I. Coverage Under Medicare Plan F

Medicare Plan F is one of the most comprehensive plan options and covers almost everything omitted by standard Medicare, including deductibles for Medicare Parts A and B. While more expensive than virtually all other alternatives due to the extensive coverage, Medicare Plan F remains the most popular supplement plan for seniors who can afford a higher level of care. The costs covered under Plan F include:

  • Part A deductibles and coinsurance costs, including hospital costs up to 365 days after benefits are used
  • Part A copayments and coinsurance for hospice care
  • Part B deductibles, coinsurance, copayments, and excess charges
  • Coinsurance for skilled nursing facilities
  • Emergency travel coverage
  • First three pints of blood in an approved medical treatment

Most major insurance providers offer Medicare Part F, so there are a range of opportunities for seniors interested in shopping around. As outlined above, the benefits are extensive, providing coverage for a majority of out-of-pocket costs not included in any of Medicare’s official Parts or in the majority of other Medigap policies.

Part A Coverage

Plan F covers many Part A expenses that are outside of what Medicare itself covers. Part A is the hospitalization aspect of Medicare, covering time spent in a hospital environment for diagnoses and treatments. In most cases, Medicare Part A pays for 80% of approved hospitalization costs, with the remaining 20% charged to the patient. For substantial procedures, the remaining 20% can be a significant amount, leaving seniors with a large bill following care.

Medicare Plan F can cover these expenses, paying the 20% coinsurance cost not paid by Medicare, as well as any deductibles associated with hospital care. Plan F can also pay for hospital coverage for up to a year after standard Medicare benefits are exhausted, which can be an advantage for those facing long-term care. Part A gap coverage also includes extra costs associated with hospice care and the first three pints of blood needed for medical treatments.

Part B Coverage

In addition to covering shortcomings in Medicare Part A, Plan F also includes expenses associated with Medicare Part B — Medicare coverage of doctor visits with approved providers. As with Part A, Medicare only covers 80% of these expenses, leaving the patient to pay for the remaining 20%. Plan F coverage pays for the remaining coinsurance, an amount that can be significant for seniors who see doctors regularly due to chronic or ongoing medical conditions.

In addition to coinsurance, Plan F also covers other Part B expenses, including copayments, deductibles, and doctor’s office fees outside of copays. Plan F is only one of two Medigap policy categories that covers excess Part B costs; Plan G is the other policy.

II. Eligibility for Medicare Plan F

Currently, Medicare Plan F is an option for anyone eligible for standard Medicare as of 2019 or earlier. These individuals can sign up for Plan F in a similar way as all other Medigap policies.

For individuals who reach Medicare eligibility after January 2020, however, the situation is somewhat different. As a result of the Medicare Access and CHIP Reauthorization Act of 2015, after this date, Medicare Plan F won’t be an option for new Medicare participants. Supplemental plans for Medicare Part B coverage for excess expenses are being eliminated across the board for new Medicare enrollees, and no future plans will cover these Part B costs.

However, this change may not affect seniors who already qualify or who currently have plans. Seniors who already have Plan F will likely be able to maintain it, even into 2020. Individuals who were eligible before January 1, 2020, may also be able to apply for Plan F plans.

Seniors who are interested in a similar plan but are no longer eligible for Plan F are encouraged to consider Plan G. This plan offers comparable benefits except for Part B deductible coverage, so it might be a good alternative for seniors seeking Plan F’s other advantages.

III. Enrolling in Medicare Plan F

Enrolling in Medicare in general can require substantial research, and this includes enrolling in Medigap supplemental plans. To receive the best pricing and ensure approval, applicants should enroll based on the government’s suggested timetable. If this isn’t possible, several different enrollment options are available for seniors considering Medicare Plan F.

Initial Enrollment

Initial enrollment takes place in the six-month period following enrollment in Medicare Plan B, which can occur as soon as an individual turns 65. This window allows new Medicare users to enroll in any Medigap policy sold in their state of residence, regardless of pre-existing health issues. During initial enrollment, underwriting disregards health issues, offering individuals who are in poor health the same prices for policies sold to healthy adults. Prices are lowest during this period, offering seniors the best chance to receive a low-cost Plan F supplemental plan. For individuals who expect to need comprehensive health care in the future, this is the best time to enroll in Medicare Plan F.

Note that this initial period won’t include Plan F for seniors newly eligible for Medicare after January 1, 2020. It may, however, include Plan F for seniors who were eligible for Medicare before this point but chose not to enroll immediately.

