Did you know that Medicare Plan F used to be the Cadillac of Medicare supplements, covering literally every single gap in Original Medicare? And here’s the kicker – if you turned 65 before 2020, you can still get it, but everyone else is completely locked out forever.
After helping thousands of folks navigate Medicare for over 25 years, I can tell you that Plan F creates more confusion than almost any other Medicare topic. People hear it’s the “best” coverage but can’t get it. Others have it but wonder if they’re overpaying. And then there’s the whole mess about whether it’s even worth keeping anymore.
Let me break down exactly what Plan F is, why it became the gold standard of Medicare supplements, and most importantly – whether you should care about it in today’s Medicare world.
Understanding Medicare Supplement Plan F
Medicare Plan F is what we call a Medigap policy – basically insurance that fills in the gaps Original Medicare leaves behind. And boy, does Original Medicare leave gaps.
Think of it this way: Original Medicare is like buying a house that covers the big stuff but leaves you paying for utilities, maintenance, and repairs. Plan F? That’s like having someone else pay all those bills for you.
How Medigap Plans Work
Here’s the deal with Medigap plans – they’re standardized by the federal government. That means a Plan F from Company A covers the exact same things as Plan F from Company B. The only difference? Price.
You’ve got to have Original Medicare (Parts A and B) first. Then you layer a Medigap plan on top.
The insurance company can’t change what’s covered or drop you as long as you pay your premiums. Even if you develop expensive health conditions. That’s huge peace of mind right there.
But here’s what trips people up: Medigap plans don’t include prescription drug coverage. You need a separate Part D plan for that.
The Role Of Plan F In Medicare Coverage
Plan F earned its reputation as the “Cadillac” plan because it covers every single deductible, copay, and coinsurance that Original Medicare doesn’t. We’re talking 100% coverage after Medicare pays its share.
No math at the doctor’s office. No surprise bills. No wondering if something’s covered.
I’ve had clients who went through cancer treatment, heart surgeries, you name it – and never saw a bill beyond their monthly premium. That’s the power of Plan F.
The psychological benefit is real too. When you’re dealing with serious health issues, the last thing you want to worry about is medical bills. Plan F eliminates that stress completely.
Coverage Details Of Medicare Plan F
Let’s get into the nitty-gritty of what Plan F actually covers. Because when I say “everything,” I mean everything Original Medicare approves.
Medical Services Covered
Plan F picks up these specific costs that Original Medicare leaves for you:
- Part A deductible ($1,632 in 2024 for each benefit period)
- Part A coinsurance for hospital stays beyond 60 days
- Part B deductible ($240 in 2024)
- Part B coinsurance (that pesky 20% Medicare doesn’t cover)
- Part B excess charges (when doctors charge more than Medicare allows)
- Skilled nursing facility coinsurance (days 21-100)
- First three pints of blood for medical procedures
- Foreign travel emergencies (80% coverage up to plan limits)
That foreign travel coverage is a sleeper benefit. Medicare generally won’t cover you outside the U.S., but Plan F gives you up to $50,000 in lifetime benefits for emergencies abroad.
Out-Of-Pocket Costs Eliminated
Here’s what makes Plan F special – your out-of-pocket costs for Medicare-covered services drop to exactly zero.
Compare that to Original Medicare alone where you could face unlimited 20% coinsurance. Get a $100,000 cancer treatment? That’s $20,000 out of your pocket without a supplement.
With Plan F? Nothing. Nada. Zip.
I’ve seen retirees on fixed incomes sleep better at night knowing their medical costs are completely predictable. Just the monthly premium and that’s it.
But remember – and this is crucial – Plan F only covers what Medicare approves. If Medicare says no to a treatment, Plan F says no too.
Eligibility Requirements For Plan F
This is where things get interesting. And by interesting, I mean frustrating for a lot of people.
Who Can Enroll In Plan F
Here’s the big restriction: You can only buy Plan F if you became eligible for Medicare before January 1, 2020.
That means if your 65th birthday was before 2020, you’re golden. You can still buy Plan F today if you want it.
But if you turned 65 in 2020 or later? Sorry, the door’s closed. Congress slammed it shut as part of the Medicare Access and CHIP Reauthorization Act.
Why’d they do this? The thinking was that having people pay the Part B deductible (which Plan F covers) would make them more conscious of healthcare costs. Whether that actually works is… debatable.
If you already have Plan F, don’t panic. You’re grandfathered in. They can’t take it away from you.
