Plan F pays your Part B deductible, but only after you meet it

Plan F is a Medigap policy that covers many of the costs Medicare leaves you responsible for — but it does not pay your deductible before you have spent the money yourself. Once you have paid your Part B deductible out of pocket, Plan F then covers the 20% coinsurance that Medicare does not pay for most doctor visits and outpatient services.

Plan F also covers your Part A deductible (the hospital deductible) in full, meaning you do not pay anything toward that deductible yourself. However, the Part B deductible — which applies to doctor visits, lab work, and imaging — works differently. You pay it first; Plan F reimburses it after.

The Part B deductible amount changes each year. For 2024, it is $240. For 2025, it is $253. These amounts are set by Medicare and may increase annually.

Key Takeaways

  • Plan F covers your Part A deductible completely, so you never pay the hospital deductible yourself.
  • Plan F covers your Part B deductible only after you have already paid it out of pocket to a doctor or provider.
  • Once you meet your Part B deductible, Plan F then covers the 20% coinsurance for most covered services for the rest of the year.
  • The Part B deductible amount changes yearly and is set by Medicare, not by your insurance company.
  • Plan F does not cover services that Medicare does not cover, such as dental, vision, or hearing aids.

How the Part B deductible works with Plan F

When you see a doctor or have an outpatient test, Medicare pays 80% of the approved amount after you have paid your deductible. You are responsible for the other 20%, called coinsurance. Plan F covers that 20% coinsurance for you — but only after you have already paid the deductible.

Here is a real example: You see a specialist and the approved charge is $500. Your Part B deductible for the year is $253 and you have not paid any of it yet. Medicare will not pay anything until you pay the $253 deductible first. You pay $253 out of pocket. Then Medicare pays 80% of the remaining $247, which is $197.60. You would normally owe the remaining 20% ($49.40), but Plan F covers that $49.40 for you.

Once you have paid your $253 deductible in a calendar year, Plan F covers your coinsurance for the rest of that year. You do not pay the deductible again until January 1 of the next year.

Plan F coverage for Part A deductible

Plan F handles your Part A deductible — the hospital deductible — completely differently. It pays the full amount, so you never pay it yourself. For 2024, the Part A deductible is $1,632 per benefit period. For 2025, it is $1,740. Plan F covers all of it.

This applies if you are admitted to a hospital as an inpatient. You do not pay anything toward the deductible; Plan F does. After that, Plan F also covers most of your hospital coinsurance for days 1 through 60 of your stay, and a portion of your costs for days 61 through 90.

What Plan F does and does not cover beyond deductibles

Plan F is one of the most comprehensive Medigap options available. Beyond deductibles and coinsurance, it covers skilled nursing facility coinsurance, blood transfusions, and foreign travel emergency care. It also covers excess charges — the amount some doctors charge above what Medicare approves — though this coverage ends on December 31, 2019 for new enrollees (people who became may be able to access for Medicare on or after January 1, 2020 cannot buy Plan F at all).

Plan F does not cover services that Medicare itself does not cover. This means it does not pay for dental work, vision care, hearing aids, long-term care, or routine physical exams. It also does not cover prescription drugs; you need a separate Part D plan for that.

Plan F also does not cover the Medicare Part B premium itself — you pay that directly to Medicare each month, separate from your Plan F premium.

When to expect Plan F to pay your Part B deductible

Plan F does not pay your Part B deductible automatically. You must submit a claim or your provider must submit one on your behalf. Most of the time, your doctor's office will file the claim to Plan F after they file to Medicare. You may receive a bill from your doctor first, asking you to pay the deductible. Once Plan F receives and processes the claim, they will reimburse you or pay the provider directly, depending on how the claim was filed.

The timing varies. Some claims are processed within two weeks; others take longer. If you receive a bill for your deductible and you have Plan F, keep the bill and contact your Plan F insurance company if you do not see a reimbursement within 30 days.

Plan F compared to other Medigap plans

Plan F is not the only Medigap option that covers deductibles. Plan G also covers your Part B deductible, but only after you pay it — the same as Plan F. Plan G does not cover your Part A deductible, so you would pay that yourself. However, Plan G premiums are often lower than Plan F premiums, which is why many people choose it.

Plan N covers some coinsurance but does not cover your Part B deductible at all. You would pay the full $253 (or whatever the current year amount is) yourself. Plan N premiums are typically the lowest of the major Medigap options.

The right plan depends on your budget, your expected healthcare use, and which costs matter most to you. Comparing actual premium quotes from insurers in your area is the only way to know which plan makes sense for your situation.

Questions to ask your doctor or insurance company

Before you choose Plan F or if you already have it, ask your doctor's office these questions: Does your office file claims to Medigap insurance, or do you need to file them yourself? How long does it usually take for them to receive payment from Plan F? If you receive a bill for coinsurance or a deductible, should you pay it right away or wait for Plan F to process the claim?

Ask your Plan F insurance company: How do I file a claim if my provider does not? What is the typical processing time? If I pay my Part B deductible out of pocket, how do I request reimbursement? Is there a important date for submitting a claim after I pay the deductible?

Frequently Asked Questions

Does Plan F pay my deductible before I go to the doctor?

No. Plan F pays your Part A deductible in full, but you must pay your Part B deductible out of pocket first. After you have paid it, Plan F covers it. You cannot use Plan F to pay the deductible upfront.

What if I have not met my Part B deductible yet and I see a doctor?

You will owe the full amount of the visit until you have paid your $253 deductible for the year. After that, Plan F covers your coinsurance. Your doctor's office can tell you how much of your deductible you have already paid if you are unsure.

Does Plan F cover the Medicare Part B premium?

No. You pay your Part B premium directly to Medicare each month. Plan F covers deductibles and coinsurance, not the premium itself. Your Plan F premium is a separate bill from your insurance company.

Can I switch from Plan F to Plan G to save money?

Yes, you can switch Medigap plans during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event. However, switching plans may involve a new underwriting process, and your new premium may be higher or lower depending on your age and health. Contact your current Plan F insurer and the Plan G insurer you are considering to compare costs before you switch.

What happens to my Plan F coverage on January 1 of a new year?

Your coverage continues, but your Part B deductible resets to zero. You will need to pay the new year's deductible amount out of pocket before Plan F covers your coinsurance again. Your Plan F premium may also change on January 1, depending on your plan and insurer.