Medigap Plan F was one of the most popular choices for Medicare beneficiaries due to its comprehensive coverage for out-of-pocket costs left over from Original Medicare. However, as of 2020, new Medicare recipients are no longer eligible to enroll in Plan F. However, for those eligible for or already enrolled in Medicare before 2020, it may still be a plan option.
Medicare Supplement Plan F in 2024: Plan Details and Eligibility
Updated: November 21, 2024
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Key Takeaways
Medigap Plan F is considered the most comprehensive among all Medigap plans. It covers all deductibles, coinsurance, and copayments related to Medicare Parts A and B. Additionally, it handles Part B excess charges and includes coverage for emergency healthcare during foreign travel.
Although Plan F provides extensive coverage, it's no longer available to new Medicare beneficiaries as of January 1, 2020. However, those eligible for Medicare before this date may still be able to purchase Plan F, and existing policyholders can keep their coverage.
When comparing Plan F with other plans, it's important to note that alternatives like Plan G provide similar benefits but don't cover the Part B deductible. This could make plans like G more cost-effective for some beneficiaries, depending on their healthcare needs and financial situation.
What is a Medicare Supplement Plan?
Medigap, or Medicare Supplement plans, are supplemental Medicare policies offered by private health insurance companies designed to augment the coverage provided by Original Medicare. Medigap helps pay for certain out-of-pocket costs that Medicare beneficiaries would otherwise be responsible for, such as deductibles, coinsurance and copayments. Different Medicare supplement plans offer different levels of coverage to meet individual needs.
What Does Medigap Plan F Cover?
Medicare Part A Coinsurance and Hospital Costs
Plan F covers the coinsurance amount and hospital costs incurred after exhausting Medicare Part A benefits.
Medicare Part A Deductible
Medigap Plan F pays for the deductible for Medicare Part A, which is the initial amount beneficiaries need to pay before Medicare coverage kicks in.
Medicare Part B Coinsurance and Copayments
Plan F covers the coinsurance and copayment amounts for Medicare Part B services, including doctor visits, medical tests and other outpatient services.
Medicare Part B Deductible
Medigap Plan F pays for the deductible associated with Medicare Part B, an annual amount beneficiaries must meet before Medicare starts covering services.
Medicare Part B Excess Charges
If a healthcare provider does not accept the Medicare-approved amount as full payment for a service, they may charge excess charges. Medigap Plan F covers these charges, ensuring beneficiaries do not have to pay them out of pocket.
Blood
Medigap Plan F covers the first three pints of blood received through a blood transfusion.
Part A Hospice Care Coinsurance and Copayments
Plan F covers the coinsurance and copayment amounts for hospice care received under Medicare Part A, including respite and inpatient care.
Skilled Nursing Facility Coinsurance
Medigap Plan F pays for the coinsurance amount for skilled nursing facility care after the first 20 days of care provided under Medicare Part A.
It's important to note that Medigap Plan F does not cover prescription drugs, routine vision care, routine dental care, hearing aids or cosmetic surgery. Medigap Plan F is no longer available to new Medicare beneficiaries, but those eligible for Medicare before 2020 can still enroll in and maintain this plan.
Why Was Medicare Supplement Plan F Discontinued?
Medicare Supplement Plan F was not discontinued entirely but underwent changes that affected its availability for new Medicare beneficiaries. The reason behind these changes was a federal law passed in 2015 called the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA aimed to address concerns about the overutilization of healthcare services by implementing cost-sharing measures.
As part of MACRA, starting from January 1, 2020, Medicare Supplement plans (including Plan F) were no longer allowed to cover the Medicare Part B deductible for newly eligible Medicare beneficiaries. This change aimed to ensure that beneficiaries have some financial responsibility due to the belief that covering the entire deductible might lead to unnecessary utilization of services.
The changes to Medigap Plan F meant that Medicare beneficiaries who became eligible for Medicare after January 1, 2020, could no longer enroll in Plan F. However, those eligible for Medicare before 2020 could still enroll in or keep Plan F if it was already their chosen coverage option.