Important Enrollment Deadlines
Timing is everything with Medigap plans, especially Plan F.
Your golden ticket is the Medigap Open Enrollment Period – six months starting when you’re 65 and enrolled in Part B. During this window, insurance companies must sell you any Medigap plan they offer, including Plan F (if you’re eligible).
No health questions. No medical underwriting. Pre-existing conditions don’t matter.
Miss that window? Things get complicated. Insurance companies can reject you, charge you more, or make you wait for coverage.
There are some guaranteed issue rights if you lose other coverage, but they’re limited. Don’t count on them.
I tell everyone the same thing: Use your Open Enrollment Period wisely. It’s basically a “get out of jail free” card for your health insurance.
Plan F Costs And Pricing Factors
Let’s talk money. Because Plan F’s comprehensive coverage comes with a price tag to match.
Premium Variations By State
Plan F premiums are all over the map – literally. What you pay depends heavily on where you live.
In Miami, you might pay $400+ per month. In rural Wisconsin? Maybe $150.
Why such huge differences? It’s all about local healthcare costs and state regulations. States like New York and Connecticut have community rating rules that spread costs across all ages. Florida and California don’t.
Competition matters too. Areas with lots of insurance companies tend to have lower prices. Rural areas with fewer options? You’re gonna pay more.
I’ve helped clients save hundreds per month just by shopping around. Same exact coverage, different companies, wildly different prices.
Age-Based Pricing Models
Insurance companies use three pricing methods, and this affects your long-term costs big time:
Attained-age rating: Premiums go up as you get older. Starts cheaper but gets expensive over time. Most common pricing model.
Issue-age rating: Premium based on your age when you buy the policy. Still goes up with inflation but not with age.
Community rating: Everyone pays the same regardless of age. Sounds great but usually starts higher.
Here’s what people miss: That “cheap” attained-age policy at 65 can become unaffordable by 75. I’ve seen premiums double or even triple over 10-15 years.
Always ask how premiums have increased historically. If a company jacks up rates 15% every year, that bargain price won’t last long.
Comparing Plan F To Other Medigap Plans
Since new Medicare beneficiaries can’t get Plan F anymore, let’s see how it stacks up against alternatives.
Plan F Versus Plan G
Plan G is basically Plan F’s little brother. The only difference? Plan G doesn’t cover the Part B deductible ($240 in 2024).
That’s it. Everything else is identical.
Here’s the kicker though – Plan G is often $30-50 cheaper per month than Plan F. Do the math: $40 monthly savings equals $480 per year. Minus the $240 deductible, you’re still ahead $240.
Why is Plan G cheaper? Fewer people can buy Plan F now, so the risk pool is aging. Older people mean more claims. More claims mean higher premiums.
Plan G’s risk pool includes younger, healthier new Medicare beneficiaries. Better risk pool, lower premiums.
I’m telling my Plan F clients to seriously consider switching. But here’s the catch – you’ll probably need to pass medical underwriting.
When Other Plans Make More Sense
Plan F isn’t always the answer, even if you can get it.
Healthy and rarely see doctors? Plan N might save you serious money. It’s like Plan G but with small copays ($20 for doctor visits, $50 for ER). Premiums can be 25-30% less than Plan F.
Really healthy and willing to take some risk? High-deductible Plan F or G could work. Super low premiums (like $50/month) but you pay the first $2,800 in 2024 before coverage kicks in.
Live in an area with great Medicare Advantage plans? Might be worth considering, especially if you want dental, vision, and hearing coverage included.
The best plan depends on your health, budget, and risk tolerance. There’s no one-size-fits-all answer.
The Future Of Medicare Plan F
So what happens to Plan F going forward? It’s not disappearing tomorrow, but it’s definitely changing.
The risk pool is aging and shrinking. No new blood coming in means premiums will likely increase faster than other plans. It’s simple math – older people use more healthcare.
Some insurance companies are already pulling out of the Plan F market. Fewer companies means less competition, which usually means higher prices.
But here’s the thing – if you have Plan F and serious health issues, keeping it might make sense even with higher premiums. The peace of mind and zero out-of-pocket costs could be worth it.
For healthy Plan F holders? Time to shop around. You might find equal coverage for less money with Plan G.
The transition away from Plan F is Congress’s attempt to make Medicare more sustainable. Whether it works or just pushes people into Medicare Advantage plans remains to be seen.
One thing’s certain: Plan F’s days as the go-to Medigap plan are over. Plan G has taken the crown.
Leave a Reply