Medicare Supplement Plan F Benefits
- Medicare Supplement Insurance (Medigap) Plan F covers more benefits than any other Medigap plan, including the Medicare Part B deductible. Learn what benefits are covered by Medicare Supplement Plan F.
Medicare Supplement Plan F has been the most popular Medigap plan in recent years. So what does this plan cover that makes it so widely selected?
In short, Medicare Supplement Plan F – also called Medigap Plan F – is the only type of Medigap plan that covers all of the benefits that can be offered by one of the 10 standardized Medicare Supplement Insurance plans that are available in most states.
It’s important to note Plan F is no longer available to Medicare beneficiaries who first became eligible after January 1, 2020. If you were eligible for Medicare before 2020, you may be able to apply for Medigap Plan F if it’s available where you live. If you had Medicare Supplement Plan F before 2020, you can keep your plan.
Below is an overview of what is covered by Medicare Supplement Plan F, along with a few key things to know about this plan in particular and Medigap in general.
What Does Medicare Supplement Plan F Pay For?
Medicare Supplement Plan F covers the following nine benefits:
Medicare Part A Coinsurance
Medicare beneficiaries do not owe any Part A coinsurance for the first 60 days of an inpatient hospital stay during a Part A benefit period. But beginning with day 61, Medicare Part A requires a daily coinsurance of $371 per day in 2021. And beginning on day 91, that daily coinsurance goes up to $742 per day.
Medigap Plan F covers those daily coinsurance requirements at 100%.
In addition, Plan F covers Part A hospital benefits for another 365 days after your Medicare Part A benefits are exhausted.
Medicare Part B Coinsurance
After first satisfying an annual deductible, Medicare Part B beneficiaries are typically responsible for coinsurance payments for 20% of the remaining cost balance for covered care.
Plan F fully covers Medicare Part B coinsurance payments.
Part A Deductible
Upon being admitted to the hospital as an inpatient, you’re required to pay a Medicare Part A deductible of $1,484 in 2021 before any Part A coverage takes effect. You have to meet this deductible for every “benefit period,” which begins the day you are admitted as a hospital inpatient and ends once you’ve gone 60 consecutive days without inpatient care. This means that you could potentially face more than one benefit within the same calendar year, and you would have to meet the $1,484 Part A deductible again each time before your Part A benefits would kick in.
Plan F covers the Part A deductible in full, no matter how many times you may be admitted for inpatient care in same year.
Part B Deductible
Medicare Part B beneficiaries have to pay a deductible of $203 per year in 2021 before Part B benefits kick in.
Medicare Supplement Plan F covers the Part B deductible in full.
Part A Hospice Care Coinsurance and Copayments
If you receive hospice, Medicare requires small copayments for drugs and other products used for pain and symptom relief, and you’re required to pay a Part A coinsurance charge for respite care.
Plan F covers these coinsurance and copayment costs in full.
Skilled Nursing Facility Care Coinsurance
There is no coinsurance requirement for the first 20 days of inpatient skilled nursing care you receive during each benefit period. But daily coinsurance payments of $185.50 are required for days 21 through 100 in 2021, and you’re responsible for all costs beyond 100 days.
Medigap Plan F provides 100% coverage of this coinsurance.
Part B Excess Charges
As long as a health care provider accepts Medicare assignment, they may only charge you up the Medicare-approved amount for their service or products.
There are certain providers and doctors, however, who don’t accept Medicare assignment, which means they’re allowed to charge you up to 15% more than the Medicare-approved amount for their services. This extra cost is called an “excess charge” and applies only to Medicare Part B services.
Plan F covers Medicare Part B excess charges in full.
First Three Pints of Blood
If you were to need a blood transfusion, you might be responsible for the cost of the first three pints and Medicare would cover the fourth pint and beyond.
Plan F pays for the first three pints of blood on your behalf.
Foreign Travel Emergency Care
There are only limited situations in which Medicare provides any coverage for emergency health care received outside of the U.S. or U.S. territories.
But Medicare Supplement Plan F covers 80% of the cost of foreign emergency care, which is the maximum allowed for any Medigap plan.
Does Medicare Plan F Cover Drugs?
Medicare Supplement Plan F does not cover prescription drugs. By law, Medicare Supplement plans do not cover prescription drug costs.
Medicare beneficiaries who want prescription drug coverage typically have two options:
- Enroll in a Medicare Advantage (Medicare Part C) plan that includes prescription drug coverage. Medicare Advantage plans are required to cover everything that Medicare Part A and Part B cover, and most plans also cover prescription drugs.
- Enroll in a Medicare Part D prescription drug plan (PDP). These plans cover prescription drug costs and can be used alongside Medicare Part A and/or Part B and a Medicare Supplement plan.
Did Medigap Plan F Go Away in 2020?
Plan F is only available to beneficiaries who became eligible for Medicare before January 1, 2020. Anyone who became eligible for Medicare after that date is not allowed to enroll in Plan F. If you had Medicare Supplement Plan F before 2020, you can keep your plan. If you became eligible for Medicare before 2020, you may be able to apply for Medigap Plan F if it’s available where you live.
Recent federal legislation dictated beneficiaries must responsible for paying the Medicare Part B deductible. Plan F and Medigap Plan C are the only Medigap plans to cover the Part B deductible, so those plans were closed off to new beneficiaries, while previous Medicare beneficiaries were grandfathered in.
The idea behind the legislation is that when the Part B deductible is already covered, beneficiaries may be encouraged to overuse health care and flood the system with small and trivial things. When a person is forced to pay a deductible to see a doctor, they may think twice before scheduling an appointment for every cough or minor discomfort.
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Medigap plans are standardized differently in Massachusetts, Minnesota and Wisconsin. If you live in one of those three states, your Plan F benefits may look different than those described above.
Not every Medicare Supplement Insurance plan is necessarily sold in every area, and you may only enroll in plans that are offered in your coverage area. Medigap plan costs can differ by location, so Plan F sold near you may cost a different amount than Plan F sold in another part of the country, despite having the exact same coverage.
You May Be Able to Consider High-Deductible Plan F
Medicare Supplement Plan F and Plan G both offer a high-deductible option in some states. With this option, you must pay $2,370 worth of Medicare-covered costs in 2021 (such as deductibles, copayments and coinsurance) before the Medigap plan will pay for anything.
The benefit of selecting the high-deductible option is that it typically comes with much lower monthly premiums than the standard version of the plan.
Plan F doesn’t have an out-of-pocket spending limit, but there are two Medigap plans, Plan K and Plan L, that contain out-of-pocket limits. Once you reach that out-of-pocket limit for the year, the plans will pay for 100% of your covered services for the rest of the calendar year.