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Medicare Plan F – Best Plan | Highest Premium

Medicare Plan F supplemental coverage is the best plan but comes with a priceGreen Pencil Check Marks

If you are considering a Medicare supplement and are looking for the best plan, Medicare Plan F fits the bill.

Plan F is technically a Medigap insurance policy but is commonly referred to as a Medicare supplement.

Of all the plans available Medicare supplement Plan F is the most comprehensive but also has the highest premium of the 10 standardized plans available.

It is also the most popular by a large margin as most insurance companies report that they sell more Plan F supplements than any other plan.

Following is a review of the plan’s benefits and a discussion who should consider this plan and who would be better served by another Medicare plan option.

Reviewing Medicare Plan F benefits

Before we jump into the plan benefits a brief review of the gaps in Medicare coverage is in order.

Medicare was not designed to be a comprehensive first dollar coverage plan. There are cost sharing requirements.

In fact, the main reason to purchase a Medicare supplement is to either eliminate or reduce these cost sharing gaps. Here are the following costs for 2017:

Medicare Part A

  • $1316 inpatient hospital deductible
  • inpatient days 61-90 $329 per day
  • inpatient days 91+ $658 per day

Medicare Part B

  • $183 annual deductible
  • 20% coinsurance for all Medicare-covered outpatient care

Skilled Nursing Facility

  • $164.50 per day for days 21-100

One aspect of these gaps that concerns most people is that there is no annual maximum out-of-pocket. Most under 65 health insurance plans have a cap on your annual out-of-pocket costs where after which, the plan pays 100%.

Medicare Plan F – Best Plan

Plan F is considered the best because it is the most comprehensive. All cost sharing amounts that would normally be your responsibility are paid by the plan.

As you can see from the benefits chart below, Plan F covers all gaps with Medicare supplement Plan G coming in a close second. Plan G does require that you pay the Part B deductible.

 

Medicare Supplement Plans Benefit Checklist
A
B
C
D
F*
G
K
L
M
N
Basic Plan (Part A Coinsurance up to an additional 365 days)
x
x
x
x
x
x
x
x
x
x
Basic Plan (Part B Coinsurance/ Co-payment; 1st 3 Pints Blood; Part A Hospice Care Coinsurance/ Co-payment)
x
x
x
x
x
x
50%
75%
x
100% except up to $20 co-pay for office visits and $50 co-pay for ER visits
Skilled Nursing Co-payment ($164.50/day for days 21 – 100 for 2017)
x
x
x
x
50%
75%
x
x
Part A Deductible ($1,316 for 2017)
x
x
x
x
x
50%
75%
50%
x
Part B Deductible ($183 for 2017)
x
x
Part B Excess Charges (additional 15% for providers not accepting Medicare assignment)
x
x
Foreign Travel Emergency (up to plan limits)
80%
80%
80%
80%
80%
80%
Out-of-Pocket Maximum
$5,120
$2,560

* Plan F includes a high deductible option where $2200 is required before benefits are paid.




Should you buy Medicare Plan F and if so when?

Deciding whether or not to purchase normally comes down to two considerations; the monthly premium and underwriting issues related to your health.

Since Medicare supplement benefits are standardized, comparing a plan among several companies will be an easy task.

Having the knowledge that plan benefits are identical among insurance companies you can concentrate on price, customer service, insurer stability and their respective histories for price increases.

Factors that may effect the premium include:

  • Age
  • Gender
  • Where you live
  • Health status
  • Where or not an early enrollment discount is offered

You should also learn about the three pricing models insurance companies use to determine Medigap premiums.

The best time to buy a Medicare supplement is during your Medigap Open Enrollment Period. This begins on the first day of the month that you are 65 or older and enrolled in Medicare Part B.

During Open Enrollment an insurance company cannot:

  • Refuse to sell you any policy that they offer
  • Make you wait for your coverage to become effective
  • Charge you due to pre-existing health conditions

You may also have Guaranteed Issue Rights to buy a Medicare supplement without medical underwriting.

These rights are normally triggered by a change in a circumstance related to your current medical coverage. An example would be losing your group coverage or your Medicare Advantage plan not renewing for the following year.

Plan F may not be your best option if…

The obvious reason not to get Plan F is it is not affordable. When determining affordability remember that Part D drug coverage is no longer included in Medicare supplement plans and you will need to factor in the additional cost of enrolling in a plan.

Another situation that could stop you from buying this plan is health if you are not in your Open Enrollment Period or have Guaranteed Issue Rights is being subject to medical underwriting.

Many companies have liberal medical underwriting requirements but there are certain health conditions and situations that will result in a denial of coverage.

If you have been denied coverage you should consider enrolling in a Medicare Advantage plan.

You may be subject to enrollment periods but underwriting is limited (you must not have end-stage renal disease) and you will protect yourself from the gaps in original Medicare.

It’s mandatory that Medicare Advantage plans include a maximum out-of-pocket amount annually.

Overall, if your budget will allow it and underwriting is not an issue, Medicare Plan F may be your best plan choice.

 

2 comments

  1. David: I have plan F and the rate is going up a bit. I will be 66 on Nov 23 and I do have type 2 diabetes and use generic meds. I am otherwise pretty healthy. Would plan N be a better choice and do you have the difference in cost. It seems to me that I would have a small co payment vs no copayment.

  2. Ralph, You would need to speak with an agent to get the premium for plan N. One thing to consider is once you switch to Plan N, you would need to go through the underwriting process if you wanted to switch back to Plan F. Moving down in benefits does not require underwriting but moving up does. Also, don’t for get that in addition to the copay, you will be responsible for the Part B deductible, currently $147.

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