Plan F is a Medigap policy that covers most of what Original Medicare does not

Plan F is a standardized Medigap insurance plan sold by private insurers. It works alongside Original Medicare (Parts A and B) to pay for costs that Medicare leaves with you — copayments, coinsurance, and deductibles. Plan F covers more of those out-of-pocket costs than any other Medigap plan, which is why it has historically been the most popular choice.

However, Plan F is no longer sold to people who became may be able to access for Medicare on or after January 1, 2020. If you were already enrolled in Plan F before that date, you can keep it. If you became may be able to access for Medicare after that date, you will need to choose a different Medigap plan — most commonly Plan G, which is very similar but slightly less comprehensive.

Key Takeaways

  • Plan F covers your Part A deductible, Part B deductible, Part B coinsurance, skilled nursing facility coinsurance, and excess charges that doctors bill above Medicare's approved amount.
  • Plan F does not cover dental, vision, hearing aids, or long-term care — those require separate insurance or out-of-pocket payment.
  • You can only enroll in Plan F if you were may be able to access for Medicare before January 1, 2020; newer beneficiaries must choose Plan G or another option.
  • Plan F premiums vary by insurer, location, and age, and can increase over time as you get older or as the plan's costs rise.
  • You keep your Original Medicare coverage and your choice of doctors; Plan F straightforward fills in gaps that Medicare does not pay.

What Plan F actually pays for

Plan F covers the Part A deductible — the amount you pay before Medicare hospital insurance kicks in. It also covers Part B coinsurance, which is the 20 percent of approved charges you normally pay for doctor visits, outpatient surgery, and lab work after you meet your Part B deductible.

Plan F pays your Part B deductible as well, which is the amount you must pay out of pocket before Part B coverage begins. It covers skilled nursing facility coinsurance — the daily cost-sharing for days 21 through 100 in a nursing home after a hospital stay. It also pays for excess charges, which occur when a doctor bills more than Medicare's approved amount and you would normally owe the difference.

One feature that sets Plan F apart from Plan G is that Plan F covers your Part B deductible, while Plan G does not. This is the main difference between the two plans, and it is why Plan F premiums are typically higher. Plan F also covers 100 percent of blood transfusions after you meet your deductible.

What Plan F does not cover

Plan F is not a comprehensive health plan. It fills gaps in Medicare, but it does not cover services that Medicare itself does not cover. Dental work, vision care, hearing aids, and routine eye exams are not covered by Plan F or by Original Medicare. If you need these services, you must pay out of pocket or purchase separate dental and vision insurance.

Plan F does not cover long-term care — the cost of living in a nursing home or assisted living facility for an extended period. It does not cover private-duty nursing, custodial care (help with bathing, dressing, and other daily activities), or experimental treatments that Medicare does not cover. Prescription drugs are also not covered by Plan F; you need Part D prescription drug coverage for that.

How Plan F premiums work

Plan F premiums are set by the private insurance company that sells the plan, not by Medicare. Premiums vary widely depending on which insurer you choose, where you live, and your age. Some insurers use community rating, meaning everyone in your area pays the same premium regardless of age. Others use age-rated pricing, where premiums increase as you get older.

Premiums can also increase over time as the insurance company's costs rise or as you age. You will receive a notice before any premium increase takes effect. If your premium becomes unaffordable, you can switch to a different Medigap plan or a different insurer during the annual open enrollment period (October 15 to December 7), though switching may mean a new waiting period for pre-existing conditions depending on your state and circumstances.

Who can still enroll in Plan F

Plan F is available only to people who were may be able to access for Medicare before January 1, 2020. "may be able to access" means the date you first became able to sign up for Medicare — usually age 65, but sometimes earlier if you receive Social Security Disability Insurance or have end-stage renal disease.

If you turned 65 before January 1, 2020, you can enroll in Plan F at any time, though you may face higher premiums if you enroll outside your initial enrollment window. If you became may be able to access for Medicare on or after January 1, 2020, Plan F is not an option for you. In that case, Plan G is the closest alternative, covering everything Plan F does except the Part B deductible.

How Plan F works with your doctors and hospitals

Plan F does not change your relationship with your doctors or hospitals. You keep your Original Medicare coverage, which means you can see any doctor or hospital in the United States that accepts Medicare. Plan F straightforward pays the out-of-pocket costs that Medicare does not cover.

When you see a doctor, you show both your Medicare card and your Plan F card. The doctor's office bills Medicare first. Medicare pays its share, then sends the bill to your Plan F insurer, which pays the remaining amount you would normally owe. You typically pay nothing at the point of service, though some doctors may ask you to pay upfront and then seek reimbursement from Plan F.

Plan F compared to other Medigap options

Plan F and Plan G are the two most comprehensive Medigap plans available. The main difference is that Plan F covers the Part B deductible ($240 in 2024, though this amount changes yearly) and Plan G does not. Plan G premiums are usually lower than Plan F premiums, so the savings on premiums may offset the cost of paying the Part B deductible yourself.

Other Medigap plans — such as Plan N, Plan K, and Plan L — cover fewer costs and have lower premiums. They require you to pay copayments or coinsurance for some services. If you are cost-conscious and willing to manage more out-of-pocket expenses, one of these plans might make sense. If you want the broadest coverage and can afford the higher premiums, Plan F (if you are may be able to access) or Plan G is usually the better choice.

Frequently Asked Questions

Can I switch from Plan F to another Medigap plan?

Yes, you can switch during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event such as moving out of state. When you switch, the new plan may impose a waiting period for pre-existing conditions, depending on your state and how long you had Plan F. Some states have protections that waive this waiting period.

Does Plan F cover preventive care like screenings and vaccines?

Plan F does not need to cover preventive care separately because Original Medicare covers it at no cost to you. Screenings, vaccines, and annual wellness visits are covered by Medicare Part B with no copayment or coinsurance. Plan F straightforward covers the costs Medicare does not, so you pay nothing for these services.

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

Your Plan F coverage continues, but the premium may change because rates vary by state and region. Contact your Plan F insurer to confirm your new rate. You may also want to compare rates from other insurers in your new state during open enrollment to see if a better rate is available.

Is Plan F the same as Medicare Advantage?

No. Plan F is a Medigap plan, which works with Original Medicare. Medicare Advantage (Part C) is a different type of plan sold by private insurers that replaces Original Medicare entirely. With Medicare Advantage, you use the plan's network of doctors and hospitals, and coverage works differently. Medigap and Medicare Advantage are separate choices — you cannot have both at the same time.

Do I need Part D prescription drug coverage if I have Plan F?

Yes. Plan F does not cover prescription drugs, so you need to enroll in a Part D plan through Medicare or a private insurer. If you do not enroll in Part D when you first become may be able to access, you may face a penalty if you enroll later. You can enroll in Part D during the annual open enrollment period or if you have a may have access to life event.