Medicare Plan F coverage is considered to be the “Cadillac” coverage among the available Medicare supplements today. The reason is that Plan F gives you first-dollar coverage for all Medicare-approved services. So whether you have a hospital stay, or a diagnostic exam or a doctor’s visit, you will simply present your Medicare supplement card, and you will owe absolutely no deductibles, co-payments or co-insurance. As long as Medicare approves the service or treatment you have done, then Medicare will pay its share and your Medicare Supplement Plan F will pay the remaining amount that Medicare does not cover.
What Does Plan F Cover – 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.
The only things Plan F does NOT cover would be those things that Medicare itself also does not cover, such as acupuncture, routine vision exams, routine dental work, etc. The way that Medigap plans, including Plan F, work is that they cover only after Medicare first pays its share.
Under Part B, Medicare will pay for 80% of your outpatient costs. As long as Medicare approves a claim and pays its 80% share, then your supplement will cover the other 20%. So naturally, if Medicare denies a claim, your Medigap plan cannot pay anything toward it either.
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 will help to pay for emergency health incidents in foreign countries up to the plan limit, although you will pay a small deductible and some cost-sharing for these services.
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, vaccines, colonoscopies, mammograms, screenings etc. Then for your other doctor visits, for things like illnesses and injuries, Plan F will cover your deductible, and that other 20%that Part B doesn’t pay.
Plan F also pays this 20% for services like surgeries, durable medical equipment, labwork, imaging tests, and many other outpatient services. For more details on the benefts covered by Plan F, see the chart on this page: What does Plan F cover?
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, from Oct. 15 – Dec. 7 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, it is to your benefit to apply during the first 6 months that your Part B is effective. During this window, you cannot be turned down for any health conditions and do not have to answer health questions on the application.
Do Different Insurance Companies Have Different Plan F Benefits?
Fortunately NO. 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
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 the prior year and medical inflation. You can compare prices and choose a company that is competitively priced 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. If you have health conditions which might make it difficult for you to change carriers again in the future after your initial window has closed, 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.