What Does Medicare Plan F Cover?
Today is the fourth part in my Medicare series. Previously we covered Medicare A & B, C and D in three different blog posts. We will not cover Part E because new enrollment has closed. Plan E is not open to new enrollees but if you had the plan prior to 2010 you may keep it. Therefore, to start today’s post What Does Medicare Plan F Cover?
Although you might not have heard about it by this name, there is a Medicare Plan F. “Original” Medicare, also called Parts A and B, covers hospitalization and many outpatient healthcare costs. Part C is the official term for Medicare Advantage, which is the services of Parts A and B, but through an HMO or PPO-type of private health insurance.
Medicare Part D helps to pay some of the costs of prescription drugs. There is no longer a Part E of Medicare. With so many options already with Parts A, B, C, and D, some people might wonder why we need a Plan F. What does Medicare Plan F cover? Part F in simple terms covers co-pays for doctor’s visits.
Many people in the insurance industry call Plan F the “Cadillac” coverage of Medicare supplement options. Another term for Plan F is “Medigap” coverage. As long as Medicare would cover the item, Medigap Part F will pay for it.
How Medigap Coverage Works
Medigap coverage means you pay nothing for healthcare services that original Medicare covers. You will have two cards – your Medicare card and your Medigap supplemental policy card. When you receive medical services, you present both cards to the service provider. Medicare will pay its portion, and Medigap will pay the rest.
What Medigap Does Not Cover
Medigap does not pay for things that original Medicare does not cover, unless your plan contains specific terms to the contrary. Neither original Medicare (Parts A and B) nor Medigap cover these things:
- Vision care and eyeglasses
- Routine dental services and dentures
- Routine hearing examinations and hearing aids
- Homeopathic treatments, like acupuncture and acupressure
- Surgery that is not medically necessary
- Prescription drugs (Part D is a separate plan)
- Foot care, unless the treatment is for a medical condition
- Help with daily living tasks, like grooming and eating
When Medicare denies a claim, Medigap will not pay any portion of the cost of the item or service. Medigap only kicks in after Medicare pays its part.
Things That Medigap Covers
Here are some examples of things that Medigap covers:
- Your annual deductible for Medicare Parts A and B
- Your copays (usually 20 percent of the hospital, doctor, or another medical bill)
- An extra 365 days of hospital coverage after you use up your Medicare hospitalization benefits
- Blood transfusions, up to three pints
- Coinsurance for Part A hospice care
- Coinsurance for a skilled nursing facility
- Some doctors charge the patient 15 percent more than the Medicare reimbursement rate. If you go to one of these doctors, you have to pay this “excess charge,” unless you have Medigap coverage. Medigap pays the 15 percent excess charge for you.
- Emergency foreign travel for medical reasons, up to $50,000. Medicare does not cover any of this expense because Medicare only pays for healthcare services inside the United States, but a Medigap policy will pay 100 percent of this cost.
- A portion of some of the expenses of emergency healthcare services in a foreign country, up to the individual policy’s limits.
Medigap policy premiums and benefits can vary widely from one company to another. You should read the details carefully and compare multiple policies.
Medigap Part F is going away for new enrollees starting January 1, 2020. If you have it already or are otherwise eligible you can keep your medigap but in an effort to prevent people from going to the doctor for a sniffle Part F is being closed to new enrollees.
Your state’s laws might differ from the general law of this article. You might want to talk to elder law attorney Frank Bruno, Jr. to discuss.
Boomer Benefits. “What Does Part F Cover?” (accessed October 24, 2019) https://boomerbenefits.com/faq/what-does-plan-f-cover/