Medicare Supplement Plan F Medigap

What Is Medicare Supplement Plan F

If you are new to Medicare, there is a chance you may not be aware that Original Medicare, known as Part A and Part B, could have you footing the bill for medical and hospital expenses such as coinsurance, copayments, and deductibles. Fortunately, there are ten standardized Medicare Supplement or Medigap plans offered in most states except for three, which are Massachusetts, Minnesota, and Wisconsin. Those states have their versions. These supplemental plans were created to help offset coverage gaps that Original Medicare may have.

Medicare Supplement Plan F or Medigap Plan F has been a favorite among many because it has the most robust benefits. However, there are insurance companies out there that may also provide a high-deductible alternative to Plan F. 

As stated in the name, it supplements your Original Medicare by covering some out-of-pocket expenses you may incur. It’s important to note that Supplement insurance like Plan F cannot be purchased by itself. Like all supplemental plans, Medicare supplement Plan F has been standardized by the federal government in most states. Regardless of your choice of carriers, you get the same coverage.

Once Medicare has paid its portion of the insurance claim, Plan F will pay for most of the remaining hospital and doctors’ costs, which is why it is so popular as it covers the most out-of-pocket expenses.

An additional plan is available called HD-F (High Deductible Plan F), which is offered for those willing to pay higher out-of-pocket costs in exchange for a lower monthly premium.

If you visit the doctor frequently or often have unpredictable medical costs, Plan F’s robust coverage could be the Plan for you. However, if you can afford to pay a little of the expenses associated with Medicare upfront, you should consider a high-deductible version of plan F. Here is a brief outline of both Medigap Plan F and the high-deductible Plan F, including the costs and covered benefits.

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What Are The Benefits of Medicare Supplement Plan F?

You can purchase Medigap plans through private insurance companies. An important thing to note about Medicare Supplement Plan F, as with the rest of the Medigap plans with letters next to their name, they contain benefits that are standardized in the majority of states. This means you’ll receive identical coverage no matter which company you purchase a Plan F from unless you are in the states with their versions which are Massachusetts, Minnesota, and Wisconsin.

A handful of insurance companies in some states offer a high-deductible version of Plan F. This high-deductible version of Plan F provides similar benefits as the Standard Plan. Still, you would pay all expenses for services covered by Medicare until you reach the deductible amount. 

Benefits Covered by Medigap Plan F 

To evaluate if Plan F is suitable for you, you must understand first what the benefits are. Here is a comprehensive list of benefits covered by Medicare Supplement Plan F and the high-deductible Plan F:

  • Medicare Part A coinsurance, plus hospital expenses up to 100% (up to an additional 365 days once Medicare benefits are exhausted)
  • The initial three pints of blood
  • Medicare Part B copayment or coinsurance up to 100%
  • Medicare Part A hospice care copayment or coinsurance up to100%
  • Medicare Part A deductible up to 100%
  • Skilled nursing facility care coinsurance up to 100%
  • Medicare Part B excess fees up to 100%
  • Medicare Part B deductible 100%
  • Foreign travel emergency care up to 80% of the plan limits
  • Medigap plans do not include prescription drug coverage if you want prescription drug coverage and have Original Medicare.

Please note you may not use your supplement plan for expenses linked to a Medicare Advantage plan; typically, you aren’t allowed to sign up for both types of plans.

Medigap Plan F covers 100% of your Medicare Part A deductible. Traditional Medicare will only cover the first 60 days of hospital stays, minus the deductible before paying the additional coinsurance.

For longer hospital stays exceeding 60 days, 61-90 days, then Medicare Plan F covers the coinsurance cost for the 61-90 day period before you have to pay additional coinsurance.

An additional 365-day hospital coverage will be added with Medicare Plan F if you exceed 90 days.

Additionally, this Plan covers the Medicare Part B deductible and 100% of excess charges, which are additional costs charged by some doctors. Traditional Medicare doesn’t pay for your first 3 pints of blood, but your Medicare Supplement plan will.

Traditional Medicare will not cover your foreign travel benefits. Plan F supplemental insurance covers overseas travel medical emergencies when traveling to different countries, provided coverage started during the first 60 days of leaving the United States.

