Hand holding the letter F; medicare plan f

New enrollment for Medicare Supplement Plan F for qualified individuals ended on December 31, 2019. But if you’re currently enrolled in Plan F, you have the opportunity to keep your plan or you can compare your options and change plans.

Medicare Supplement Plan F was one of 10 standardized Medigap plans created to help with the out-of-pocket costs not covered by Medicare Parts A and B. Standardized means that the plans were designed to offer the same benefits regardless of where you buy, with the exceptions of Massachusetts, Minnesota, and Wisconsin, where plans were set up differently.

This article provides a comprehensive look at Medicare Plan F to help you decide if you want to keep your current Medicare Supplement Plan F or switch to another available option.

Is Medicare Plan F Being Discontinued?

No, Medicare Plan F is not being discontinued, but it is no longer an option for those who are new to Medicare.  The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) prevented Medicare Supplement plans (F and C, specifically) from providing coverage for Part B deductibles. As a result of this legislation, Medicare beneficiaries  who become eligible after December 31, 2019, will not have access to Medicare Supplement Plan F coverage, unless they have a Medicare Part A effective date prior to 2020.

However, beneficiaries who became eligible for Medicare before January 1, 2020, are able to keep Plan F coverage or enroll in a new Plan F policy.

What Does Medicare Supplement Plan F Pay For?

Medicare Supplement Plan F is the only plan that covers all Medicare Supplement insurance benefits. The following are the benefits available with Medicare Supplement plans. “Yes” means that Plan F covers 100% of this benefit.

Medigap Benefits
Click to view expanded chart
Covered Under Plan F Purpose of Coverage
Part A coinsurance and hospital costs up to an extra 365 days after Medicare benefits are used up Yes If you’re admitted to the hospital for more than 90 days, you pay $682 in coinsurance for each “lifetime reserve” coverage day you have. Your Medicare benefits are used up when you run out of lifetime reserve days, at which time your Medicare Plan F benefits kick in.
Part B coinsurance or copayment Yes This benefit helps pay your share of the cost for covered medical services, which is usually 20% of the Medicare-approved amount.
Blood: first 3 pints Yes Unless blood is donated to you, you pay for the first three units of blood you get in a calendar year that a hospital or provider has to buy for you. This benefit helps cover the hospital or provider costs.
Part A hospice care coinsurance or copayment Yes This benefit helps pay the 5% coinsurance of the Medicare-approved amount for inpatient respite care and/or the copayment of up to $5 for each prescription and other pain relief products you get while under hospice care.
Skilled nursing facility (SNF) care coinsurance Yes This benefit helps pay the coinsurance amount for days 21-100 of SNF care, which is $170.50 per day for each benefit period.
Part A deductible Yes The plan pays your Part A hospital insurance deductible, which is $1,364 in 2019 for each benefit period.
Part B deductible Yes This plan covers the annual Part B medical insurance deductible, which is $185 in 2019.
Part B excess charge Yes A provider who doesn’t accept the Medicare-approved amount for a covered service as full payment can charge you extra. Medicare Supplement Plan F is one of the few plans that covers this charge
Foreign travel exchange up to plan limits 80% This benefit has a lifetime limit of $50,000 to help pay the costs for certain emergency care you receive outside the U.S. after you’ve paid a $250 annual deductible.
Out-of-pocket limit N/A Some Medigap plans have an annual out-of-pocket limit that you must meet before the plan begins to pay all the costs for covered services. This doesn’t apply to Medigap Plan F. An out-of-pocket limit is different from a deductible.

What Doesn’t Medigap Plan F Cover?

  • Prescription drug coverage: Medicare Supplement policies sold after January 1, 2006, do not cover prescription drugs. Original Medicare doesn’t cover prescriptions either. So, you can only get Part D prescription benefits if you enroll in a Medicare Part D prescription drug plan or buy a Medicare Advantage policy that includes coverage for prescription drugs.
  • Supplemental health benefits: Like other Medigap plans, Medicare Supplement Plan F doesn’t include coverage for things like hearing aids, vision and dental care, long-term care, and private-duty nursing. You can get some of these benefits through a supplemental health insurance plan or through Medicare Part C, also known as Medicare Advantage.

