A Quick View of Medicare Supplemental Plan F

Medicare Supplement Plan F was the top-selling Medicare supplement plan for many years.  This plan has been closed to people turning 65 after 1-1-2020, and has been replaced by Medicare Supplement Plan G.

For seniors who currently have Plan F, you are “grandfathered” and are able to keep this plan for a lifetime!  Plan F is the only plan that pays 100% of what Medicare does not pay.  We urge all our clients to keep this plan if it fits “comfortably” in your budget. If you feel the premium is getting a bit uncomfortable, you can get a lower cost Plan G, N or Advantage plan. Please notify us and we can help you easily change plans and/or insurance companies.

Summary of Plan F

At age 65 Medicare became your basic health insurance coverage. There are two essential parts to Medicare –
Part A and Part B.

  • Part A covers hospital and skilled nursing facility costs
  • Part B covers physician services, diagnostic tests and surgical expenses

With Medicare there are gaps in coverage (deductibles and coinsurance). These are costs you need to pay if you don’t have supplemental insurance for Medicare. Some of these expenses can be quite large. Supplement plans for Medicare act like an umbrella to protect you from those Medicare gaps in coverage by paying those extra costs for you.

With the bestselling Medicare Supplemental Plan F, your costs for health care will be zero! Let me say that again, Medicare Plan F ensures that you have no additional medical costs. And the premiums for supplemental Medicare plans are much smaller than a premium for a comparable plan for the under-65 market ($2000/month)

Part A is extremely important. It is possible to have a $500,000+ hospital bill. In contrast, a surgery may only cost $5,000. The hospital bill is often the most expensive part of the total medical bill. Medicare Part A covers the costs for facility stays such as at a hospital or skilled nursing facility.

Medicare (Part A) – Hospital & Skilled Nursing Facility Services
Services
 Medicare Pays Plan Pays You Pay
Hospitalization –
First 60 Days		 All but $1,556  $1,556
(Part A deductible)		 $0
Skilled Nursing Facility –
First 20 days		 All approved amounts $0 $0
Skilled Nursing Facility –
21st through 100th day		 All but $194.50 a day Up to $194.50 a day $0

For the first 60 days you are in the hospital—which is a huge amount of time—Medicare Part A pays all of the expenses except  $1,556. This is called the Part A deductible.

If you have Plan F, the plan pays the Part A deductible. Your net cost is $0. Zero is nice! 🙂

Remember “Zero.” That’s the answer to the final exam at the end of this educational section. 🙂

Normally hospitalization is for acute care. Once you are stabilized—often around 3 to 7 days—you are moved to a Skilled Nursing Facility to recover. For the first 20 days in a Skilled Nursing Facility, Medicare pays all the expenses. For days 21 to 100, Medicare pays all except $194.50 per day. Your supplemental insurance for Medicare pays the $194.50 per day. Your net cost is, once again $0. Zero is nice! 🙂

Medicare Part B pays for non-facility costs such as doctor’s visits, lab work, x-rays, MRIs, CT Scans, surgeons, assistant surgeons, anesthesiologists, chief bottle washer, you name it!

Medicare (Part B) – Medical Services
Services Medicare Pays Plan Pays You Pay
Medical Expenses – In or Out of Hospital
First $233 of Medicare Approved Amounts $0 $233 (Part B deductible) $0
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Clinical Laboratory Services
Tests for Diagnostic Services 100% $0 $0

For the first $233 of non-facility medical services, Medicare Part B pays $0. That $233 is your Part B deductible. If you have Medicare Supplement Plan F, it pays that Part B deductible for you. Your net cost is $0. Zero is nice! 🙂

When you visit a doctor, blood tests are covered 100% by Medicare. After you satisfy the deductible, Medicare becomes an 80/20 plan, where Medicare pays 80% of the costs and you pay 20%.

If, for example, you have an MRI that costs $1,000, your 20% coinsurance (what you are responsible for) is $200. However, you don’t have to pay that amount. Your Medicare Plan F will pay it for you!

If you have cancer that requires chemo and radiation therapy costing $100,000, your 20% responsibility would be $20,000. Ouch. But your Medicare Supplemental Plan F will pay that $20,000 for you. Your net cost is… say it with me, “$0.” Zero is really nice in this situation.

If you have Medicare Plan F, how much will you pay for the following scenario?

You go to the doctor complaining about fatigue. Your doctor requests a variety of blood tests, and when you return, there is a frown on the doctor’s face.“I’m concerned about your health and want you to get an MRI and a CT Scan.”

When the doctor reviews your scans, he informs you that you have a very serious medical condition. You are admitted to the hospital right way, have extensive surgery; and end up in hospital for 14 days, with another 60 days spent recovering in a skilled nursing facility.

The total cost would be north of $500,000.

If you have Medicare Part F as a medical supplemental plan, how much will you be required to pay?

    1. $500,000
    2. $250,000
    3. $0  🙂

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What if I need to change plans?

At Hopper Insurance Services we can help you get the right supplemental plans for Medicare. We invite you to give us a call and we will go over a variety of other plan options. As you can see from this abbreviated summary, if you have a serious medical condition and are 65 years or over, the costs of doctors, labs, x-rays, imaging, surgery, hospital and skilled nursing facilities can quickly escalate.

However, if you budget or situation changes, and the cost of the supplement feels too high, we can help you find a lower cost plan.  We represent the three top insurance companies that write a variety of Medicare products.