Medigap Plan F
Last Updated September 3rd 2016
Medicare Supplement Plan F, also known as Medigap Plan F is the most popular of all the standardized Medicare Supplement Plans. It offers the most comprehensive coverage and accounts for over 50% of all Medicare Supplement sales. There are nine benefits that can be covered by Supplemental Insurance, Medigap Plan F covers them all.
Medigap Plan F Cost and Rate Increases
Because a Plan F Medicare Supplement has the most comprehensive coverage of all the plans, it’s also the most expensive. There’s also a hidden cost. By having first dollar coverage, Plan F is often over utilized. Meaning, insureds see the doctor more often resulting in more insurance claims. Historically, Plan F tends to have higher rate increases over time when compared to other plans.
Medigap Plan G is very similiar to Medigap Plan F. The only difference is Plan G doesn’t cover the Part B Deductible. Due to not having first-dollar coverage, Medigap Plan G historically has had much lower rate increases.
Medigap Plan F is Being Phased Out in 2020
With the phasing out of Plan F in 2020, it may no longer be a good coverage option. If you own a plan prior, you will be able to keep it. However, new insureds will not be able to enter the plan. Over time, this could result in very large rate increases due to not having younger and healthier insureds to offset the costs.
What Does a Medigap Plan F Cover
- Medicare Part A Coinsurance (Hospital)
- Medicare Part B Coinsurance (Medical)
- Blood (First 3 Pints)
- Part A Hospice Care Coinsurance and Copay
- Skilled Nursing Facility Care Coinsurance
- Part A Deductible
- Part B Deductible
- Part B Excess Charges
- Foreign Travel Emergency
Medigap Plan F and Your Covered Medicare Part A Costs (Hospital) Per *Benefit Period
The following chart shows your coverage under Medicare Part A, along with your gap coverage with a Medicare Supplement Plan F and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.
Hospitalization
This includes semi-private room and board, general nursing, and miscellaneous services and supplies.
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| First 60 days | All but $1,288 | $1,288 Deductible | $0 |
| 61st through 90th day | All but $322 a Day | $322 a Day | $0 |
| During your 60 lifetime reserve days | All but $644 a Day | $644 a Day | $0 |
| Once lifetime reserve days are used, during your additional 365 days | $0 | 100% of Approved Expenses | $0 |
| Beyond the additional 365 days | $0 | $0 | All Costs |
Skilled Nursing Care
You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days of leaving the hospital.
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| First 20 days | All Approved Amounts | $0 | $0 |
| 21st Through 100th day | All but $161 a Day | Up to $161 a Day | $0 |
| 101st Day and after | $0 | $0 | All Costs |
Blood
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| First Three Pints | $0 | 100% | $0 |
| Additional Amounts | 100% | $0 | $0 |
Hospice Care
You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| Hospice Care | All but very limited coinsurance for outpatient drugs and inpatient respite care. | 100% | $0 |
* A benefit period begins when you receive services as an inpatient in a hospital. It ends after you have been out of the hospital and have not received skilled care in another facility for 60 consecutive days. All Part A copayments and deductibles start new with the beginning of each new benefit period.
Medigap Plan F and Your Covered Medicare Part B Costs (Medical)
The following chart shows your coverage under Medicare Part B, along with your gap coverage with a Medicare Supplement Plan F and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.
Medical Expenses in the Hospital or While Receiving Outpatient Treatment
This includes physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| First $166 of Approved Amounts | $0 | 100% | $0 |
| Remainder of Approved Amounts | 80% | 20% | $0 |
| Part B Excess Charges | $0 | All Costs | $0 |
Blood
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| First Three Pints | $0 | 100% | $0 |
| Next $166 of Approved Amounts | $0 | $166 Part B Deductible | $0 |
| Remainder of Approved Amounts | 80% | 20% | $0 |
Clinical Laboratory Services – Tests for Diagnostic Services
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| Lab Services and Tests | 100% | $0 | $0 |
Medigap Plan F and Your Covered Costs for Approved Home Health Care Service Under Both Medicare Part A and B
The following chart shows your coverage under Medicare Part A and Part B, along with your gap coverage with a Medicare Supplement Plan F and what your out-of-pocket costs would be. This does not include the premium amount for your Supplemental Plan.
Medicare Approved Home Health Care Services
| Medicare Pays | Medigap Plan F Pays | You Pay | |
|---|---|---|---|
| Medically Necessary skilled care services and medical supplies | 100% | $0 | $0 |
| Durable Medical Equipment First $166 | $0 | $166 Part B Deductible | $0 |
| Remainder of Approved Amounts | 80% | 20% | $0 |
Supplemental Plan F Benefit Comparison
*Plans K-N provide for different cost sharing.
*Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% for Plan K, and 75% for Plan L. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The annual out-of-pocket limit does NOT include costs from your provider that exceed Medicare-approved amounts (excess charges).
*Plan F is also offered as a high-deductible plan. With a high-deductible Plan F, you must pay for Medicare-covered expenses such as copays and deductibles up to $2,180 in 2016 before the policy pays anything.
*Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.
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