Many beneficiaries looking for comprehensive coverage will ask us: What Does Plan F Cover?
Medicare Plan F covers all of the gaps in Original Medicare. It is considered to be the “Cadillac” coverage among the available Medicare supplements today. Plan F gives you first-dollar coverage for all Medicare-approved services.
Whether you have a hospital stay, or a diagnostic exam or a doctor’s visit, you will simply present your Medicare card along with your Plan F supplement card. You will be good to go. As long as Medicare approves the service or treatment you have done, then Medicare will pay its share. Then your Medicare Supplement Plan F will pay the remaining amount that Medicare does not cover.
You’ll want to be aware though, of any thing that Medicare doesn’t cover, because things that fall outside of Medicare won’t be covered by your Plan F either.
What Does Plan F Cover at my Doctor’s Office?
All of your preventive care is covered 100% by Medicare Part B. This includes items like:
- Your annual physicals, well-woman exams and vaccines
- Important imaging exams like colonoscopies and mammograms
- Screenings for diabetes, cardiovascular conditions, bone density and other conditions
Medicare dictates which preventive screenings are allowed – your primary care doctor will know which screenings to provide to you that will be covered. Most doctors will inform you if they offer tests that Medicare does not cover.
Plan F coverage also includes your other doctor visits for illnesses and injuries. Medicare Part B first pays 80%. Then your Plan F supplement pays your deductible and the other 20%. Some doctors charge a 15% excess charge beyond what Medicare pays. Plan F covers that for you.
Plan F also pays the 20% for a long list of other Part B services. This includes durable medical equipment, lab work, tests, mental health care, home health, chiropractic adjustments and much more. There is no overall cap on what Plan F will cover, although Medicare itself does impose some caps on certain things like physical therapy. Just remember that if Medicare approves the claim, your Plan F will ALWAYS pay.
Your Plan F coverage also covers excess charges. In fact, Plan G and Plan G are the only two plans that cover excess charges. Some doctors decide to charge 15% more than Medicare pays them. This “excess charge” is then your responsibility to pay. Your Plan F coverage or Plan G coverage will pay it for you. This is nice because you don’t have to worry about whether your doctor is one who charges excess charges.
Check out the Medigap chart on this page where you’ll see that Plan F is quite comprehensive: Medigap Chart
What Does Plan F Cover at the Hospital?
Medicare Part A covers inpatient hospital services, skilled nursing, blood transfusions and home health services that occur in the hospital. Medicare Part B also covers some procedures that occur in a hospital or are related to hospital care. This includes ambulance rides, surgeries, diagnostic imaging, physical therapy and injectable drugs administered in a hospital setting, like chemotherapy.
Plan F covers ALL of your share of these services. You will pay nothing for any of these Medicare-approved services. Medicare pays its 80% share, and Plan F pays the rest.
Here’s a list view of your Plan F coverage at the hospital:
- Hospital deductible ($1340 in 2018) and coinsurance (20%)
- 365 days of additional hospital coverage after Medicare’s coverage is exhausted
- Hospice care at any hospice facility
- Blood (if needed in a transfusion)
So what does Plan F cover in the hospital? Essentially ALL of your share.
What’s Not Covered by Plan F?
The only things Plan F does NOT cover would be those things that Medicare itself also does not cover, such as:
- Acupuncture, acupressure and other homeopathic treatments
- Routine vision care and eyeglasses
- Routine dental care and dentures
- Foot care that is not related to medical conditions
- Hearing aids and routine hearing tests
- Cosmetic surgery
- Custodial care (help with bathing, dressing, eating, etc.)
- Prescription drugs – Medigap plans do not include meds, so you’ll want a Part D plan for your prescriptions
In Other Words, Medicare Decides What Plan F Covers
The way that Medigap plans, including Plan F, work is that they cover only after Medicare first pays its share. So naturally, if Medicare denies a claim, your Medigap plan cannot pay anything toward it either.
People are surprised by this – we get many calls asking things like ” Does Medicare pay for eyeglasses?” or “Does Medicare eye exams?” The answer is no if the matter is routine. Medicare will, however, pay for one pair of very basic eyeglasses after a cataract surgery.
