Medicare Part F Coverage: Benefits and Inclusions Explained
Overview of Medigap Plan F
Medicare Supplement Plan F (also called Medigap Plan F) is one of the most comprehensive supplemental insurance policies available to individuals with Original Medicare. This plan is specifically designed to cover the “gaps” in Medicare out-of-pocket costs, including deductibles, coinsurance, copayments, and even Medicare excess charges-making it the only Medigap plan to provide first-dollar coverage for all Medicare-approved services. After you pay your Plan F monthly premium, you typically pay nothing more for covered medical services and supplies.
However, due to recent federal legislation, Plan F eligibility is restricted to those who became eligible for Medicare prior to January 1, 2020. If you qualified for Medicare after this date, Plan F is no longer available to purchase for new enrollees, but those who were already eligible or enrolled may keep or even change their Plan F policy.
It’s important to note there is also a high-deductible Plan F option available in many states. With this version, you’ll pay a lower monthly premium, but you must meet a higher deductible out-of-pocket before the plan starts to pay for covered benefits.
Detailed Coverage: What Plan F Pays For
Medigap Plan F stands out due to its comprehensive coverage-often referred to as “first-dollar coverage.” This means once you pay your monthly premium, you typically owe nothing for any Medicare-approved Part A or Part B service. Here’s a detailed look at what Plan F covers in 2026 and beyond:
Hospital and Skilled Nursing Facility Costs (Medicare Part A)
- Part A deductible: Covers the full Medicare Part A deductible (e.g., $1,736 in 2026).
- Hospital coinsurance: Pays for daily hospital coinsurance costs for up to 365 additional days after Medicare benefits are exhausted.
- Skilled nursing facility coinsurance: Covers copayments for skilled nursing facility care.
- Hospice care: Covers Medicare-eligible hospice copayments and coinsurance.
- First 3 pints of blood: Pays for the first three pints of blood each year, a benefit not covered by basic Medicare.
Doctor and Outpatient Services (Medicare Part B)
- Part B deductible: Covers the full Part B annual deductible (about $240 in 2024, may increase in 2026).
- Part B coinsurance: Pays the 20% coinsurance for all Medicare-approved outpatient medical services.
- Part B excess charges: Covers up to 15% above Medicare-approved amounts charged by providers who do not accept Medicare assignment.
Other Core Medigap Plan F Benefits
- Foreign travel emergency: Pays 80% of emergency medical care costs outside the US (with lifetime limits; usually $50,000 cap).
- Medicare-approved services: Plan F pays all costs for services Medicare approves, meaning you’ll never pay coinsurance or copays for covered care.
Plan F will also cover medications only if they are administered in a clinical/hospital setting and covered by Medicare Part A or B. Retail prescription drugs are not covered; you will need a Medicare Part D plan for comprehensive prescription drug coverage.
Example Scenario
Suppose you have a hospital stay. Medicare pays its share; Plan F covers all hospital deductibles and coinsurance, including additional days if needed. If you visit a specialist, Medicare pays 80% of the approved cost, Plan F pays the other 20%, any excess charges, and your deductible. Your cost at point of service is $0.
Services and Costs Not Covered by Plan F
Although Medigap Plan F coverage is extensive, there are notable exclusions:
- Non-Medicare-approved services: If Medicare denies a claim, so does Plan F. Examples include acupuncture (unless medically necessary for specific pain management), cosmetic procedures, or experimental treatments.
- Retail prescription drugs: Ongoing outpatient medications-those you buy from a pharmacy-are not covered. For this, pair Plan F with a separate Part D drug plan.
- Vision and dental care: Routine eye exams, glasses, dental cleanings, and other dental/vision services are not included in Plan F.
- Hearing aids and exams: Plan F does not cover hearing aids or routine hearing exams.
- Long-term care: Nursing home stays beyond short-term rehabilitation are not covered.
- Private-duty nursing: Personal or non-skilled nursing (e.g., live-in caregivers) is excluded.
For a more limited coverage option that does include some cost-sharing, compare with Medicare Plan K, which provides partial benefits at a lower premium.
