Medicare includes several cost-sharing methods, like utilizing copayments and coinsurance amounts. Plan F exists to help people pay for those items so they do not have to pay for them out of their pocket.
TIP
Most Medigap plans are standardized across states, making them easier to compare. To determine if a Medigap plan is right for you, it helps to balance the various coverage levels with the total costs of each plan.
Eligibility & Enrollment For Medicare Plan F
So, who is eligible for a Plan F Medigap policy, and how do you enroll?
Eligibility Requirements
Generally, if you qualify for Original Medicare, you can likely sign up for Plan F coverage. This means that you must be 65 or older and have been a U.S. citizen or legal permanent resident for at least five years.
While you need at least 40 work credits to receive premium-free Part A coverage, Plan F has no work credit requirement. However, remember that you might be paying a Part A and B premium in addition to your Plan F premium.
You can become eligible for Medicare at a younger age after receiving Social Security disability benefits for 24 months. Those who are diagnosed with ALS or ESRD can also qualify for Medicare. Those individuals will typically also be eligible for Plan F coverage.
Enrollment Process
Once you determine that you are eligible for Plan F, how do you enroll? You can enroll in Medigap Plan F at any time, although the best time to enroll is during the Medigap general enrollment period.
This period starts when you turn 65 and enroll in Medicare Part B for the first time. If you enroll during this initial six-month period, you will pay the same premium for Plan F regardless of your health history. However, if you wait to sign up, then you will be subject to health insurance underwriting. Your premium will likely increase based on your overall health and wellness, plus your pre-existing conditions.
Medigap Plan F Restrictions
You should also know that you cannot enroll in both Plan F and a Medicare Advantage Plan. You may only enroll in Plan F if enrolled in Original Medicare. Suppose you are already on a Medicare Advantage Plan. In that case, you can switch your coverage to Plan F instead during Medicare’s annual open enrollment or Medicare Advantage selection period. You can explore Medicare’s website to learn more about these Medigap Medicare programs.
*Note: As of January 2020, Medicare Supplement Plan F is no longer available to new Medicare enrollees.
The Bottom Line
If you need a Medigap insurance policy, there are many options. The options available are Plan A, Plan B, Plan C, Plan D, Plan G, Plan F, Plan K, Plan L, Plan M, and Plan N.
Medicare Supplement Plan G and Plan F are the best plans on the market; however, Plan F is no longer available to new Medicare enrollees. Plan F includes coverage for nearly all items not covered by Original Medicare — including your Part B deductible!
If you need help lowering your out-of-pocket costs associated with the Medicare program, a Medigap plan can be a great option!
Frequently Asked Questions
The most significant benefit of a Plan F Medigap policy is that it helps reduce your overall out-of-pocket healthcare expenses. Plan F covers copays and deductibles that Original Medicare does not cover.
Instead of paying for these items each time you visit the doctor, you pay a monthly premium for your Plan F coverage. This coverage then covers items you would otherwise pay for on your own.
No, Plan F does not cover dental expenses. Original Medicare and Plan F do not provide dental coverage.
If you wish to receive dental coverage, then you would need to find a Medicare Advantage plan that provides this coverage. However, remember that you cannot simultaneously enroll in Medigap and a Medicare Advantage plan. You must choose one or the other.
The most significant difference between Plan F and Plan G is that Plan G does not cover your Medicare Part B deductible, while Plan F does. The other coverage details for these two types of policies are essentially identical.
The law no longer allows Medigap to cover your Part B deductible, so remember that Plan F is no longer available to new Medicare enrollees.
No, you cannot purchase both a Medicare supplement plan and a Medicare Advantage plan. These two types of plans are exclusive of each other. Similarly, you cannot buy a Medicare supplement plan if enrolled in both Medicare and Medicaid.
You can, however, switch from a Medicare Advantage plan to a Medicare supplement plan or vice versa. Some situations allow you to change from one plan to another without penalty; however, you will generally not have guaranteed issue rights if you decide to switch from one plan to another.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
