What Medicare Plan F Covers

Medicare Plan F is a Medigap policy — supplemental insurance that works alongside Original Medicare (Parts A and B) to cover costs that Medicare does not pay. Plan F covers the largest range of out-of-pocket expenses of any Medigap plan available today.

Plan F pays your Part A deductible (the amount you owe before Medicare hospital coverage begins), your Part B deductible (the amount you owe before Medicare doctor visits and outpatient care begin), coinsurance for hospital stays, coinsurance for doctor visits and outpatient services, and the cost of blood transfusions. It also covers skilled nursing facility coinsurance and foreign travel emergency care. The only major cost Plan F does not cover is prescription drugs — you need a separate Part D plan for that.

Because Plan F covers so many costs, it is often called a "first-dollar" plan. When you go to the doctor or hospital, Plan F typically pays what Medicare does not, leaving you with little or no bill. This is different from other Medigap plans, which cover fewer categories and leave you responsible for some costs.

Key Takeaways

  • Plan F covers your Medicare deductibles, coinsurance, and copayments for hospital and doctor visits, but does not cover prescription drugs.
  • Plan F is only open to people who first became may be able to access for Medicare before January 1, 2020; people who became may be able to access on or after that date cannot purchase it.
  • Plan F premiums vary by insurance company and location, and they typically increase each year as you age.
  • You must enroll in Plan F during your initial enrollment period or during the annual open enrollment window to avoid paying higher premiums later.
  • Plan F works with Original Medicare, not with Medicare Advantage plans.

Who Can Buy Plan F

Plan F has an important may be able to access rule based on when you first became may be able to access for Medicare. If you became may be able to access for Medicare before January 1, 2020, you can purchase Plan F at any time. If you became may be able to access for Medicare on or after January 1, 2020, Plan F is not open to you — you can only choose from Plans A, B, C, D, G, K, L, M, or N.

This rule exists because Congress phased out Plan F for newer Medicare beneficiaries to encourage people to choose plans with higher deductibles, which may lower overall program costs. If you are unsure when you first became may be able to access, your Social Security statement or your Medicare card will show your may be able to access date.

You must be enrolled in Original Medicare (Part A and Part B) to buy a Medigap plan. You cannot use Plan F if you have Medicare Advantage instead. If you currently have Medicare Advantage and want to switch to Original Medicare with Plan F, you can do so during the annual open enrollment period (October 15 to December 7 each year), but you should understand the differences before you switch.

How Plan F Premiums Work

Plan F premiums vary significantly depending on which insurance company sells the plan and where you live. The same plan from two different insurers can cost $50 per month or $200 per month — there is no standard price. You will need to contact insurers directly or use the Medicare Plan Finder tool on Medicare.gov to compare rates in your area.

Premiums typically increase each year. Some insurers use an "age-based" model, where your premium goes up as you get older. Others use a "community-rated" model, where everyone in your area pays the same premium regardless of age. A few use a "no-age-rated" model, where your premium stays the same as you age but may increase for everyone due to inflation. Ask each company which method they use before you enroll.

Plan F premiums are separate from your Medicare Part B premium, which you pay to Medicare itself. You pay both: your Part B premium to Medicare, and your Plan F premium to the insurance company you choose.

When to Enroll in Plan F

The best time to enroll in Plan F is during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after. During this window, insurance companies cannot charge you more based on your health history — a protection called "may provide issue." If you wait until after this period ends, some insurers may deny you coverage or charge you a higher premium based on your medical conditions.

If you miss your initial enrollment period, you can still enroll during the annual open enrollment period from October 15 to December 7 each year. Coverage begins January 1 of the following year. Outside these windows, you generally cannot enroll in Plan F unless you have a may have access to life event, such as losing employer coverage or moving to a new state.

Delaying enrollment can be costly. If you go without Medigap coverage and then try to enroll later, some insurers will charge you a higher premium to make up for the months you were uninsured. This is called a "late enrollment penalty," and it can add hundreds of dollars per year to your premium for the rest of your life.