Another goal of discontinuing the full coverage of the Part B deductible through Plan F was to encourage beneficiaries to consider other Medigap plans, such as Plan G, which offers similar benefits except for the Part B deductible. These changes aimed to promote cost-sharing and reduce the Medicare program's financial burden.
Medicare Supplement Plan F Cost
The cost of Medigap Plan F can vary based on several factors, including age, location, gender and tobacco use. Here's an overview of the costs, with a sample consumer of a 70-year-old non-smoking woman in Florida.
- Monthly Premiums: Medigap Plan F requires beneficiaries to pay a monthly premium to the insurance company offering the plan. For a 70-year-old non-smoking woman living in Florida, the premium range for Medigap Plan F is around $211 and $302. These figures are approximate and subject to change.
- Deductibles: Medigap Plan F does not have an annual deductible for Medicare Part A and Part B services. Therefore, beneficiaries are not required to meet a specific deductible amount before the plan's coverage begins. In addition, Plan F covers the deductibles for both Medicare Part A (hospital insurance) and Part B (medical insurance).
- Coinsurance and Copayments: Medicare Supplement Plan F covers the coinsurance and copayment amounts for Medicare Part A and Part B services. Coinsurance is the percentage of the cost of a service that beneficiaries are responsible for paying, while copayments are fixed amounts paid for each service or visit.
- Excess Charges: Medigap Plan F also covers Medicare Part B excess charges. Excess charges occur when healthcare providers do not accept Medicare's approved amount as full payment for a service.
- Foreign Travel Emergency Coverage: Medicare Supplement Plan F includes coverage for emergency medical care during foreign travel. If a medical emergency occurs while traveling outside the United States, Plan F helps cover eligible expenses, subject to certain limits and deductibles.
Medigap Plan F also has a high-deductible option. Selecting this plan means that before your Plan F coverage kicks in, you must pay for Medicare-covered costs up to a certain amount ($2,700 for 2023). While the high-deductible version of Plan F often has a lower premium, you must pay out of pocket for Medicare-covered costs up to the deductible amount before the policy will begin to pay.
Medigap Plan F Cost Comparisons
The cost-effectiveness of choosing a high deductible plan versus a high premium plan depends on an individual's anticipated healthcare needs and expenses. Consider the following example.
Person A and Person B are both 70-year-old non-smoking women in Florida. Person A chooses the high deductible Plan F, while Person B opts for a high premium Plan F with a monthly premium estimate of $275.
Person A (High Deductible Plan F):
- Monthly Premium: Person A chooses the high deductible Plan F, which typically has lower monthly premiums. Let's assume her monthly premium is $100.
- Deductible: With the high deductible Plan F, Person A has an annual deductible of $2,700.
- Out-of-Pocket Costs: Person A must pay the full $2,700 deductible before her plan covers her medical expenses. Once she meets her deductible, the plan covers the remaining out-of-pocket costs for covered services throughout the year.
Person B (High Premium Plan F):
- Monthly Premium: Person B chooses the high premium Plan F with a monthly premium estimate of $275.
- Deductible: The high premium Plan F has no deductible, so Person B does not need to meet any deductible amount before her plan starts covering her medical expenses.
- Out-of-Pocket Costs: Person B will have lower out-of-pocket costs for covered services throughout the year, as her plan starts covering the expenses without requiring her to meet a deductible.
Cost Comparison: In this example, Person A would pay a lower monthly premium of $100 but would need to cover the $2,700 deductible before her plan starts covering medical expenses. This means she can expect to pay at least $3,900 on the Medigap plan ($2,700 deductible + $1,200 in premiums) for that year if she meets her deductible.
If Person A's healthcare expenses for the year do not exceed $2,700, she would likely have lower overall costs than Person B. However, if her expenses exceed $2,700, she will pay at least $3,900 for the year.
On the other hand, Person B would have higher monthly premiums of $275 but would not have to meet a deductible, meaning her plan would immediately start covering her medical expenses from the beginning of the year, which could be advantageous if her healthcare expenses are substantial. If her healthcare costs exceed $3,300 ($275 x 12), she benefits from this plan choice and saves $600 compared to the high deductible plan.