Who Can Get Plan F? (Eligibility and Enrollment After 2020)
Plan F eligibility changed due to federal law: only those who became eligible for Medicare before January 1, 2020 (“pre-2020 eligibles”) can buy or switch to Plan F in 2026 and beyond. This includes people who turned 65 or qualified by disability before 2020, whether or not they previously enrolled in Plan F or completed their Medigap Open Enrollment Period.
If you became Medicare-eligible after January 1, 2020, you cannot buy Plan F-even during the 6-month Medigap Open Enrollment Period that begins the month you are both 65 and enrolled in Part B. You’ll need to consider alternatives such as Plan G or Plan N.
Open Enrollment and Underwriting
- Open Enrollment: Enroll within 6 months of enrolling in Medicare Part B for guaranteed issue rights-no health questions or higher premiums.
- After Open Enrollment: If you apply outside this window, insurers may require medical underwriting. You may be denied coverage or charged more due to pre-existing conditions, unless you qualify for a Special Enrollment Period after losing other coverage.
This is true whether you’re turning 65 or qualifying for Medicare due to disability. For clarification on whether you need to be retired to enroll, see Do You Have to Be Retired to Get Medicare? Key Facts.
Can I Switch Between Medigap Plans?
Yes, eligible individuals can generally change between Plans F, G, and N, but medical underwriting may apply outside the open enrollment or guaranteed issue timeframes. Always compare costs and coverage annually, as premiums and plan rules can change.
How Does Plan F Compare to Other Medicare Supplement Plans?
Though Plan F benefits are the broadest, it is not always the best choice for every beneficiary, especially given the premium cost and eligibility restrictions. Here is how it stacks up:
| Benefit | Plan F | Plan G | Plan N |
|---|---|---|---|
| Part A Deductible | 100% covered | 100% covered | 100% covered |
| Part B Deductible | 100% covered | You pay (e.g., $240 in 2024) | You pay |
| Part B Coinsurance | 100% covered | 100% covered | 100% (minus up to $20 office/$50 ER copays) |
| Part B Excess Charges | 100% covered | 100% covered | None |
| Foreign Travel Emergency | 80% | 80% | 80% |
| Availability | Pre-2020 eligible only | All eligible | All eligible |
| Premiums (Typical) | Higher ($150-$250/mo) | Lower ($100-$200/mo) | Lowest (~$140/mo example) |
Plan F is the only Medigap plan paying both Part A and Part B deductibles and all coinsurance/charges, offering $0 out-of-pocket for covered services. Plan G, available to all new Medicare beneficiaries, excludes only the Part B deductible. Plan N offers slightly lower premiums, but you pay limited office/ER visit copays and do not get excess charge coverage.
High-deductible versions of both Plan F and Plan G are available in some states, providing lower monthly premiums for those willing to spend more out-of-pocket before benefits begin. To dive deeper into partial coverage and cost-saving alternatives, visit our Plan K coverage guide.
FAQs About Plan F Coverage and Availability
- Is Plan F still available in 2026? Yes, if you were eligible for Medicare prior to January 1, 2020. Plan F remains open for these individuals to enroll or switch in 2026 and beyond.
- Does Plan F cover everything? Plan F covers all Medicare-approved gaps-deductibles, coinsurance, excess charges-for Parts A and B. It does not cover retail prescriptions, dental, vision, hearing, or non-Medicare approved services.
- Why choose Plan F over Plan G or N? Choose Plan F if you desire zero out-of-pocket for Medicare-covered services and expect significant hospital or doctor care. However, if you want lower premiums and don’t mind paying the annual Part B deductible or some copays, Plans G or N may be more cost-effective.
- How much will I pay for Plan F? Typical monthly premiums for Plan F range from $150-$250, depending on your age, gender, location, insurer, and tobacco use.
- Example: For a specialist visit, Medicare pays 80%, and Plan F covers the remaining 20%, including any Part B deductible and excess charges-you pay $0 at the visit.
- If I lose my Medicare card, what should I do? Follow steps here: Lost Medicare Card: What to Do Next.
- How do I cover prescriptions? Pair Plan F with a stand-alone Part D drug plan. Learn more about timing your enrollment in When Can I Enroll in Medicare Part D?
