What Is Medigap Plan F?
Key Takeaways
- Plan C provides the most robust coverage of any type of Medicare Supplement plan, including coverage for the Part B deductible, skilled nursing coinsurance, and medically necessary emergency care for the first 60 days abroad.
- Like other Medigap plans, Plan C helps cover out-of-pocket costs not included in Original Medicare, such as copays, coinsurance, and deductibles.
- Medigap Plan C is only available to those who qualified for Medicare before 2020.
Medigap Plan F is the most comprehensive type of Medicare Supplement plan, covering most out-of-pocket costs associated with Original Medicare. However, only those who became Medicare-eligible before Jan. 1, 2020 qualify for Plan F, and it’s one of the most expensive Medigap options. In some states, you can enroll in Plan F as a high-deductible plan with lower monthly costs.
If you’re eligible, you might consider reducing your medical expenses with Medigap Plan F. Here’s what you should know.
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Medigap at a Glance
Original Medicare, the federally administered public health insurance program for people who are 65 or older or have certain disabilities, consists of Medicare Part A, which is hospital insurance, and Part B, which is medical insurance. While Original Medicare covers many healthcare costs, you still have to pay deductibles (the amount you’re charged before insurance kicks in), copayments (a set amount for a service), and coinsurance (a percentage of a Medicare-approved amount for a service).
Medicare Supplement Insurance, often called Medigap for short, helps with those out-of-pocket costs. After enrolling in Medicare Part A and Part B, you can fill coverage gaps by purchasing a Medigap plan from a private insurer.
- Medigap plans charge a monthly premium, which you must pay in addition to your Medicare Part B premium (Part A is premium-free for most people).
- Medigap plans do not cover prescription drugs. People on Original Medicare can join a separate Medicare Part D prescription drug plan from a private insurance carrier.
- You cannot enroll in both a Medigap plan and a Medicare Advantage (Part C) plan at the same time. Private insurers offer Medicare Advantage plans to substitute for Original Medicare coverage, and most include additional benefits.
Signing up for Medigap is a common choice: As of 2022, 42% of Original Medicare beneficiaries had a Medigap policy. Each plan type offers different levels of coverage, so it’s important to learn about your options and choose the right one for your needs.
Understanding Medigap Plan F
Medigap Plan F is the most robust type of Medicare Supplement plan, helping with the costs of coinsurance, copays, deductibles, and certain types of medical care. Only those who became eligible for Original Medicare before 2020 may purchase Plan F.
Key Features of Medigap Plan F
- 100% coverage for Part A and Part B deductibles, copays, and coinsurance
- 80% coverage for international care following a foreign travel emergency
- High deductible plans available in some states
What Does Medigap Plan F Cover?
Plan F offers the most comprehensive Medigap coverage, including:
- Coinsurance, copays, and hospital costs for Original Medicare Parts A and B
- Blood transfusions (first 3 pints)
- Hospice care coinsurance or copayment
- Skilled nursing facility coinsurance
- Deductibles for Parts A and B
- Part B excess charge (to pay the difference if a healthcare provider charges more than the Medicare-approved amount for a service)
- Up to 80% of out-of-pocket costs for foreign travel emergencies
Medicare Supplement Plan F vs. Plan G
Medigap Plans F and G are often grouped together because they provide similar levels of coverage. The difference is that Plan F pays for the Part B deductible, while Plan G does not; otherwise, their coverage offerings are the same, and both types offer a high-deductible Medigap plan in some states.
Despite the similarities, fewer people are eligible for Medigap Plan F than Plan G. To purchase a Plan F policy, you must have turned 65 or otherwise become eligible for Medicare before 2020. Anyone enrolled in Original Medicare can still purchase Medigap Plan G.
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Costs for Medigap Plan F
Medigap plans are available for purchase through private insurance companies, which may sell the same plan types at different price points. Costs might differ depending on when you enroll, as well as your health conditions, location, age, and sex.
- Premiums: Insurance companies price Medigap plans as either community-rated (charging the same premium to beneficiaries of all ages), issue-age-rated (basing the premium on the beneficiary’s age), or attained-age-rated (pricing the premium based on age and increasing the price as the beneficiary ages). You will pay more in premiums for Medigap Plan F than for less comprehensive plans, but in some states you can lower this monthly cost by purchasing a high-deductible plan.
- Deductibles: If you enroll in a high-deductible plan, you must pay this amount (adjusted annually) before your benefits kick in.
- Copays: Plan F pays for all Original Medicare copayments.
- Coinsurance: Plan F covers all coinsurance and hospital costs associated with Medicare Parts A and B.
High-Deductible Plan F Option
You may have the option to purchase Medigap Plan F as a high-deductible plan to save on monthly premium costs. With the high-deductible version, you’ll pay a lower premium but be responsible for any out-of-pocket expenses until you’ve met your Plan F deductible ($2,870 for 2025).