Plan F Versus Other Medigap Plans

Plan F covers more than any other Medigap plan, which makes it the most comprehensive option — but it also typically has the highest premium. Plan G is similar to Plan F but does not cover the Part B deductible; many people find Plan G costs less per month while still covering most major expenses. Plans A, B, C, D, K, L, M, and N cover fewer services and leave you responsible for some coinsurance or copayments, but their premiums are usually lower.

The right plan depends on how much you expect to use healthcare and how much premium you can afford to pay each month. If you see doctors frequently or have hospital stays, Plan F's broad coverage may save you money overall. If you are generally healthy and want to keep your monthly costs low, a plan with a lower premium and higher out-of-pocket costs might suit you better. You can compare plans side by side using the Medicare Plan Finder tool.

How Plan F Works With Your Doctor Visits and Hospital Care

When you have Plan F and go to a doctor who accepts Medicare, here is what happens: Medicare pays its share of the bill first, and Plan F pays what Medicare does not cover. You typically owe nothing. The doctor's office bills Medicare, Medicare processes the claim, and the claim automatically goes to your Plan F insurer. You do not have to file paperwork or pay upfront and wait for reimbursement.

For hospital stays, the process is the same. Medicare Part A covers most inpatient hospital costs after you meet the deductible. Plan F covers that deductible and any coinsurance you would owe for a longer stay. Again, you typically pay nothing out of pocket.

If you see a doctor who does not accept Medicare (called a "non-participating" provider), Plan F may not cover the visit, or coverage may be limited. Always confirm that your doctor accepts Medicare before your appointment. You can search for Medicare-accepting doctors on Medicare.gov or by calling your Plan F insurer.

What Plan F Does Not Cover

Plan F does not cover prescription medications. You must enroll in a separate Medicare Part D prescription drug plan to have coverage for pills and injections. Part D plans vary in cost and which drugs they cover, so you will need to compare plans based on the medications you take. You can enroll in Part D during your initial enrollment period or during the annual open enrollment window.

Plan F also does not cover routine dental care, vision exams, hearing aids, or long-term care. Some Medicare Advantage plans include these benefits, but Original Medicare with Medigap does not. If these services are important to you, you may want to explore Medicare Advantage as an alternative, or budget separately for these costs.

Plan F covers foreign travel emergency care for up to 80% of the cost, but only for the first 60 days of a trip outside the United States. It does not cover routine care abroad or care in countries where Medicare does not have agreements. If you travel internationally often, ask your Plan F insurer about the details of this coverage before you leave the country.

Frequently Asked Questions

Can I switch from Plan F to a different Medigap plan later?

Yes, you can switch to another Medigap plan during the annual open enrollment period (October 15 to December 7). However, if you have been enrolled in Plan F for more than six months and you switch to a plan with a lower level of coverage, some insurers may charge you a higher premium based on your health history. Switching to a plan with equal or greater coverage is usually may provide issue.

What happens to my Plan F if I move to a different state?

Your Plan F coverage ends when you move. You must enroll in a new Medigap plan in your new state within 63 days of moving to keep may provide issue protection. Contact your current insurer to learn about they sell plans in your new state, or use Medicare.gov to compare options. Moving is a may have access to life event, so you can enroll outside the normal open enrollment window.

Do I need to see my doctor for a referral to see a specialist with Plan F?

No. Original Medicare does not require referrals, and Plan F does not add that requirement. You can see any specialist who accepts Medicare without asking your primary care doctor first. However, some doctors may recommend seeing a specialist, and coordinating your care can help you get better results.

Will Plan F cover me if I travel outside the United States?

Plan F covers emergency care during the first 60 days of travel outside the U.S. and its territories, up to 80% of the cost after you meet a deductible. Routine care and non-emergency care are not covered. If you travel internationally for extended periods or regularly, ask your insurer about the exact terms before you leave, and consider purchasing travel health insurance for additional protection.

What if my Plan F insurer stops selling the plan in my area?

If your insurer discontinues Plan F, they must give you at least 30 days' notice and help you switch to another plan. You can move to a different Plan F from another insurer, or switch to a different Medigap plan. Because this is a may have access to event, you have may provide issue protection for 63 days after your coverage ends, even if you are switching to a plan with lower coverage.