One exception is that Medicare supplement Plan F will cover up to $50,000 in foreign travel emergency benefits. Since this care occurs outside the U.S., Medicare obviously does not cover that. Plan F fortunately will help to pay for emergency health incidents in foreign countries up to the plan limit. You will pay a small deductible and some cost-sharing for these services. Read more about the foreign travel coverage here.
Will you need help covering dental, vision and hearing expenses while you are on Medicare? Check out our page about the private Dental, Vision and Hearing policy we offer. It allows you to see your own providers.
Other procedures not covered by Medicare might involve naturopathy or holistic health provided by physicians who are not contracted with Medicare. Always ask your doctor before agreeing to any procedure.
Can I use my own doctor?
Yes. You will have the freedom to choose any doctor or hospital that accepts Medicare. Your Plan F will be accepted by any participating provider, regardless of which insurance company you choose to buy your supplement from. Currently Medicare has over 800,000 participating providers across the nation. This means you will have access to some of the very best providers in the nation.
It’s important to also know that ANY Medicare supplement company gives you access to all of these physicians. So it will truly benefits you to shop for the plan in your area that has the lowest current rate but that also has a good rate trend history. For example, we get hundreds of call every year about United Healthcare Medicare supplement Plan F, and it’s a definitely a plan that we represent and are authorized to offer. However, we can always compare other carriers to see if we can find you lower rates. So don’t settle for a Medigap company just based on name brand. A UHC Plan F will provide great benefits, but ALL Medicare supplement Plan F policies give you the exact same benefits and doctor access.
Do your research before you enroll and later find out you are paying $300 more per year than you needed to. You can start by reading our Medicare Supplement Plan F Reviews here.
Does Medicare Plan F Cover Prescriptions?
Medicare decides what is covered and what is not. Medicare Part B covers injectable or infusion drugs given in a clinical setting. If Medicare pays its 80% share on such a drug, your Plan F will cover the rest of it. However, neither Original Medicare nor Plan F cover outpatient prescriptions. You’ll need to enroll in Medicare Part D for that.
Does Plan F cover long term care?
No Medicare does not cover any long-term care, and therefore Medicare supplements also cannot supplement the cost of long-term care.
Am I Guaranteed to be Approved for Plan F?
Not always. You will get ONE open enrollment window to choose your first Medicare supplement without health underwriting. This window starts on Part B effective date and lasts for only 6 months. In most states, after that one-time window expires, you can only change to another insurance company if you can pass the medical questions. This comes as a surprise to many people who mistakenly believe that the Annual Election Period in the fall is also a time when you can change your Medigap plan. It is not. The fall Annual Election Period only pertains to changing your Part D drug plan or Medicare Advantage plan.
Note: Oregon and California have rules that also allow you to change from one Medigap Plan to the same or lesser Medigap plan each year on the month of your birthday. If you live in one of these states and wish to change your Medigap plan, consult an insurance agency who can help explain this rule to you.
So if you are new to Medicare and considering Plan F, consider applying during the first 6 months that your Part B is effective. During this window, you cannot be turned down for any health conditions. You do not have to answer health questions on the application. Once that window passes, it is gone forever.
Learn more about Plan F and your one-time Open Enrollment Period by attending one of our New-to Medicare webinars.
Do Different Insurance Companies Have Different Plan F Benefits?
Fortunately NO. We get questions all the time about this – for instance a caller may ask us whether an AARP Plan F is the same as a Mutual of Omaha Plan F or Aetna Plan F. Rest assured that Medigap plans are standardized by the government. The benefits for a standard Plan F are the same whether you buy that policy from one insurance company or another. This allows you to shop based on price and a few other factors.
So if the coverage is all the same, what do you base your decision on? Well, all Medigap insurance companies have different rates based on their loss ratios from claims and medical inflation. You can compare prices and choose a company with competitive prices in your area.
Also, at Boomer Benefits, we also can look up the rate-increase history for all of the companies offering Medigap plans. This allows us to tell you which companies have had the highest and lowest rate trends. Read our Plan F Reviews for more information about which companies pay on time like they are supposed to.
Finally, if you have health conditions which might make it difficult for you to change carriers in the future , this rate increase history can be very helpful in evaluating which carrier you choose for the long term.
To discuss this with one of our friendly agents, you can click here to request a personalized quote for Medicare Supplement Plan F policies in your area, or call us at 1-855-732-9055.
To view other Frequently Asked Questions, click here.