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Plan

What Does Medicare Supplement Plan F Cover?

Medicare Supplement Plan F is one of the most popular Medicare Supplement Insurance plans because it offers the most comprehensive coverage of the currently available Medicare Supplement insurance plans.

Medicare Supplement Plan F covers the most amount of benefits compared to the other Medicare Gap plans.  Plan F covers the ‘gap’ in coverage associated with Parts A and B. This plan enables someone to be able to visit a doctor’s office or hospital to receive approved treatment and walk out without paying anything, virtually eliminating all out of pocket costs. (It is important to understand that these plans do not cover prescription drugs.)

Plan F also includes coverage for other Medicare-approved expenses not associated with Parts A or B. This includes foreign travel emergencies and skilled nursing facility coinsurance. Importantly, Plan F is one of only two plans that include coverage for Medicare Part B excess charges.

Plan F Coverage of Medicare Part A Expenses

Plan F covers the Medicare-approved expenses not covered under Medicare Part A (deductibles, coinsurances, and copays). Part A is the hospitalization component of Original Medicare and covers Medicare expenses typically associated with a hospital stay.

Generally, Medicare covers approved charges for hospitalization at 80%.  This leaves the remaining 20% of expenses to be the responsibility of the Medicare patient. Plan F covers the 20% of Medicare-approved hospital expenses not covered under Part A. Plan F also covers other costs, such as:

  • Part A hospital deductible and coinsurance
  • Hospital costs up to an additional 365 days after Medicare benefits are exhausted
  • Part A Hospice care coinsurance or copayment
  • Blood (the first three pints)
  • Other Medicare-approved expenses associated with Part A hospitalization

Plan F Coverage of Medicare Part B Expenses

Plan F also covers the Medicare Part B expenses. Part B covers doctor visits and related charges covered under Medicare for providers. Like Part A, Part B only covers 80% of the Medicare-approved expenses. It leaves the remaining 20% on the Part B participant.

Plan F covers Medicare Part B approved services at the doctor’s office, such as:

  • Medicare Part B coinsurance and copayment
  • Medicare approved doctor’s office fees
  • Part B deductible
  • Medicare Part B excess charges
  • Other Medicare-approved expenses associated with Part B coverage

Plan F is one of only two Medicare Supplement plans that cover the Medicare Part B excess charges (the other being Plan G).

Plan F Coverage for Other Medicare-Eligible Expenses: Foreign Travel Emergencies and Nursing Facilities

This plan coverage also includes 80% of approved costs associated with foreign travel emergencies, which is vital for the many seniors who enjoy taking cruises or other trips outside the United States. There are plan limits, but this coverage can help offset charges associated with becoming sick or injured while traveling outside of the U.S.

Plan F also includes Medicare-approved skilled nursing facility coinsurance costs. This coverage is essential as hospitalization (among other causes) can lead to the need to stay for an extended period in a skilled nursing facility for recuperation. Medicare limits this benefit to the first 100 days of a stay in a skilled nursing facility. Because of this, If you need extended coverage beyond 100 days, individuals should consider a long-term care plan.

Medicare Supplement Plan F Is Not Plan F Everywhere

There are some exceptions to Plan F benefits, specifically in the States of Massachusetts, Minnesota, and Wisconsin, where State laws provide for different versions of standardization in the plan. These states are often called “a la carte” states as there are no standardized plans. Medicare recipients essentially “build their own” plans benefit-by-benefit. However, individuals in these states would have the ability to build a plan identical to Plan F.

Medicare Supplement Plan F vs. Other Medicare Supplement Plans

When comparing pricing of Plan F to the other plans, it is critical to remember that based on utilization and other factors, other Medigap plans may sometimes be a better fit and have lower total overall cost than the comprehensive coverage Plan F.

Cost of Medicare Supplement Plan F

Plan F costs can be relatively reasonable regarding monthly premiums for the level of coverage. Although Plan F offers the most comprehensive coverage, Plan F can often allow for lower total health expenses compared to other options available.

Pricing for Plan F is the only variable among insurance companies that offer that plan in a particular state. This is because the Federal Government standardized Plan F and all the other Medicare Supplement plans. They did this with the specific goal of making shopping for a plan more manageable. No matter which company provides Plan F, they all must pay for Medicare approved expenses.

The rates for Plan F will also depend on the current health conditions, age, gender, and tobacco use for the person interested in enrolling in that plan.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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