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Medigap Plan F Explained

Lisa Tortorello | May 19, 2011

While Medicare is a health plan that covers many medical services and supplies, there are several costs it does not cover. To close these "gaps" in health coverage, you may want to consider investigating what is called a Medigap policy.

Medigap Policies - An Overview

According to Medicare.gov, a Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in medical coverage left from the original Medicare plan. As such, Medigap is a supplemental medical insurance policy that works alongside of Medicare.

Insurance companies may only sell you a "standardized" Medigap policy. They are required to have clear, specific benefits that you can easily be compared and understood.

Choosing a Medigap Policy - A Look at Plan F

Each Medigap plan has a different set of basic and extra benefits, but none include a prescription drug benefit (This is covered through the Medicare Prescription Drug Plan (Part D) which is offered by Medicare-approved private companies.).

Following is a look at the benefits covered under Medigap Supplement Plan F, which is a high-deductible plan. This means you must pay out-of-pocket for Medicare-covered costs, up to the deductible amount of $2,000, before the Medigap Plan will cover any costs. After the deductible is met, Medigap Supplemental Plan F is one of the most comprehensive of the Medigap insurance plans available, and often pays costs in excess of Medicare-approved amounts. Medigap Supplemental Plan F is generally considered one of the most popular of the plans available.

10 Plan F health insurance benefits

Once the deductible is met, Plan F covers 100 percent of these 10 described benefits (it covers coinsurance only after you have paid the plan deductible):

  1. Medicare Part A coinsurance hospital costs up to an additional 365 days after Medicare benefits are exhausted
  2. Medicare Part B coinsurance or co-payment
  3. First 3 pints of blood
  4. Part A hospice care coinsurance or co-payment
  5. Skilled nursing facility care coinsurance
  6. Medicare Part A deductible
  7. Medicare Part B deductible
  8. Medicare Part B excess charges
  9. Foreign travel emergency (up to plan limits)
  10. Medicare preventative care Part B coinsurance

Requirements to buy Medigap

In most cases, to purchase a Medigap policy, you must have Medicare Part A and Part B. You will have to continue paying your Medicare Part B premium and will also be responsible for paying a premium to the insurance company from which you purchased the Medigap policy. If you are married, your spouse must have his/her own Medigap policy.

Medigap Plan F benefits are the same regardless of the company, but the price may change. This is why it is important to "shop around" for your supplemental medical insurance coverage.

If you currently have a Medigap Policy, and are switching from Medicare to a Medicare Advantage Plan, you will not need and cannot use a Medigap Policy. Although you may choose to drop your Medigap policy, be sure to first consult with your State Health Insurance Assistance Program and the insurance company which issued the Medigap Policy.



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