Costs Associated with Medigap Plan F

Typically Plan F is the most expensive plan because it offers the most comprehensive coverage offered by the ten plans. However, this may not be the situation every time, and you should compare plans to find the best options for your needs and the area where you live. Although Medigap Plan F benefits are robust, not all Original Medicare costs may be covered. In addition, it is still up to you to pay the monthly premium for Medicare Part B. And those that haven’t been employed and worked for at least ten years may not be eligible for premium-free Medicare Part A; there is a chance you could have to pay for it.

Costs for Plan F are based on where you live and the carrier you choose. 

Some costs you may incur with the standard Plan F:

  • Monthly premiums (typically more than the high-deductible version of Plan F premiums)
  • Yearly deductibles (generally less than the high-deductible version of Plan F)
  • Coinsurance payments
  • Copayments 

Costs Associated with Choosing High-deductible Plan F

Expenses you may encounter with a high-deductible Plan F typically include monthly premiums; however, it is usually less expensive than a standard plan because you pay a higher deductible for services. If you pick a high-deductible plan, all out-of-pocket costs associated with Original Medicare are your responsibility up to a designated amount. Once that amount is reached, the policy kicks in.

It is possible to find a Medigap plan that costs less per month. However, if you go to the doctor all the time, need many healthcare-related services, or have high out-of-pocket costs, you should consider Plan F as it provides the most coverage for costs left behind by gaps in Original Medicare.

Just like other insurance, Medicare Supplement insurance premiums depend on the company. Therefore, it’s important to evaluate all options available to you to find a product at the price that fits your needs and budget. If you are considering a Medigap plan, it’s best to enroll during the Medicare Supplement Open Enrollment Period. This six-month window starts automatically when you turn age 65 or are older plus have Part B. 

The upside to enrolling during this time is that insurance companies providing Medigap insurance may not decline you for coverage. Even with pre-existing conditions or other health concerns. Once this window is closed, it could be more difficult to sign up for a Medicare Supplement plan or change plans with existing health problems.

What’s not included in your Plan F coverage?

While out of the ten different Medigap Plans, Plan F will offer you the broadest coverage. What’s important to know is if you still need to pay your Medicare Part B monthly payments.

If you don’t qualify for the premium-free Medicare Part A, then you might have to pay the Part A premium as well.

What if Medicare Supplement Plan F is too expensive for my budget?

For those who find the Medicare Plan F too costly for their budget, then Plan G might be a better option since it can be much cheaper than the Medicare Plan F depending on your location and save money on monthly premiums.

The difference between Plan F and Plan G is you must pay the Plan B premiums if you have Plan G.

One Plan may save you more money than the other, but this will depend on your health, personal preference, and budget for your current situation.

Medicare Supplement Plan F Enrollment Period

Anyone enrolled in Medicare Part B will then be eligible to enroll in one of the Medicare Supplemental plans or Medigap plans like Plan F. The most straightforward way for you to qualify for this coverage will be during your 6-month open enrollment period (OEP). This will begin for you on (the 1st day of the 1st month) which you have turned 65; or older, plus you are enrolled in Part B.

Enrolling during the Open Enrollment Period will automatically qualify you for a policy and guarantees you won’t be rejected or charged higher premiums for any pre-existing health conditions. Conversely, waiting to enroll after the OEP will cause the policy to be “medically underwritten,” resulting in higher premiums or problems in finding coverage. Use the chart below to compare Medigap Plan F to the other options available.

Medigap Benefits Medigap Plans
A B C D F* G* K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Part B deductible No No Yes No Yes No No No No No
Part B excess charge No No No No Yes Yes No No No No
Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $6,620 in 2022 $3,310 in 2022 N/A N/A

(source)

What is Going On With Medicare Plan F?

Approximately forty-nine million Americans currently rely on Medicare for their health coverage needs. Those currently enrolled in Medicare are well aware of the gaps in coverage by original Medicare. The vast majority of qualifying enrollees who come under the Medicare umbrella opt to purchase additional coverage in the form of a supplemental plan, or Medigap as it is also called. In fact, in 2010, approximately twenty percent of those who enrolled in Medicare opted for an additional plan to cover gaps in Medicare coverage.

