Medicare Plan F

We all know that Medicare is a sea of various letters, acronyms, and code words. All this jargon can be confusing and intimidating. This is especially true when considering the multiple Parts and Plans of Original Medicare and the coverage available from private insurance companies. In this short article, we’ll dive into the details of Medicare Plan F. We’ll see how this name is a bit of a misnomer but that the plan itself provides stellar coverage.

Is Medicare Plan F a Real Thing?

To be technical here, no, Medicare Plan F does not exist. People generally mean this is Medicare Supplement Plan F. Or Medigap Plan F. Plan F refers only to one specific standardized Medicare Supplement plan. Now that we’ve directly answered this question, let’s look into some of the details of Medicare Supplement Insurance and Plan F specifically.

What is Medicare Supplement Plan F?

Now that we know that this plan is more accurately known as Medicare Supplement (Medigap) Plan F, we can talk about how this plan helps you pay less for health care.

Plan F is a standardized Medicare Supplement Insurance plan, which means that the terms of the plan and its benefits are standardized across 47 of the US states (Michigan, Wisconsin, and Massachusetts have their laws for Medicare Supplement plans).

So, how do these plans work?

As the name suggests, they work by supplementing Original Medicare. These kinds of plans are not standalone coverages. Instead, Medicare Supplement plans cover what Original Medicare doesn’t cover for you. In this way, they close the “gaps” in Medicare, where the term Medigap came from.

What are the gaps in Medicare? This term refers to any amount you’re expected to pay out of pocket. These kinds of costs could include:

  • Deductibles
  • Co-payments or co-insurance
  • Emergency coverage outside of the United States

There are ten standardized Medigap plans, known by Plan letter; plans: A, B, C, D, F, G, K, L, M, and N. Each one of these standardized plans provides unique coverage of the Medicare gaps. Medigap Plan F is the most comprehensive plan available.

A Senior Businesswoman in a Taxi is happy with her Medicare Plan F policy.

What does Medicare Plan F Cover?

As the most comprehensive plan available, Medigap Plan F will cover 100% of these gaps in Medicare:

  • Part A coinsurance or co-payments for inpatient hospitalization
  • Up to 365 more hospital days than Original Medicare provides
  • Part B co-insurance
  • Your first three pints of blood
  • Part A hospice care coinsurance or co-payments
  • Skilled nursing care co-payments or co-insurance
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Emergency coverage outside of the United States

Every single possible gap is covered in full by Plan F. It is important to note, though, that this applies only to Medicare-approved services and procedures (except emergency coverage outside the US). If you have any procedure performed that is not covered by either Part A or Part B of Original Medicare, Plan F will not cover it; you will have to pay it out of pocket.

While Parts A and B provide very comprehensive coverage, there are several categories of treatments and procedures that are not covered and are therefore not surrounded by Plan F. This includes things that are cosmetic in nature, treatments for infertility, and other generally routine stuff like:

  • Most dental care
  • Routine vision
  • Routine foot care
  • Acupuncture
  • Hearing aids and exams

Everything else with a Medicare-billable code is covered by Plan F at 100%.

You can see how comprehensive this plan is. Assuming that you only use Medicare-approved services and procedures, you can reasonably expect to have zero out-of-pocket expenses for health care in any given year. This is one of the reasons that Plan F has become so popular over the years. Even though Plan F is generally the most expensive Medigap plan available (because it is so comprehensive), it provides an entirely predictable cap on your medical costs. Year after year, you can expect to avoid paying for medical expenses.

Can everyone get Medigap Plan F?

You might know that Medicare Supplement Plan F has “gone away” or isn’t available anymore. This is only partially true. It is true that due to a change in federal law, people who become eligible for Medicare after December 31, 2019, do not qualify for Plan F. However, Plan F continues to be available to everyone who became eligible for Medicare before that date. Even if you were eligible but didn’t enroll in Medicare before the cut-off date, this is true. For instance, if you were still working and covered by an employer plan. Or even if you were in Medicare, but surrounded by a different Medicare Supplement Plan, like Plan A, for instance. In these cases, you can still enroll in Medigap Plan F if you meet the underwriting requirements.

For people who become eligible for Medicare after this cut-off date, Medigap Plan G is the most comprehensive plan available.

When can you enroll in Medigap Plan F?

There is a quick answer to this question and a more complicated one. The short answer is that you can apply for it at any time of the year in most circumstances. The more complex answer is that it depends on your circumstances. There is an optimal time to apply for coverage.

The best time to enroll in Plan F is in your Medigap Open Enrollment Period. During this period, you have the right to enroll in any Medicare Supplement plan available in your state. You can’t be declined, and you can’t be charged a higher rate due to pre-existing health conditions.

A specific set of circumstances triggers this open enrollment period. It will only begin once you have satisfied both of these criteria:

  • You are 65 or older, and
  • You are enrolled in Medicare Part B

Your Medigap Open Enrollment Period can never start before you turn age 65, even if you enter Medicare before you turn 65 due to disability or illness. And, your enrollment period won’t begin until you enter Part B, even if you delay taking it for years because you’re still working and covered by your employer plan.

It should be noted that in some states, you won’t be able to enroll in Medicare Supplement Plan F (or any other Medigap plan) younger than 65. Some states will allow you to, but pre-65 coverage can be costly.

It is possible to enroll in Plan F once your open enrollment period has expired. For instance, if you initially chose Plan A years ago, you can still apply for Plan F if you want more comprehensive coverage. However, unless you qualify for a Guaranteed Issue period, you will have to go through Medical Underwriting. This means that you’ll have to answer health status questions, and the insurance company will investigate your health history. Your application may be declined, or you might be subject to a higher premium based on your health.

The final take on Plan F

We’ve seen that the notion of Medicare Plan F is a misnomer but that Medigap Plan F is a very comprehensive plan that will drastically limit your out-of-pocket costs for health care under Medicare. If you’re unsure if Plan F is still available to you, reach out to us today. We can help ensure you get the most of your rights under Medicare. We can also help you compare quotes for all the plans available in your area during a free consultation.