Plan F Coverage: What Medicare Supplement Plan F Pays For

Medicare Supplement Plan F helps pay many of the out-of-pocket costs left by Original Medicare, including deductibles, coinsurance, and copayments. It is a standardized Medigap policy—not a Medicare Advantage plan—and it generally pays its share only after Medicare has approved a covered service and processed the claim.

What Plan F covers

For a person eligible to buy it, standard Plan F covers the following Medicare cost-sharing items when they apply to Medicare-covered care:

• Part A hospital coinsurance and hospital costs for up to 365 additional days after Medicare hospital benefits are used up.
• Part A deductible for inpatient hospital care.
• Part A coinsurance or copayment for hospice care.
• Skilled nursing facility care coinsurance.
• Part B deductible.
• Part B coinsurance or copayments, generally including the 20% share a person otherwise pays for Medicare-approved services after the Part B deductible.
• Part B excess charges, when a provider is legally permitted to bill them.
• Costs for the first three pints of blood used in a covered medical service.
• 80% of qualifying foreign-travel emergency care, up to the plan’s limit.

These are benefits for Medicare cost-sharing, not a promise to pay every medical bill. Plan F does not turn a service Medicare excludes into a covered service. It also does not replace Medicare: enrollment in both Medicare Part A and Part B is generally needed for the Medigap coverage to work as intended.

How the coverage works

Original Medicare is the primary payer. You normally show your Medicare card and receive care from a provider who accepts Medicare. Medicare first decides whether the service is covered and calculates its approved amount. The Plan F insurer then pays covered cost-sharing according to the policy. Many Medigap claims are sent automatically by Medicare to the insurer, though billing arrangements can vary.

For example, suppose Medicare approves a covered outpatient service and assigns a 20% Part B coinsurance amount after the applicable deductible. A standard Plan F policy generally covers that coinsurance. But if the service is not covered by Medicare, or Medicare does not approve it, Plan F normally does not pay simply because the bill is medical care. Check coverage with Medicare and the provider before non-emergency services when there is uncertainty.

Plan F’s coverage of the Part B deductible is a defining feature. That feature is also why eligibility matters: federal rules generally prevent people who became newly eligible for Medicare on or after January 1, 2020, from buying Medigap plans that cover the Part B deductible, including Plan F. People who were eligible before that date may still be able to buy it, subject to availability and applicable enrollment rules. Eligibility is based on when someone became eligible for Medicare, not simply their current age.

What Plan F does not pay for

Plan F is not comprehensive health insurance by itself. It supplements Original Medicare, so services outside Medicare’s coverage are generally outside the plan too. Common examples include most routine dental care, routine eye exams and eyeglasses, hearing aids, and long-term custodial care. Medicare coverage has specific exceptions and conditions, so the details of a service matter.

Plan F also does not include Medicare Part D prescription drug coverage. Someone with Original Medicare who wants outpatient prescription coverage generally considers a separate Part D plan. Medigap plans also do not provide the bundled extras that some Medicare Advantage plans may offer; those are different coverage arrangements with different rules.

Foreign-travel emergency coverage is limited rather than unlimited. Plan F generally covers 80% of eligible emergency medical costs during the initial portion of a trip, after a deductible, subject to a lifetime maximum. Review the policy’s current outline of coverage for the exact conditions and limits. Do not assume ordinary treatment abroad or planned care overseas is covered.

Plan F and the high-deductible option

In some places, insurers offer a high-deductible version of Plan F. It has the same broad categories of benefits, but the policyholder pays Medicare-covered cost-sharing up to a specified annual deductible before the plan begins paying. The deductible amount is set under federal standards and can change; confirm the current figure in the policy materials rather than relying on an old brochure.

This distinction can change the timing and amount of out-of-pocket payments. With standard Plan F, covered cost-sharing is generally paid by the plan without the separate high-deductible threshold. With high-deductible Plan F, the insured must first meet that threshold for covered benefits. Neither version removes costs for services Medicare does not cover.

How Plan F compares with Plan G

Plan G is often compared with Plan F because their standardized benefits are otherwise very similar. The key difference is that Plan G does not cover the Part B deductible; the insured pays that deductible when it applies. Plan F does cover it, but access to Plan F is restricted for people newly eligible for Medicare on or after January 1, 2020.

Comparisons should use the actual premiums and policy details available to the individual, not an assumption that one plan will always cost less overall. Premiums vary by insurer, location, rating method, and other permitted factors. A useful comparison considers the premium plus the cost-sharing the person may pay, while remembering that future costs and use of care cannot be known exactly. Plan letters are standardized for covered benefits, but premiums and customer service are not.

Choosing and checking a Plan F policy

Start by confirming eligibility and whether policies are available in your area. Then compare written policy information and the total cost of coverage. Questions worth checking include:

• Is the policy standard Plan F or high-deductible Plan F?
• What is the premium, how is it rated, and can it change?
• Does the policy cover the benefits described in the current standardized outline?
• How are claims submitted, and which providers accept Medicare?
• What are the precise foreign-travel emergency conditions and limits?

Medigap enrollment rights and switching rules can depend on circumstances and timing. Before dropping an existing policy, verify whether you can obtain another policy and understand any underwriting or enrollment conditions that may apply. For a personal eligibility or enrollment question, use official Medicare information or contact a State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.

Frequently Asked Questions

Does Plan F pay the Medicare Part B deductible?
Yes. Standard Plan F covers the Part B deductible for eligible policyholders. People newly eligible for Medicare on or after January 1, 2020, generally cannot buy plans that cover this deductible, including Plan F.

Does Plan F cover prescription drugs?
No. Plan F does not include outpatient prescription drug coverage. A person with Original Medicare can look into separate Part D coverage if needed.

Does Plan F pay for dental, vision, or hearing care?
Usually not for routine dental, vision, or hearing services that Original Medicare does not cover. Specific Medicare-covered exceptions may be treated differently, so check the service and policy details.

Does Plan F cover every bill after Medicare pays?
No. It pays specified Medicare cost-sharing, not every remaining balance. Noncovered services, costs above policy limits, and care that does not meet Medicare’s coverage requirements may remain the patient’s responsibility.

Is high-deductible Plan F the same as standard Plan F?
It covers the same general benefit categories, but the policyholder pays an annual deductible before the insurer pays covered benefits. Check the current policy documents for the deductible and other terms.

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