Plan F Gap Insurance

Medigap Plan F

Medigap Plan F

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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.

Medicare Resources IconMedigap 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

First introduced in 1992, Medigap Plan F covers all nine of the standardized Medicare Supplement benefits.
  • 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 PaysMedigap Plan F PaysYou Pay
First 60 daysAll but $1,288$1,288 Deductible$0
61st through 90th dayAll 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
$0100% of Approved Expenses$0
Beyond the
additional 365 days
$0$0All 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 PaysMedigap Plan F PaysYou Pay
First 20 daysAll Approved Amounts$0$0
21st Through 100th dayAll but $161 a DayUp to $161 a Day$0
101st Day and after$0$0All Costs

Blood

Medicare PaysMedigap Plan F PaysYou Pay
First Three Pints$0100%$0
Additional Amounts100%$0$0

Hospice Care

You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

Medicare PaysMedigap Plan F PaysYou Pay
Hospice CareAll 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 PaysMedigap Plan F PaysYou Pay
First $166 of Approved Amounts$0
100%$0
Remainder of Approved Amounts80%20%$0
Part B Excess Charges
$0All Costs$0

Blood

Medicare PaysMedigap Plan F PaysYou Pay
First Three Pints$0100%$0
Next $166 of Approved Amounts$0$166 Part B Deductible$0
Remainder of Approved Amounts80%20%$0

Clinical Laboratory Services – Tests for Diagnostic Services

Medicare PaysMedigap Plan F PaysYou Pay
Lab Services and Tests100%$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 PaysMedigap Plan F PaysYou Pay
Medically Necessary skilled care services and medical supplies100%
$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

Medigap Plan F Benefit Chart

Medigap Plan F Benefit Chart

*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.

Compare Other Medicare Supplement Plans

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Compare Medigap Plan F Rates and Availability

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