General Enrollment

After the initial enrollment period comes to an end, Medicare recipients have to apply for Medicare Plan F during the general enrollment period. Unlike traditional health insurance in which enrollment opens once a year, either through an employer or the Healthcare.gov exchange, Medigap policies can be purchased at any time.

However, during general enrollment, there’s no guarantee that an insurance company will sell a policy, particularly for individuals who are already in poor health and are likely to face significant medical treatment in the future. Each insurance provider has its own underwriting policies that govern approval and insurance rates. Seniors who are approved for Plan F will likely face higher costs during general enrollment than during initial enrollment because health is not taken into consideration within the six-month open enrollment period for new Medicare users.

Not all applicants are permitted to enroll in Medicare Plan F during general enrollment, but seniors are encouraged to shop around and obtain quotes from a variety of providers. Denial by one company doesn’t necessarily mean blanket rejection.

Special Enrollment

While Medigap policies are generally subject to individual insurance provider underwriting policies, certain circumstances fall under different approval criteria. Individuals who have guaranteed issue rights can buy a Medigap policy under enrollment policies similar to initial enrollment.

Also known as Medigap protections, guaranteed issue rights allow seniors who qualify under specific circumstances to access Medigap policies without discrimination against all preexisting health conditions. Some of these guaranteed issue rights cover:

  • Seniors with a Medicare Advantage plan that is withdrawing from Medicare or their plan no longer applies due to relocation
  • Seniors with Original Medicare who were covered by COBRA or a union plan that will no longer be in effect
  • Seniors with a Medicare SELECT policy who move out of the SELECT service area
  • Seniors who joined a Medicare Advantage or Program of All-Inclusive Care for the Elderly plan and choose to withdraw within the first year
  • Seniors who left a Medigap policy to enroll in a Medicare Advantage or SELECT policy and choose to withdraw within the first year
  • Seniors covered by Medigap policies from an insurance provider that goes bankrupt or otherwise terminates coverage through no fault of the insured
  • Seniors who leave a Medigap or Medicare Advantage plan due to being mislead by the provider

IV. FAQs

Who Should Use Medicare Plan F?

Medicare Plan F, as one of the most extensive Medigap options, is a good fit for many seniors who use Medicare. However, it isn’t right for everyone. Individuals best-suited for Plan F include patients who are:

  • Frequent Travelers: Due to the inclusion of emergency travel coverage, Plan F is a good choice for seniors who plan on extensive international travel. While not covered in full — Plan F pays up to 80% — this is among the best options offered in Medigap plans.
  • On a Fixed Income: Because medical costs fluctuate, it can be difficult to predict what sort of investment will be required in the future. Seniors on a fixed income can control costs with Medicare Plan F, keeping month-to-month expenses relatively flat. As premiums are generally reasonable, it’s possible for seniors to pay an affordable monthly amount as a preventative measure against high costs down the road.
  • Facing High Medical Expenses: During the senior years, it’s not uncommon for medical costs to accelerate. Individuals who are expecting costs to climb or are already facing chronic health conditions can mitigate the high cost of treatment with Plan F.

Who Shouldn’t Use Medicare Plan F?

Despite the advantages, Medicare Plan F isn’t right for everyone. Due to the comprehensive coverage, Medicare Plan F can be too much for some seniors. Patients who may not be a good fit for Plan F include seniors who are:

  • Relatively Healthy: For seniors with no health problems and none expected on the horizon, Plan F may provide too many benefits to the point that paying for expanded care is unnecessary.
  • High-Income with No Health Concerns: Seniors with no expected additional health care costs who have the means to pay for occasional expensive treatments may not need to incur the added expense of Plan F as a solely preventative measure.

How Much Does Plan F Cost?

Medicare Plan F costs can vary based on several factors, including state of residence, enrollment time frame, and, for individuals who applied outside of the initial enrollment period, the barriers of traditional underwriting. In general, Medicare Plan F costs range from around $150 to $250 per month. These costs may be higher for seniors living in high-income areas – like Manhattan, for example – or who chose not to enroll during initial enrollment. Plan F policies are not guaranteed, and all applicants may not qualify for approval.

Who Sells Medicare Plan F Insurance?

Medicare Plan F insurance plans are sold by private providers in the same way as other Medigap plans. It’s important to note that Medigap providers do not need to sell all plans; in most cases, insurance providers can pick and choose which plan options they list. However, most have Plans C and F because laws mandate that these plans must be available if any Medigap plans are provided.

Be aware that the number of providers offering Plan F is likely to diminish after January 2020 because this supplemental insurance will no longer be available to new Medicare enrollees.