Medicare Plan F

Overview

Medicare Supplement Plan F, also known as Medigap Plan F, is renowned for its comprehensive coverage. It fills all the gaps in Medicare, covering deductibles, copays, and coinsurance. This makes it an attractive choice for beneficiaries who want minimal out-of-pocket costs for Medicare-approved services.

However, Plan F was phased out for those who became eligible for Medicare on or after January 1, 2020. For those eligible before this date, Plan F remains an option, providing unmatched coverage. For newer beneficiaries, Medigap Plan G has emerged as the most comprehensive alternative.

Why Choose Plan F?

Key Benefits

Plan F’s popularity stems from its “first-dollar coverage” design. Once Medicare pays its portion of a claim, Plan F covers the rest, ensuring beneficiaries pay $0 out-of-pocket for Medicare-approved services.

Plan F offers:

• Complete Coverage: Includes Part A hospital and Part B outpatient deductibles, copays, and coinsurance.
• No Excess Charges: Covers Part B excess charges, ensuring doctors cannot bill beyond Medicare-approved amounts.
• Nationwide Access: Freedom to choose any doctor or specialist in the U.S. who accepts Medicare.
• No Referrals Required: Allows direct access to specialists without primary care referrals (though some offices may still require them).
• Guaranteed Renewability: Policies cannot be canceled due to health conditions or high claim usage.

Real-World Example

Consider Gracie, a Medicare Plan F beneficiary:

• She visits a specialist for knee issues, undergoes an MRI, and eventually requires knee replacement surgery.
• Her total medical costs, including hospital stay and follow-up care, amount to $70,000.
• Medicare covers 80%, and Plan F pays the remaining $14,000.
• Gracie’s out-of-pocket costs? $0, aside from her monthly Plan F premium.

How Much Does Plan F Cost?

Factors Affecting Premiums

The monthly premium for Plan F varies based on factors such as:

• Location: Rates differ by state and zip code.
• Age and Gender: Older individuals and males often face higher premiums.
• Tobacco Use: Smokers typically pay more.
• Household Discounts: Some insurers offer reduced rates for multiple policies within a household.

Typical Costs

In many areas, a 65-year-old female might pay between $120 and $140 per month for Plan F. Males and tobacco users can expect higher rates. Regularly comparing premiums between insurers is essential, as benefits are standardized across companies, but costs are not.

Annual Reviews

Plan F rates can change annually, making it beneficial to review your policy each year. If costs rise significantly, consider comparing rates with other insurers or exploring alternative plans, such as Plan G.

Plan F vs. Plan G

Medigap Plan G is often compared to Plan F, as it offers similar coverage with one key difference: Plan G requires beneficiaries to pay the annual Part B deductible themselves. This deductible is $240 in 2025.

Savings Opportunity

While Plan F eliminates all out-of-pocket costs, Plan G’s lower premiums can result in annual savings of $200 to $300 compared to Plan F. Many beneficiaries find this trade-off appealing, especially when working with a licensed agent to identify the most cost-effective option.

Switching Medigap Plans

Underwriting Requirements

Switching from Plan F to another Medigap plan often requires medical underwriting in most states. However, some states offer special enrollment periods that allow beneficiaries to change plans without underwriting.

Considerations

If you’re already on Plan F but find premiums increasing, check if your state offers guaranteed issue periods or alternative cost-saving measures.

Takeaways

• Medicare Plan F offers unparalleled peace of mind with its comprehensive coverage and zero out-of-pocket costs.
• It remains available to those eligible for Medicare before January 1, 2020.
• Beneficiaries should review Plan F premiums annually and compare costs with alternative plans like Plan G to ensure long-term savings and affordability.
• Licensed agents, such as those at Boomer Benefits, can help you navigate your options and find the best plan for your needs.