Medicare Plan F covers many of the cost “gaps” in Medicare Part A and Part B. These can include deductibles, copayments, and coinsurance.
Medicare Plan F is a Medigap policy. These policies help people pay some of the extra expenses of Medicare Part A and Part B.
Together, Medicare Part A and Part B are called Original Medicare. Part A covers hospital expenses, and Part B covers other medical expenses.
However, as of January 1, 2020, Medigap policies can no longer pay for the Medicare Part B deductible. As Medicare Plan F covers the Medicare Part B deductible, it is not available to people who have only become eligible for Medicare after this date.
In this article, learn more about Medicare Plan F, including who is eligible, what it covers, the costs, and how to enroll.
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.
Medicare Plan F is one of the Medicare Supplement Insurance plans called Medigap. Each of the Medigap policies is standardized and must follow federal and state laws. Private insurance companies offer the insurance plans.
All Medicare Plan F plans offer the same benefits, but not all plans cost the same amount. Each insurance company can set its premiums and may provide more benefits.
Not all insurance companies offer Medigap policies in every state. However, if companies offer Medigap policies, they must offer Plan A, Plan C, and Plan F. Offering other Medigap plans is not compulsory.
People become eligible for all Medigap policies during the Medigap Open Enrollment Period. The open enrollment starts in the month a person turns 65 and ends 6 months later.
To be eligible, a person must also have enrolled in Medicare Part B. During the Medigap Open Enrollment Period, insurance companies must offer a policy even if a person has a preexisting health condition.
Private insurance companies can use medical underwriting if a person waits until after the Medigap Open Enrollment Period to enroll. This process estimates how much a person may cost an insurance company based on age and medical conditions.
A person may not qualify for a Medigap policy after the Open Enrollment Period.
Before January 1, 2020, everyone was eligible for Medicare Plan F. However, Medigap policies can no longer pay for the Medicare Part B deductible. Therefore, people new to Medicare can no longer get Medicare Plan F.
Standardized benefits include the Medigap Plan F options that state and federal law allow. Some private insurance companies offer more benefits.
The standard benefits that all Medigap Plan F policies offer include:
- Part A hospital costs for an additional 365 days after the end of Medicare benefits
- Part A coinsurance for an additional 365 days after the end of Medicare benefits
- Part A hospice coinsurance or copayments
- Part A deductible
- Part B coinsurance or copayments
- Part B deductible
- Part B excess charge
- skilled nursing facility coinsurance
- blood (first 3 pints)
- foreign travel — 80% of expenses up to the plan limit
Medicare sets a limit for allowable charges for services or procedures. In some states, a doctor can charge 15% more than Medicare allows. This cost is a Part B excess charge. If a Medigap policy does not pay for excess charges, the person is responsible for the charge out of pocket.
Private insurance companies set the cost of Medigap policies. Each company can decide whether they will offer Medigap policies in the state in which a person lives.
If more benefits become added to the policy, its cost may be higher. Some states offer high deductible Medicare Plan F policies.
People can use the Medicare Plan Finder to find the average cost of Medicare Plan F policies in their zip code. This tool allows people to see which companies are offering policies and their contact information and premiums.
People who have worked and paid Medicare taxes for 10 years or more do not need to pay for Medicare Part A.
However, those who have worked for less than 10 years must pay a premium. If a person has worked and paid Medicare taxes for between 7.5 and 10 years, the premium is $252 per month. If the duration is less than 7.5 years, the premium is $458 per month.
Everyone must pay a premium for Medicare Part B, and their income will determine the amount. The base rate paid by most people is $144.60 per month.
A person can enroll during the Initial Enrollment Period. If they delay enrollment, they may pay the penalty on the premium for Part B. This may also apply to Part A if they do not get it for free.
Starting January 1, 2020, people new to Medicare cannot enroll in Medicare Plan F. If a person enrolled in Medigap Plan F before this date, they can keep their policy.
If a person was eligible for Medicare before January 1, 2020, but did not enroll, they may still qualify.
Once a person’s Initial Enrollment Period has passed, they may pay the penalty for Parts A and B. This penalty will not include Medigap Plan F.
However, after the Medigap Open Enrollment Period, the insurance company may deny coverage.
To enroll in Medicare Plan F, a person must determine whether they are eligible and whether it is available in their area.
They can use the Medicare Plan Finder or contact the State Health Insurance Assistance Program (SHIP) or State Insurance Department. These agencies can help determine which companies offer Medicare Plan F.
A person can choose an insurance company in their area that offers Medicare Plan F. The company can help the person find out whether they are eligible.
To enroll, a person must fill out an application. The company may not ask for family history or genetic testing.
Medicare Plan F is a Medigap Supplement Insurance Plan. It covers many of the out-of-pocket expenses of Medicare Part A and Part B.
Starting January 1, 2020, people new to Medicare cannot enroll in Medicare Plan F.
If a person enrolled in Plan F by January 1, 2020, and has continued to pay the premium, they can keep the policy. If a person became eligible for Medicare before January 1, 2020, they might be eligible for Plan F.