A Comprehensive Guide to Medigap Plan F – Everything You Need to Know

Medigap Plan F is among the most well-known and comprehensive Medicare supplement insurance plans available. It is designed to cover the gaps left by traditional Medicare, helping beneficiaries manage out-of-pocket expenses such as copayments, coinsurance , and deductibles. Although it was one of the most popular plans, changes in Medicare policy have altered its availability for new beneficiaries.

In this article, we’ll dive deep into what Medigap Plan F is, its coverage, benefits, eligibility, and whether it’s still the right choice for those looking to supplement their Medicare coverage.

What Is Medigap?

Before discussing Plan F specifically, it’s important to understand what Medigap is in general. Medigap, also known as Medicare Supplement Insurance , is a type of health insurance policy sold by private insurance companies to fill the gaps in Original Medicare. While Medicare Parts A and B cover many medical costs, they don’t cover everything. There are still expenses like copays, coinsurance, and deductibles that beneficiaries must pay out of pocket.

That’s where Medigap comes in. These policies are designed to help cover those additional costs, so you don’t have to. Multiple Medigap plans are available, each labeled with a different letter (e.g., Plan A, B, C, D, F, G, etc.), and each plan offers various levels of coverage. However, all Medigap plans are standardized, meaning that Plan F, for example, will provide the same coverage no matter which insurance company you buy it from.

Who Is Eligible for Medigap Plan F?

If you became eligible for Medicare before January 1, 2020, you can still enroll in Medigap Plan F. However, if you became eligible after this date, Plan F is no longer available to you. It’s important to note that eligibility is based on when you became eligible for Medicare, not when you enrolled. So, if you were eligible for Medicare before 2020 but delayed enrollment, you may still have the option to purchase Plan F.

If you’re already enrolled in Plan F, you can continue to keep your plan as long as you pay the premiums. You may also be able to switch from another Medigap plan to Plan F if you qualify.

What Does Medigap Plan F Cover?

Medigap Plan F is known for offering the most comprehensive coverage of all Medigap plans. If you’re enrolled in Plan F, it essentially means you have little to no out-of-pocket medical expenses beyond your monthly premiums. Here’s a breakdown of what Medigap Plan F covers:

Medicare Part A coinsurance and hospital costs: Plan F covers any coinsurance and hospital costs that you might incur under Medicare Part A, including up to an additional 365 days of hospital care after your Medicare benefits are exhausted.

Medicare Part B coinsurance or copayments: When you visit a doctor or specialist, Medicare Part B usually covers 80% of the approved amount. With Plan F, the remaining 20% is covered, so you don’t have to pay anything out of pocket.

Blood (first three pints): Medicare typically covers blood starting from the fourth pint, but with Plan F, the first three pints are also covered.

Part A hospice care coinsurance or copayment: Hospice care is another area where Plan F provides additional coverage, ensuring you’re not paying extra costs during a challenging time.

Skilled nursing facility care coinsurance: If you need skilled nursing care, Plan F covers the coinsurance cost that Medicare Part A doesn’t.

Medicare Part A and B deductibles: Plan F is one of the few Medigap plans that cover both the Medicare Part A and Part B deductibles. This means you won’t have to pay these annual deductibles out of pocket.

Foreign travel emergency (up to plan limits): For travelers, Plan F provides coverage for medical emergencies that occur outside the U.S. up to a certain limit.

Why Was Medigap Plan F So Popular?

Medigap Plan F became incredibly popular because of its comprehensive coverage. For many Medicare beneficiaries, the idea of not having to worry about any out-of-pocket expenses after paying their premium was very appealing. It was particularly popular among those who had regular doctor visits or ongoing medical needs, as it eliminated the need to budget for unexpected healthcare costs.

Another reason for its popularity was its simplicity. Instead of worrying about multiple deductibles, coinsurance payments, or copays, Plan F offered peace of mind by covering all the gaps left by Original Medicare.

Pros and Cons of Medigap Plan F

Pros:

Comprehensive coverage: Plan F offers the most extensive coverage of all Medigap plans, leaving you with no out-of-pocket costs beyond your premium.

Simplicity: You won’t have to worry about deductibles, coinsurance, or copays, making it easy to budget for healthcare costs.

Travel coverage: Plan F provides coverage for foreign travel emergencies, which can be a big plus for frequent travelers.

Cons:

Higher premiums: Because Plan F offers the most comprehensive coverage, it typically has higher premiums than other Medigap plans.

No new enrollees: If you meet the eligibility criteria for Medicare after January 1, 2020, you can’t enroll in Plan F.

Potential for increasing premiums: Since no new beneficiaries can join Plan F, there’s a concern that premiums for existing enrollees may increase over time as the pool of policyholders shrinks.

Conclusion

Medigap Plan F was once the go-to Medicare supplement plan for beneficiaries looking for comprehensive coverage. Its all-inclusive nature made it an attractive choice for anyone who wanted to avoid out-of-pocket healthcare costs. However, changes in Medicare policy have limited its availability to those who were eligible before January 1, 2020.

If you’re already enrolled in Plan F, you can continue to enjoy its benefits. However, for those new to Medicare, Medigap Plan G is the most similar option, providing nearly identical coverage with the exception of the Medicare Part B deductible.