Are you eligible, and could it help you lower your healthcare costs?

Many older Americans face out-of-pocket expenses that aren’t covered by the basic benefits of Medicare Part A and Medicare Part B. To help cover these costs, some people choose to buy a Medicare Supplement Insurance plan. There are 10 supplement plans (each identified by a letter), and the most popular and comprehensive by far is Plan F (also called Medigap Plan F). It leaves you with nearly zero out-of-pocket costs for hospital and office visits.

Before you make a decision about purchasing supplemental Medicare insurance, try to estimate what your out-of-pocket costs will be for the year. If you expect a lot of expenses beyond what Medicare Parts A and B pay for, then a comprehensive option that covers payment “gaps,” like Plan F, might help you save money—especially if you anticipate that your annual out-of-pocket expenses will be higher than the annual cost of supplemental plan premiums. You should always compare prices to find the best rate in your area. 

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Am I eligible for Medicare Plan F?

You must already have Original Medicare coverage to buy any supplemental plan, but changes to the federal Medicare program in 2020 mean that not everyone is eligible for Plan F. 

According to Medicare.gov, as of January 1, 2020, Medigap plans sold to new people with Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare. If you already have either of these plans (or the high deductible version of Plan F) or were covered by one of these plans before 2020, you’ll be able to keep your plan. Also, if you were eligible for Medicare before January 1, 2020 (meaning your 65th birthday occurred before that date) but not yet enrolled, you may still be able to buy one of these two plans.

If you aren’t eligible for Medicare Plan F but still want a relatively comprehensive plan, you might consider Medicare Plan G, which is exactly the same as Plan F except it doesn’t cover the Part B deductible (which was $198 in 2020). 

Also, people who are under the age of 65 and have Medicare coverage due to a disability or end-stage renal disease may not be able to buy any MedSup or Medigap policy or get the one they want.

What does Medicare Plan F Cover?

Plan F provides the most comprehensive coverage of all the supplemental plan options. It pays for all the gaps in Original Medicare Parts A and B, including your hospital and outpatient deductible. This means zero out-of-pocket costs when you go to the doctor. 

Because the federal government standardizes the benefits of each Medicare supplement plan of the same letter, the benefits of Plan F insurance policies are the same regardless of which private insurance company you buy it from. 

Plan F coverage includes:

  • Medicare Part A deductible
  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • Part A hospice care coinsurance or co-payment
  • Medicare Part B annual deductible ($198 in 2020)
  • Medicare Part B excess charges*
  • Part B coinsurance or co-pays
  • Skilled nursing facility care coinsurance
  • First three pints of blood
  • Foreign travel emergencies (80 percent, up to plan limits)

Other benefits of Plan F include choosing your doctor, not needing a referral to see a Medicare specialist, and guaranteed plan renewal—your coverage can never be canceled due to health conditions or the number of claims you file. 

*Excess charges are those that fall beyond the Medicare-approved charge. For example, if Medicare’s basic benefit allowable charge for a medical visit is $100, but the doctor bills you $110, Medicare will cover 80 percent of the allowed charge and pay the doctor $80. Without Plan F, you would be responsible for the remaining 20 percent of the allowable charge (in this case, $20) plus the excess charge of $10, making your total out-of-pocket expense $30. Plan F, however, covers that extra $30.

What Isn’t Covered by Medicare Plan F

Plan F does not cover anything that Medicare doesn’t cover, including:

  • acupuncture, acupressure, or homeopathic treatments
  • routine vision care and eyeglasses
  • routine dental care and dentures
  • foot care that is not related to medical conditions
  • hearing aids and routine hearing tests
  • cosmetic surgery
  • custodial care (help with bathing, dressing, eating, etc.)
  • long-term care

None of the Medigap plans include outpatient prescription drug coverage, so you’ll need to get a Medicare Part D plan if you want prescription benefits. If you receive an injected or infusion drug in a clinical setting, however, Medicare Part B pays its 80 percent share on such a drug, and your Plan F will cover the rest of it. 

What Does Plan F Cost?

It probably won’t surprise you that since Plan F covers the most, it’s also the most expensive Medicare supplement plan. And since supplement plans are sold by private insurance companies (whereas Medicare Parts A and B are usually bought from the federal government), the cost of Plan F monthly premiums can vary depending on who you buy from. The cost is also affected by your age, gender (men are usually charged slightly more), where you live, and if you’re a smoker. It’s important to shop around and compare the prices offered in your area, and doing so each year could save you more (though switching companies might require a new medical screening). You can also ask local insurance companies if they offer discounts on the supplemental plans, especially if multiple people in your household are purchasing. Quitting smoking can help lower the cost too. 

There is also a high-deductible version of Plan F in some states. See the FAQ below for more information. 


Can I have a Medicare Advantage plan and a Medicare Supplemental Insurance like Plan F at the same time?

No, Medicare Advantage and Medicare supplemental health insurance (like Plan F) are not compatible. You are required to choose between one or the other. Insurance companies aren’t even allowed to sell more than one supplemental plan to you. 

What is high-deductible Plan F?

Medicare Plan F is available as a high-deductible plan in some states. These plans usually have lower premiums than “standard” Plan F policies. The trade-off is that while your monthly payments are lower, you’ll have higher out-of-pocket costs if you need healthcare services. With the high-deductible option, you are responsible for paying Medicare-covered costs (coinsurance, co-payments, and deductibles) up to the deductible amount (which was $2,340 in 2020) before your policy pays anything. As a result, high-deductible Plan F is a better fit for people who are fairly healthy. Remember, though, that neither standard nor high-deductible Plan F is available to people who are newly eligible for Medicare on or after January 1, 2020.

When can I buy a Plan F policy?

Technically, you can buy it any time (if you’re eligible), but the best time to buy any supplemental plan is during your open enrollment period. This window starts on your Part B effective date and lasts for only six months. If you try to buy a supplemental plan outside of your enrollment period, you’ll have to jump through a few extra hoops, possibly including an additional medical screening. As a result, your costs may be much higher, and companies can even refuse to sell you a plan.  

What’s the difference between Medicare Plan F and Medicare Plan G? 

The only difference in coverage between these two plans is that Plan G doesn’t pay your Medicare Part B deductible, but Plan F does. All other benefits are the same, including that these two plans are the only ones that cover your Part B excess charges. But Plan F is not available for people who became eligible for Medicare after January 1, 2020. 

Are there any states where the supplemental plans are different? 

Medigap policies are different in the following three states, often called “a la carte” states because they do not offer standardized plans. Medicare enrollees in these states “build their own” plans benefit by benefit. However, individuals in these states would have the ability to build a plan identical to Plan F.

  • If you live in Massachusetts, you can learn more here.
  • If you live in Minnesota, you can learn more here.
  • If you live in Wisconsin, you can learn more here.

Conclusion

If it’s important to you to keep your out-of-pocket healthcare costs low or if you travel frequently, Plan F might save you money. Regardless of which Medicare supplement plan you choose, be sure to compare prices in your area. 

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Updated October 13, 2020

mal profeta is a writer, editor, educator, and public health advocate. They serve as the communications director of an NIH-funded clinical and translational science research center that focuses on addressing health disparities in Appalachia. A former Fulbright recipient, they are completing an MFA in poetry at New York University. More at malprofeta.xyz.