As you get to know Medicare, you’ll become very familiar with the “parts” that make up original Medicare (Medicare Part A and Medicare Part B), Medicare Advantage (Medicare Part C), and prescription drug coverage (Medicare Part D).
If you’re new to Medicare, you may not realize that there are also Medicare “plans” designated by alphabet letters, in addition to the better-known “parts.”
These additional plans are the pieces of Medicare known as supplemental insurance, or Medigap. They are also sometimes referred to as MedSup. There are currently 10 Medigap plans, although not every state, county or zip code has access to all of them. The ten Medigap plans are:
One of the most popular of these, historically, has been Medicare Supplement Plan F.
Supplement Plan F is a high-coverage plan which pays for a lot of the out-of-pocket costs typically incurred by Medicare beneficiaries. Plan F has two versions. One has a high deductible but costs less per month than the other. Despite its popularity, the ability to purchase Plan F is changing. As of January 2020, it is no longer available to every Medicare recipient.
As of January 1, 2020, new Medicare enrollees cannot purchase Plan F. However, anyone who had Plan F before can keep it.
Medigap Supplement Plan F (Medigap Plan F) is a form of supplemental insurance that is sold by Medicare-approved, private insurers to people who have original Medicare. Plan F provides the most robust coverage of any supplemental insurance plan and for this reason, is very popular with people who know they may incur significant out-of-pocket medical costs.
Like all Medigap plans, supplemental Plan F helps to cover the out-of-pocket expenses that Medicare does not, such as copays and coinsurance. Since these expenses can become substantial, Medigap plans are beneficial for many people who have original Medicare. Since they cover many of the same things, Medigap plans are not available to people who have Medicare Advantage (Medicare part C).
Medicare Supplement Plan F only covers services that are covered by original Medicare (Parts A and B). If you receive a medical treatment that Medicare does not cover, such as acupuncture, Plan F will also not cover it. Plan F also does not cover medications under most circumstances, since these are covered by Medicare Part D.
After your Plan F deductible has been met, you can expect Plan F to pay the following:
- Part A deductible: Plan F covers 100 percent of your Part A deductible.
- Emergency care outside the U.S.: Plan F covers 80 percent of the costs of emergency care required outside of the U.S., up to plan limits.
- Extensive hospitalization: Plan F will cover your Part A coinsurance and hospital costs for an additional 365 days (one year) after your Medicare benefits have been used up.
- Part B copay: Your copay for Part B services is the set rate you are required to pay for doctor visits and some other medical expenses. Copays are required whether or not you have met your Part B deductible.
- Part B coinsurance: Your Part B coinsurance is the percentage of a medical bill you are required to pay after your deductible has been met. For Medicare recipients, this is typically around 20 percent. You will be responsible for paying the Part B deductible before Plan F will start paying your Part B copays.
- Part B excess: If your doctor or provider charges you more than the Medicare-approved amount for a service, Plan F will pay for the overage.
- First three pints of blood: Medicare does not pay for pints of blood that you might need, until the 4th pint. If you require a blood transfusion, Plan F will pay for the first three pints of non-donated blood you receive. Non-donated blood refers to blood that is not given to you directly by a friend or family member.
- Your out-of-pocket coinsurance or copayment for Part A hospice care: Original Medicare pays for most of the costs associated with hospice care. However, you may incur coinsurance costs for inpatient respite care, such as the costs associated with short-term relief for your in-home hospice caregivers. Medicare does not pay for your room and board if you get hospice care in a facility where you currently live, such as a nursing home. You may also incur copays for certain medications or products required for pain or symptoms relief while you are in hospice.
- Coinsurance for a skilled nursing facility (SNF): Original Medicare pays in full for your stay in a skilled nursing facility, if certain conditions are met, but only for a short period of time. You are required to start paying coinsurance for your care on the 21st day of your stay. If you remain in the SNF for over 100 days, you are responsible for the entire cost of your stay.
On January 1, 2020, all Medigap plans were changed to no longer cover the Part B deductible. Medicare Part B is the part of original Medicare that pays for 80 percent of most medical expenses you receive outside of a hospital setting. Because of this change, Supplement Plan F can no longer be sold to people who became eligible for Medicare as of January 1, 2020.
If you are not new to Medicare and already have either version of Plan F, you will be able to keep it.
If you were eligible for Medicare before January 1, 2020, but did not enroll for any reason, you may still be able to purchase a Supplement Plan F.
Like all Medigap plans, Supplement Plan F is available to buy from private insurers that are approved by Medicare. The cost for Plan F may vary by insurer. Your zip code, as well as the carrier you choose, can impact the cost of your plan. In some instances, people who smoke cigarettes or use other tobacco products may be required to pay higher monthly premiums for Plan F.
Because it offers the highest level of coverage, Plan F tends to be more expensive than other Medigap plans.
There are two versions of Plan F:
- Standard Plan F
- High-deductible Plan F (Plan F+)
Each plan covers the same benefits. However, high-deductible Plan F requires that you pay all fees incurred for medical expenses until your deductible is met. In 2019, the deductible for Plan F was $2,300. In 2020, the deductible for Plan F is $2,340. High-deductible Plan F often has a lower monthly premium than standard Plan F.
Help choosing a Medigap Plan
These sources provide information about Medigap plans:
Supplement Plan F is a Medigap plan meant to cover the costs not paid for by original Medicare.
Due to its comprehensive and robust coverage, it has traditionally been popular with people who get original Medicare and know that they will need extra coverage for things such as copays and coinsurance.
Due to a change in the rules for Medigap plans, Plan F will no longer be available to purchase for people who are new to Medicare as of January 1, 2020.
A possible exception to this is people who were eligible for Medicare before January 2020 but did not apply.
If you already have Plan F, you will be able to keep it.