What is covered under Plan F?

what is medicare insurance

Because of its popularity, most Medigap carriers sell Plan F. The details of the plan will remain the same no matter where it is purchased though the cost might vary.

The following is a list of costs and benefits covered by Medicare Supplement Plan F:

  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Preventative care Part B coinsurance
  • Part A hospital and coinsurance costs up to an additional 356 days after Medicare benefits are exhausted
  • Part B coinsurance or copayment
  • First three pints of blood used in an approved medical procedure (annually)
  • Part A hospice care copayment or coinsurance
  • Skilled Nursing Facility (SNF) coinsurance
  • Foreign travel emergency

Medicare Supplement Plan F may offer expansive coverage, but it does not cover everything. Under Plan F, beneficiaries are still required to pay their Medicare Part B premium payments each month. Additionally, it is possible to have Medicare Part A without a monthly premium if the beneficiary has worked and paid Social Security taxes for at least 40 calendar quarters (10 years). Otherwise, a monthly premium for Part A coverage is also required. These costs are not covered under Medicare Supplement Plan F.

What are the costs associated with Plan F coverage?

Plan F costs will vary depending on the carrier.

There is also an additional high deductible Plan F option. This variation on the standard Plan F requires beneficiaries to pay out-of-pocket expenses for the first $2,070 in charges, after which Plan F will kick in and start paying for coverage. There is no change to the list of coverage under this high deductible plan; it is simply a cheaper alternative to the standard Plan F.

Other Medicare Supplement plans are available at lower costs, but the details of Plan F make it an attractive option for those facing high out-of-pocket costs and need regular medical attention.

8 things to know about Medigap policies 

  1. You must have Medicare Part A and Part B.
  2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy


  3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  8. It’s illegal for anyone to sell you a Medigap policy if you have aMedicare Medical Savings Account (MSA) Plan.

Medigap policies don’t cover everything

Medigap policies generally don’t cover long-term care. vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren’t Medigap

Some types of insurance aren’t Medigap plans, they include:

  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
  • Veterans’ benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans

Dropping your entire Medigap policy (not just the drug coverage) 

If you decide to drop the entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

If you drop your entire Medigap policy and the drug coverage wasn’t creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.

Source: whatismedicareinsurance.com

Category: Insurance

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