Other Things to Know About Medicare Supplement Plan F

  • New enrollment isn’t available: This plan has been discontinued as of December 31, 2019. If you already have Medicare Supplement Plan F, you’re all set. But this plan is no longer available for new enrollments.
  • You can’t have both Medigap and Medicare Advantage: If you have a Medicare Advantage plan and want to enroll in Medicare Supplement Plan F, you must first make sure you can leave your plan and return to Original Medicare before your Medigap coverage begins.
  • You can’t have Medigap if you have a Medicare MSA plan: An insurance company cannot legally sell you a Medigap policy if you have an MSA (medical savings account) plan through Medicare.
  • Medigap Plan F has a separate premium: The premium you pay for Medigap Plan F is completely separate from the monthly premium you pay for Medicare Part B. Medicare premiums are billed directly through the Medicare program, while Medicare Supplement insurance premiums are billed through the company that sold you the plan.
  • Guaranteed renewability: Medicare Supplement plans (F included) are guaranteed renewable, regardless of any health problems you may have. As long as you pay your premiums on time, an insurance company cannot cancel your policy.
  • Covers one person: You can only buy a Medicare Supplement policy for yourself. Your spouse would have to buy his or her own policy to get Medicare Plan F coverage.
  • No networks: You can use your Plan F or Plan F+ coverage nationwide at any provider that accepts Medicare.
  • High-deductible Plan F: The high-deductible version of Medicare Plan F has a lower monthly premium and higher out-of-pocket expenses. You pay for Medicare-covered costs up to the $2,340 ($2,370 in 2021) before the plan begins to pay for anything. If you currently have Medicare Supplement Plan F, you can switch to high-deductible Plan F by contacting your insurance provider.

Medicare Supplement Plan F Comparison: Plan F Versus Other Plans

To understand the benefits of Medigap PLan, it helps to do a side-by-side comparison with other plans. The chart below shows the percentage rate at which benefits are covered under each plan. Sections with “No” means the plan does not cover that benefit. You will notice that Plan C and Plan G are the most similar to Medicare Supplement Plan F in terms of the level of coverage available. The only differences are:

  • Plan C does not cover Part B excess charge while Plan F covers at 100%.
  • Plan G does not cover Part B deductible while Plan F covers at 100%.

You will also notice that Plan K and Plan L provide the least amount of coverage—many benefits are covered at less than 100% and some have no coverage at all. Plus, those plans have out-of-pocket limits.

Medigap Benefits Plan A Plan B Plan C Plan D Plan F Plan G Plan K Plan L Plan M Plan N
Part A coinsurance and hospital costs up to an extra 365 days after Medicare benefits are used up 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%***
Blood: first 3 pints 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care coinsurance No No 100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible No 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible No No 100% No 100% No No No No No
Part B excess charge No No No No 100% 100% 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 $5,560 $2,780 N/A N/A
**The plan pays 100% of the costs for covered services for the calendar year after the out-of-pocket yearly limit and yearly Part B deductible has been met.

***Plan N’s Part B coinsurance is covered at 100%, except for up to $20 in copayment for some doctor’s office visits and up to $50 in copayment for emergency room visits that don’t require inpatient admission.

The Advantages of Medicare Supplement Plan F

Senior man looking up at skyMedicare Supplement Plan F’s main advantage is that it covers all the Medigap benefits—some of which only a few other plans cover. For instance, Medigap Plan F is the only that covers both your Part B deductible and Part B excess charge. You could pay an excess charge of up to 15% more than the Medicare-approved amount to a provider who doesn’t accept Medicare assignment. (An assignment is when a provider accepts the Medicare-approved amount as full payment.) While most providers accept assignment, there are some who don’t accept assignment for all services covered under Medicare.

Having the most comprehensive coverage often means paying a higher monthly premium than you would with other plans—unless you go with the high-deductible Plan F option. If you do choose this option, there’s still that $2,340 deductible ($2,370 in 2021) to think about. Look at it is like this: Would you rather pay a specific monthly premium (and deductible, if applicable) to get the most coverage, or not know how much you may pay out-of-pocket for certain expenses like excess charges?

Explore Your Medicare Supplement Options

If you aren’t sure whether Original Medicare covers all your needs or if you want to see what could be available outside of your current Medicare Supplement Plan F, get your free FitScore®. HealthMarkets’ FitScore Forever® technology can help match your healthcare needs to the best Medicare Supplement plan for you. After answering a few questions about yourself, FitScore Forever can find top recommended plans based on your answers. Then, we’ll continuously compare plans for you, and notify you if a better option for your needs becomes available, all at no cost to you.

HealthMarkets is here to help. Get started.

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References

https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html | https://www.bankrate.com/financing/retirement/medigap-plan-f-the-most-costly-yet-popular/ | https://www.dfs.ny.gov/consumer/medplan/medplanp.htm | https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html | https://www.medicare.gov/coverage/blood.html | https://www.medicare.gov/coverage/hospice-and-respite-care.html | https://www.medicare.gov/coverage/skilled-nursing-facility-care.html | https://www.medicare.gov/your-medicare-costs/part-a-costs/assignment/costs-and-assignment.html | https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html | https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html#collapse-2283 | https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap | https://www.cms.gov/Medicare/Health-Plans/Medigap/FandJ | https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs | https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance | https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

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