Those who are turning sixty-five by 2020 will face a significant change in coverage options. One of the most talked-about changes coming up is eliminating Medigap Plan F. Yes, Plan F is going away, but not immediately and not for everyone. So the logical, natural next question a lot of people are asking is:

What is happening with Medigap plan F?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) puts an end to the sale of any supplemental policy that provides coverage for the deductible of Medicare Part B after January 1st, 2020. This change will affect two plans that cover plan B deductible,  Plan C and F. However, this only affects new enrollments. Those who now have a supplemental Plan C or F get to keep it. That is good news.

Currently, Medicare Supplemental Plan F, also known as Medigap Plan F, has been the most popular of the supplemental plans because of its comprehensive coverage for parts that are not covered by Medicare alone.

Let’s do a brief review of what plan F covers. The Plan covers 100% of Part B coinsurance or copayment. There are a total of eight plans that also offer the same coverage. Only Plan F and Plan G also cover Medicare Part B excess charges. Excess charges are fees added by doctors who do not accept Medicare assignment rates. Plan F also covers 100% of Medicare Part A coinsurance and hospital costs for up to a year, beyond the time when Medicare benefits have been exhausted. It also covers 100% of foreign travel emergencies within plan limits.

Plan F also covers 100% of the first three pints of blood, Part A hospice care coinsurance and copayments, and skilled nursing facility coinsurance, all of which are gaps in original Medicare coverage. As you can see, Plan F is a very robust supplemental plan, hence the reason it has been called “The Cadillac” of additional plans. The more reason those who currently have the plan will be happy to know that they get to keep it.

Why is Plan F being phased out?

Medical service providers expect to be adequately compensated for their services. 

However, Medicare limits the amount that doctors can charge for specific services, which does not sit well with the medical community. As a result, many suggested that they may cease to participate in Medicare altogether. Congress, in turn, passed MACRA, the law that transformed how Medicare doctors are compensated for services to maintain an acceptable level of medical care for the Medicare recipient community.

Ensuring that quality care is offered to Medicare recipients comes at a cost, an estimated two hundred billion over the next decade. So the government now faced a new problem; where would the funds come from to cover the additional expense of paying the doctors more? Congress figured out that by ending supplemental plans, such as Plan F and C, that provided deductible coverage, they could make up for some of the additional expense of coverage.

Currently, those with plan F get first-dollar coverage. Medicare covers the first eighty percent from the very start, then Medigap plan F kicks in and pays the deductible plus the remaining twenty percent. The patient then pays zero money for their doctor visits.

Those that oversee the budget were concerned that with such an arrangement, no cost-sharing by the patient would make it easy for people to run to the doctor for unnecessary visits. They then determined that all Medicare Beneficiaries must be subject to a deductible.

What are the alternatives if Plan F is going away?

For those eligible for Medicare on January 1st, 2021, and after- there are still options to reduce out-of-pocket expenses for medical care:

  • Choose from the several Medigap plans that will still be available. One of the better alternatives is Plan G which covers everything Plan F covers except Medicare part B deductible.

Plan D is also quite comprehensible, covering the same thing Plan G covers, less the Part B excess charges, which are covered by the current plan F and G. If you carefully consider your options, you can find good coverage for the things that matter. Take hospitalization, for instance; ALL Medigap plans offer the extra protection you need to cover in case of an extended hospital stay. In addition, they all have the additional 365 days of coverage after Medicare’s base Plan runs out.

  • Consider Medicare Advantage.

There are two ways in which you can get your Medicare coverage – The Original Medicare Plan (Part A and Part B), and there is also Medicare Advantage (Part C), which is provided by private insurance companies and includes Hospital Insurance as well as Medical Insurance. These plans come in the form of HMOs or PPOs.

You will also need to decide on Prescription Drug Coverage (Part D). Again, whether you go Original Medicare or MA (Medical Advantage), you will need to make provision for this coverage if you foresee yourself making use of it. Fortunately, Medical Advantage plans have built-in drug coverage plans if you opt to go that route.

What will happen to Plan F rates after 2020?

Many of those currently enrolled in Plan F are concerned about rate increases, and rightfully so. Some carriers may increase the cost of the plans. Costs, of course, vary by factors such as Zip code, Gender, and use of tobacco status. Fortunately, it is an open marketplace. Since the Plan must offer the same coverage and benefits across all carriers, but not at the same price, enrollees grandfathered into the Plan can shop carriers for the best price. 

The best course of action is to speak with a qualified professional who can guide you to make the best decision for your specific needs. 

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