From January 2020, Medigap Plan F will not be available to people who are new to Medicare. People can keep Plan F if they were already enrolled.
This article will describe Medigap Plan F, including its availability, coverage, enrollment, and options. It also provides a comparison with Plan G.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Starting from January 1, 2020, Medigap Plan F (and Plan C) will not be available to people who are new to Medicare. These people are those who turn 65 on or after January 1, 2020, or get Medicare Part A on or after January 1, 2020.
However, if a person previously had Medicare Plan F, or the high deductible version of Plan F, before January 1, 2020, they can keep their plan.
Also, if a person who was eligible for Medicare before January 1, 2020, has not yet enrolled, they may be able to buy Medigap Plan F.
The reason for the changes is because as of January 1, 2020, Medigap plans no longer cover the Part B deductible for people new to Medicare.
Although private insurance companies sell Medigap plans, Medicare requires these plans to offer standardized coverage.
A person can only have Medicare Part F if they have original Medicare. If a person has Medicare Advantage, they cannot have Medigap coverage in addition.
Also, each Medigap policy is individual, and spouses cannot buy one policy to cover both people.
Plan F benefits
Plan F coverage includes:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- blood (first 3 pints)
- Part A hospice care coinsurance or copayment
- skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charge
- foreign travel exchange (up to plan limits) at 80% of costs
In comparison with other Medigap plans, Medigap Plan F is one of the most comprehensive in terms of coverage. One of the few aspects that this Medigap plan does not cover is an out-of-pocket limit.
However, plans K and L create an out-of-pocket limit. In 2021, the out-of-pocket limit for Plan K is $6,220, and the limit for Plan L is $3,110. After a person reaches this limit, their Medigap plan will cover any future costs.
High deductible plan
In some states, a person may be able to purchase Plan F as a high deductible plan. This means that a person will pay for their Medicare-covered costs up to a deductible, which is $2,370 for policyholders in 2021.
Medicare Plan G is similar to Medicare Plan F and is still available to new Medicare enrollees.
This plan offers the same benefits as Medicare Plan F, except that it does not pay the Medicare Part B deductible.
As with Medicare Plan F, some states offer Medicare Plan G as a high deductible plan. For 2021, the deductible amount is $2,370.
Medicare requires Medigap plans to be standardized, but health insurance companies do not have to charge a standard premium for the policies. Insurance companies may quote a person different rates for the same plan.
When a person first signs up for Medicare, they can sign up for a Medigap plan, and the plan cannot take into account their preexisting medical conditions.
After the initial Medicare enrollment period, a Medigap insurance company can require a physical examination or review of a person’s health history before qualifying.
Also, after the Initial Enrollment Period (IEP), a Medigap plan does not have to accept a person into the plan.
The average monthly cost for Medicare Plan F depends on where a person lives and at what point in their life they are applying for Medigap.
While a person who is new to Medicare can no longer purchase a Medicare Plan F plan, they can purchase other plans in several ways:
- Search for available Medigap plans online at Medicare.gov.
- Contact an insurance company directly to ask about Medigap plans.
- Call Medicare at 800-MEDICARE (800-633-4227) to find out about available plans.
A person must contact a Medigap plan company individually before purchasing a Medigap policy.
Medicare Plan F is no longer on offer to people new to Medicare as of January 1, 2020. Changed Medicare regulations state that Medigap policies cannot pay for the Part B deductible.
People who turn 65 on or after January 1, 2020, or get Medicare Part A on or after January 1, 2020, can no longer get Medigap Plan F.
People who already have Medigap Plan F can keep their plan.
A person does not have to purchase a Medigap plan to have a Medicare policy.