MEDIGAP PLANS SIMILAR TO PLAN F
There are alternatives to Medigap Plan F for consumers seeking different coverage options. Consider the following:
- Plan G: Plan G offers similar coverage as Plan F, the only difference being that Plan G does not cover the Part B deductible.
- Plan N: Plan N offers lower premiums in exchange for you taking on a small amount of cost-sharing. Plan N includes copayments for some office visits and emergency room trips but could be a more affordable option overall.
- Medigap Plan D: Plan D provides solid coverage, similar to Plan F, but excludes Part B deductible and excess charges. It's a good alternative for consumers seeking potentially lower-cost coverage.
Medicare Supplement Plan Enrollment Process
Navigating the enrollment process for Medicare Supplement Plans can seem complicated. The following steps will guide you through the stages of eligibility, verification, plan selection, insurance company selection, application submission and policy issuance.
- 1
Eligibility Check
Firstly, verify that you are eligible for Medicare Supplement Insurance. To be eligible for Medigap, you need to enroll in Medicare Parts A and B. Check your eligibility and Medicare open enrollment period, which begins when you turn 65 and enroll in Part B, on Medicare.gov.
- 2
Plan Selection
Using the plan comparison tool on Medicare.gov, review the different Medigap plans available to decide on the one that best suits your healthcare needs and financial situation.
- 3
Insurance Company Selection
Choose an insurance company that sells the Medigap plan you have selected. Pricing varies, so it's a good idea to compare providers. Also, consider the company's reputation, customer service and financial stability.
- 4
Application Submission
Apply for the Medigap plan with the selected insurance company. This step usually involves filling out an application form with personal details and health-related questions. Medicare.gov can provide guidance on this process.
- 5
Wait for Approval and Policy Issuance
After application submission, you'll need to wait for approval. If your application is accepted, you'll receive your policy, and the coverage will start on the effective date stated in the policy.
Remember, it's important to continue paying your Medicare Part B premium and the Medigap policy premium. And be aware that a Medigap policy only covers one person, so if you and your spouse both want Medigap coverage, you'll have to purchase separate policies.
Medigap Plan F FAQs
What is Medicare Supplement Plan F?
Medicare Supplement Plan F is the most comprehensive Medigap plan, covering all Medicare Part A and B deductibles, coinsurance and copayments. It also covers Part B excess charges and has provisions for foreign travel emergency healthcare, essentially leaving beneficiaries with minimal to zero out-of-pocket expenses for Medicare-approved services.
Is Medigap Plan F still available?
As of January 1, 2020, Medigap Plan F is not available to new Medicare beneficiaries. However, if you were eligible for Medicare before January 1, 2020, you may still be able to purchase Plan F.
Who is eligible for Medicare Supplement Plan F?
Consumers eligible for Medicare before January 1, 2020, are still eligible to enroll in Medigap Plan F. Those already enrolled in Plan F before this date are also allowed to keep their plan.
What is Medicare Part F and G?
Medicare Part F refers to Medigap Plan F, a popular supplemental insurance plan that covers gaps in Original Medicare. Plan G, on the other hand, is similar to Plan F but doesn't cover the Medicare Part B deductible. It's an attractive alternative for new beneficiaries who are not eligible for Plan F.
Does Medicare Plan F cover dental?
Medigap Plan F, like all Medigap plans, does not cover routine dental care. Medigap policies help cover costs associated with Original Medicare, such as deductibles and copayments, but they don't include dental, vision or hearing care coverage.
About Brenna Kelly
Brenna Kelly, the former Health Insurance Content Manager at MoneyGeek, is a licensed health insurance agent and real estate associate. She is qualified to provide expert insight and advice on medical insurance, disability, long-term care, critical illness, Medicare Supplements and Medicare Advantage Plans.
Kelly has a Bachelor of Science and a Master of Arts in Applied Sociology from the University of Central Florida. She uses her content production experience and health insurance expertise to deliver informative articles.
sources
- CMS.gov. "MACRA." Accessed October 25, 2024.