Medicare will still pay its share of your healthcare costs even if you haven’t yet met your Medigap deductible.
For example, if you purchase high-deductible Medigap Plan F and receive inpatient hospital care, your Medicare Part A coverage will kick in after you’ve paid your Part A deductible — even though you’ll still have a portion of your Medigap Plan F deductible remaining. Once you’ve met the Plan F deductible, your Medigap coverage will function just like the standard version of Plan F.
See It in Action
Let’s say you’re an Original Medicare beneficiary with severe arthritis. You anticipate needing regular medical care in the coming year, and you qualify for Medigap Plan F. You decide to purchase the standard version of Plan F to offset high out-of-pocket (OOP) medical expenses.
Here’s how your Plan F coverage might function for a two-day hospital stay due to complications from arthritis:
Treatment | Estimated upfront cost | Medicare coverage | Plan F coverage |
Hospital room and board | $5,800 | 100% after $1,676 Part A deductible (OOP reduced to $1,676) | 100% of Part A deductible (OOP reduced to $0) |
Diagnostic X-rays and blood tests | $400 | 80% after $257 Part B deductible $30 Part A copay for receiving tests in the hospital (OOP reduced to $315) | 100% of Part B coinsurance 100% of Part A copay (OOP reduced to $0) |
Rheumatologist fees | $300 | 80% with Part B deductible met (OOP reduced to $60) | 100% of Part B coinsurance |
Corticosteroid injection | $200 | 80% with Part B deductible met (OOP reduced to $40) | 100% of Part B coinsurance |
How Medicare Supplement Plan F Compares With Other Medigap Plans
| Benefits | Plan F | Plan C | Plan G |
|---|---|---|---|
| Available to those who became eligible for Medicare in or after 2020? | No | No | Yes |
| Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes |
| Part A deductible | Yes | Yes | Yes |
| Part B deductible | Yes | Yes | Not covered |
| Part B excess charge | Yes | Not covered | 100% |
| Out-of-pocket limit | N/A | N/A | N/A |
| Blood (first three pints) | Yes | Yes | Yes |
| Skilled nursing facility care coinsurance | Yes | Yes | Yes |
| Foreign travel exchange up to plan limits | 80% | 80% | 80% |
How To Choose a Medigap Plan
In most states, you can choose from 10 types of Medigap plans, each labeled with a different letter: A, B, C, D, F, G, K, L, M, and N. All Medigap plans supplement Original Medicare to pay for OOP costs such as deductibles and coinsurance, but coverage levels vary among plan types. For some Medigap plans, including Plan F, you’ll have to meet special eligibility requirements and choose either a high-deductible or a standard plan.
Here’s how to select the right Medigap plan for you:
- Assess your needs. Consider any surgeries, hospital stays, specialist visits, prescription drugs, or skilled nursing care you might need in the near future. If you expect you’ll seek medical care frequently, a robust Medigap plan such as Plans F and G may suit you best.
- Evaluate your eligibility and coverage options. When did you become Medicare-eligible? If it was after 2019, you may not qualify for Medigap Plan F. Consider the coverage options available to you in your area, including any high-deductible plan variations.
- Crunch the numbers. Consult your budget to determine what kind of premium you can afford. If you need a lower premium price, you might consider a high-deductible Medigap Plan F or G. If you can afford a higher premium for more robust coverage, you may opt for a standard Plan F or G instead.
- Research insurers. You’ll buy your Medigap plan through a private insurer; choose wisely. Discuss your options with healthcare providers you trust, and consider reading reviews and provider comparisons from trusted online resources. Choose an insurance company with a positive reputation.
When you’re ready to enroll in a Medicare Supplemental Insurance plan, mark your calendar. The most convenient time to purchase Medigap is when you first enroll in Medicare. Your Medigap initial enrollment period lasts for six months, beginning on the first day of the month you are 65 or older and enrolled in Medicare Part B. After that, you can still enroll in Medigap, but your health status may affect your premium price and plan eligibility.
Putting It All Together
Medigap Plan F provides extensive coverage to pay for the out-of-pocket costs associated with Original Medicare, including copayments, coinsurance, deductibles, and hospital care.
Though Plan F is the most robust form of Medicare Supplement Insurance, it’s also the hardest to qualify for; Plan F is only available to those who became eligible for Medicare before Jan. 1, 2020. Moreover, Medigap Plan F premium prices can be high unless you choose a high-deductible plan.
Consider working with a licensed insurance broker or agent to find out if you’re eligible for Medigap Plan F and whether it’s the choice for your budget and medical needs.
Sources
Compare Medigap Plan Benefits. Medicare.gov.
Key Facts About Medigap Enrollment and Premiums for Medicare Beneficiaries. KFF.