Medicare Plan F is one of 10 Medigap plans that offer supplemental coverage to beneficiaries of original Medicare. While Plan F is the most popular Medigap plan for its comprehensive coverage, it was phased out in 2020 and is no longer available to new members. Many new Medicare enrollees are considering Plan G instead, which offers much of the same coverage except for Medicare Part B deductibles.
How Medigap Works
Medicare supplement plans (Medigap) work with Original Medicare (Part A and Part B) to fill in the “gaps” in coverage. Medigap may only be used with original Medicare and not Medicare Advantage plans (Part C). While Medicare Advantage and Medigap are both offered by private insurers, the former offers additional benefits, but the latter only supplements existing ones.
Medicare enrollees pay an additional monthly premium for Medigap benefits. However, Medigap’s purpose is to help lower out-of-pocket costs for coinsurance and deductibles. Medigap beneficiaries enjoy extended financial coverage for medical and hospitalization expenses under Medicare parts A and B.
Specifically, Medigap plans can cover Part A deductibles, extended hospital stays, and excess Part B charges. Medigap does not cover additional benefits such as vision, dental, or hearing healthcare, and enrollees should pursue a Medicare Advantage plan for those. Medigap beneficiaries also require separate Part D coverage for prescription drug benefits.
Medigap Plan F vs. Plan G
|Benefits||Plan F||Plan G|
|Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes|
|Part A deductible||Yes||Yes|
|Part B deductible||Yes||Not covered|
|Part B excess charge||Yes||100%|
|Blood (first three pints)||Yes||Yes|
|Skilled nursing facility care coinsurance||Yes||Yes|
|Foreign travel exchange up to plan limits||80%||80%|
The primary differences between Medigap Plan F vs. Plan G are availability and Part B deductibles. Since Congress passed the Medicare Access and CHIP Reauthorization Act, insurers were no longer allowed to offer Plan F, which covered Part B deductible costs, after January 1, 2020. Medigap Plan G offers comparable benefits to new enrollees, minus Part B deductible coverage.
What Medicare Supplement Plan F Covers
Plan F offers comprehensive gap coverage to help significantly reduce out-of-pocket costs and extend the benefits of original Medicare. Plan F benefits include Part A coinsurance for hospitalization up to 365 days after Medicare is exhausted, Part A deductible, Part A hospice care, and Part B coinsurance and deductible coverage.
Plan F is one of the only Medigap plans to cover Part B deductible and excess charges. Plan C, discontinued in 2019, previously offered the only alternative to Plan F for Part B deductible coverage. Plan G offers the excess charges benefit previously offered by Plan F.
What Medicare Supplement Plan F Does Not Cover
Plan F does not offer dental, vision, or hearing healthcare benefits. Applicants must enroll in a Medicare Advantage plan for such coverage. Medigap Plan F also does not cover prescription drug coverage; enrollees seeking these benefits should pursue Part D. Additionally, Plan F does not supplement long-term care in a nursing facility or private-duty nursing services.
Who Should Consider Plan F?
Plan F suits beneficiaries who need comprehensive coverage, mainly to help meet their Part B deductible for routine medical care. Medigap Plan F can benefit enrollees with recurring health needs who visit doctors often. Though Plan F premiums can be pricey, Medigap offers a high-deductible option to offset higher monthly premium costs.
What Medicare Supplement Plan G Covers
Plan G provides coverage almost identical to Plan F, including 50% of Part B coinsurance and hospital care, thus lowering out-of-pocket costs. Plan G covers Part A, but not Part B deductibles, which include hospital and medical care, respectively, under original Medicare.
Unlike some other Medigap plans, Plan G also covers benefits, including excess charges, some foreign travel healthcare, and skilled nursing facilities. Plan G is a natural choice for beneficiaries who joined Medicare after January 1, 2020, but still, prefer Plan F benefits since the two plans are similar.
What Medicare Supplement Plan G Does Not Cover
The difference between Plan F and Plan G Medicare benefits comes down to Part B deductibles. While Medigap Plan G matches every other area of coverage offered under Plan F plus Part B excess charges, it does not cover the Part B deductible. This means Plan G enrollees are responsible for paying the full cost ($226 in 2023) of the Part B deductible outright.
Who Should Consider Plan G?
Beneficiaries who require comprehensive coverage like Plan F but only became eligible or enrolled after January 1, 2022 often pursue Plan G as the next best thing. Though Plan G does not cover the Part B deductible, beneficiaries may still pay less for Plan G premiums and the Plan B deductible than a single Plan F policy.
Medigap Plans F and G vs. Other Medigap Options
There are 10 Medigap plans offered by Medicare-approved private insurers, A, B, C, D, F, G, K, L, M, and N, available in nearly every state nationwide. Lettered plans are standardized to offer the same coverage from state to state, though costs vary by provider.
Medigap Plan F provides the most comprehensive coverage, including Part B deductibles. Plan G is the next-most comprehensive, covering excess Part B charges but not Part B deductibles. Plan N is a comparable choice for beneficiaries seeking lower premiums for coverage, not including the above benefits.
Medigap Plans F and G vs. Medicare Advantage
Beneficiaries should consider their medical needs and budget when contemplating Plan F or G vs. Medicare Advantage. Medicare Advantage covers some alternative treatments and dental, vision, and hearing coverage and often includes prescription drugs. Medigap supplements original Medicare expenses, including coinsurance, copays, and deductibles.
Medicare Advantage suits relatively healthy beneficiaries who do not anticipate exorbitant medical costs in the foreseeable future. Medicare Advantage is a cost-effective option for all-in-one routine Part A and Part B benefits, but includes a limited provider network and typically requires referrals for specialists.
Medigap is a more sensible choice for people with chronic conditions or who require long-term medical care. Medigap Plans F and G offer comprehensive coverage, including Part A deductibles, Part B copays, and hospitalizations beyond Medicare benefits. While Medigap premiums cost more, beneficiaries enjoy greater savings on out-of-pocket costs.
How to Enroll in Medigap Plan F or G
People are eligible to enroll in Medicare from three months before they turn 65 until three months after their 65th birthday month. The preferred enrollment period for Medigap lasts for six months, beginning the month your Medicare benefits start. After that period, beneficiaries can apply for Medigap at any time but may be subject to underwriting for pre-existing conditions.
A few states (Massachusetts, Minnesota, and Wisconsin) offer Medigap plans outside the national standard, which means they set their own rates and enrollment criteria. Additionally, some states maintain their own Medigap open enrollment periods.