Beneficiaries who were Medicare-eligible before January 1, 2020, are eligible for Plan F.
Medicare Supplement Plan F pays and covers Medicare Part A and Part B deductibles/copayments.
Medicare Supplement Plan F pays the coinsurance for skilled nursing facility charges.
Medigap Supplement Plan F pays Part B excess charges, covering 15% more than the Medicare allowable costs.
Among the private insurance policies that supplement Medicare Part A and Part B, Medicare Supplement Plan F offers the most comprehensive coverage. As long as your medical provider accepts Medicare, the plan pays all the out-of-pocket expenses that remain after the Part A and Part B benefits have been applied—leaving you with no out-of-pocket costs.
Who Is Eligible for Medicare Supplement Plan F?
If your Medicare eligibility started prior to January 1, 2020, you are eligible to choose Medicare Supplement Plan F. Nonetheless, Medicare beneficiaries who are ineligible for Medigap Plan F can select from other supplemental alternatives, such as Plan G or Plan N.
What Medicare Part A and Part B-related Costs Does Medicare Supplement Plan F Cover?
Plan F offers the following benefits for 2022. However, you can expect the plan’s benefits to increase annually at the start of the calendar year.
Medicare Part A-related Benefits
Although Medicare Part A offers significant hospital coverage for seniors, there are still out-of-pocket expenses that you can anticipate once you receive inpatient care. Here are several benefits that Medicare Plan F offers to supplement your Plan A coverage:
- Deductible for days 1-60 of your inpatient hospital stay. You pay no deductible or coinsurance for the first 60 days of your inpatient stay.
- Coinsurance for days 61-90 of your inpatient hospital stay. From the 61st through the 90th day of your stay, the coverage includes $389 per day during the benefit period.
- Coinsurance for days 91 and onward of your inpatient hospital stay. After the first 90 days of your stay, Medigap Plan F pays the $778 daily coinsurance for your lifetime reserve days—which are the 60 additional days of inpatient care that Medicare offers during your lifetime.
- Payment for up to 365 days of your inpatient hospital stay after lifetime reserve days are exhausted. Once you have used your 60 lifetime reserve days, Plan F provides up to 365 additional days of inpatient hospital coverage.
- Blood. Plan F pays for the initial three pints. Medicare covers the fourth pint of blood and beyond.
- Payment for days 21-100 of your stay in a skilled nursing facility. Following a three-day stay in a hospital, Medicare Part A pays for your first 20 days in a skilled nursing facility. Plan F pays $194.50 per day from day 21 through day 100.
Medicare Part B-related Benefits
In addition to 20% coinsurance, Medicare Part B beneficiaries have multiple out-of-pocket costs. Here are the Part B-related expenses that Medicare Supplement Plan F covers:
- No deductible. Plan F pays the Part B yearly deductible.
- Coinsurance. Beneficiaries are still responsible for a 20% copayment after Medicare pays its allowable for physician services, durable medical equipment, and outpatient procedures. Medicare Supplement Plan F pays the 20% coinsurance.
- Excess charges. Medigap Plan F covers up to 15% of physicians’ charges that exceed Medicare’s approved allowable charges.
When Does Your Medicare Supplement Plan F Coverage Start?
Your Plan F coverage begins as soon as you make your first premium payment. There is no waiting period between the insurer’s receipt of your first payment and the start of your coverage.
Does Medicare Plan F Cover Prescription Drugs?
Medicare Supplement Plan F does not cover prescription medicines that your doctor prescribes for you to take at home. However, Plan F does cover the cost of prescription medications that you receive at a hospital.
How Much Does Medigap Plan F Cost in 2022?
Private insurers compete by offering Plan F at different prices, and since different insurance companies may serve different states, your price may vary depending on the following:
- The state that you live in.
- In most cases, you can expect to pay between $150 and $250 each month.
- Keep in mind that additional factors, such as your age, gender, and tobacco usage can affect your rates.
For some beneficiaries, the coverage may seem expensive. However, with Medicare Supplement Plan F, you pay little more than your insurance premiums for your medical care. Thus, you can budget for your medical services without worrying about surprise medical bills that you may be unable to afford.
Does Plan F Offer Lower Cost Options?
There is a high-deductible Medigap Plan F option with lower premiums. With this option, beneficiaries pay a deductible upfront in exchange for a lower rate. On average, High Deductible Medicare Supplement Plan F beneficiaries pay premiums of about $40 to $80 per month.
Are There Additional Medicare Supplement Plan F Options?
Innovative Medicare Supplement Plan F is a new supplemental policy that offers all the benefits of the standard Medigap Plan F but also includes vision and hearing benefits.
Will Plan F Coverage Cost More in the Future?
All Medicare Supplement Plans increase in cost each year. As you choose your Medigap plan, be sure to look at past rate increases to help you make a decision that meets your needs and fits your budget. In recent years, the average rate increases for Plan F have ranged between 3% and 6%.
Why Is Medicare Supplement Plan F Unavailable for Newer Beneficiaries?
The Centers for Medicare and Medicaid Services (CMS) discontinued Medicare Supplement Plan F for newer beneficiaries when the Medicare Access and CHIP Reauthorization Act (MACRA) passed. As a result, only beneficiaries who received Medicare before January 1, 2020, are eligible for standard Medigap Plan F, High Deductible Medigap Plan F, and Innovative Medigap Plan F.
When Can Beneficiaries Enroll in Plan F?
If you are eligible, you can enroll in Medicare Supplement Plan F whenever you are ready. Nevertheless, it is often best to sign up during your one-time Medigap Open Enrollment Period. When you enroll during this period, you are not required to answer any health questions.