Medigap Plan F is a comprehensive Medicare Supplement insurance plan that offers the most extensive coverage among all the standardized Medigap plans. However, as of 2020, Plan F is no longer available for new Medicare beneficiaries. Only those who were eligible for Medicare before January 1, 2020, can enroll in Plan F.
Medigap Plan F covers all the gaps in Original Medicare, including both Medicare Part A and Part B deductibles, coinsurance, and copayments. This means that beneficiaries with Plan F have little to no out-of-pocket costs for Medicare-approved services. With Medigap Plan F, you can enjoy coverage for hospital costs and coinsurance under Part A, as well as coinsurance or copayments for medical services under Part B. The plan also covers skilled nursing facility coinsurance, excess charges that providers may charge beyond the Medicare-approved amount, and even provides coverage for emergency medical care during foreign travel, up to plan limits.
While Plan F offers comprehensive coverage, it is important to note that it typically has higher premiums compared to other Medigap plans due to its extensive benefits. It is no longer available for new Medicare beneficiaries, but those who were enrolled in Plan F before January 1, 2020, can keep their coverage and enjoy its full benefits.
Below is a comprehensive list of the covered services provided by Medicare Supplement Plan F, which include benefits under Medicare Part A, Medicare Part B, and other areas:
Service | Who pays what? |
---|---|
First 60 days | Medicare pays: All cost but $1,632 Plan pays: $1,632 (Part A Deductible) Member pays: Nothing |
61st thru 90th day | Medicare pays: All cost but $408/day Plan pays: $408/day Member pays: Nothing |
91st day and after (While using 60 lifetime reserve days) | Medicare pays: All cost but $816/day
Plan pays: $816/day Member pays: Nothing |
Once lifetime reserve days are used; additional 365 days | Medicare pays: Nothing Plan pays: 100% of Medicare-eligible expenses Member pays: Nothing |
Beyond the additional 365 days | Medicare pays: Nothing
Plan pays: Nothing Member pays: All cost |
Service | Who pays what? |
---|---|
First 20 days | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
21st thru 100th day | Medicare pays: All but $204/day Plan pays: Up to $2040/day Member pays: Nothing |
101st day and after | Medicare pays: Nothing Plan pays: Nothing Member pays: All cost |
Service | Who pays what? |
---|---|
First three pints | Medicare pays: Nothing Plan pays: All cost Member pays: Nothing |
Additional amount | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Service | Who pays what? |
---|---|
Hospice Care | Medicare pays: All but very limited
copayment/ coinsurance for outpatient drugs and inpatient respite care Plan pays: Medicare copayment and coinsurance Member pays: Nothing |
Service | Who pays what? |
---|---|
Part B Deductible | Medicare pays: Nothing Plan pays: $240 (Part B Deductible) Member pays: Nothing |
Part B Coinsurance | Medicare pays: 80% Plan pays: 20% Member pays: Nothing |
Part B Excess Charges
(above Medicare approved amounts) | Medicare pays: Nothing Plan pays: All cost Member pays: Nothing |
Service | Who pays what? |
---|---|
Test for diagnostic lab services | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Service | Who pays what? |
---|---|
First three pints | Medicare pays: All cost Plan pays: Nothing Member pays: Nothing |
Additional amount (First $226 of
Medicare approved amounts) | Medicare pays: Nothing Plan pays: $240 (Part B deductible) Member pays: Nothing |
Remainder of Medicare approved amounts | Medicare pays: 80% Plan pays: 20% Member pays: Nothing |
Service | Who pays what? |
---|---|
Medically necessary skilled care
services and medical supplies/ Durable medical equipment (First $226 of Medicare approved amounts) | Medicare pays: Nothing Plan pays: $240 (Part B deductible) Member pays: Nothing |
61st thru 90th day | Medicare pays: 80% Plan pays: 20% Member pays: Nothing |
Service | Who pays what? |
---|---|
First $250 each calendar
year/Remainder of charges | Medicare pays: Nothing (exccept under limited circumstances) Plan pays: $0/80% to a lifetime maximum of $50,000 Member pays: $250/20% and amounts over the $50,000 lifetime maximum |
No, only individuals who became eligible for Medicare before January 1, 2020, can apply for Plan F. The enactment of the Medicare Access and CHIP Reauthorization (MACRA) legislation in 2015 prohibits the sale of Medicare Supplement plans that cover Medicare's Part B deductible. The objective of this legislation is to phase out these plans, including Plans C, Plan F, and High-Deductible Plan F, and ensure that all Medicare beneficiaries have some out-of-pocket expenses when receiving healthcare services.
Absolutely! If you have enrolled in Medicare Supplement Plan F before January 1, 2022, you can continue to maintain your coverage without any changes.
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