What Does Medicare Plan F Cover?

Health Care Directive
Many people in the insurance industry call Plan F the “Cadillac” coverage of Medicare supplement options.

So what does Medicare Part 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 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?

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 Plan 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.

Your state’s laws might differ from the general law of this article. You might want to talk to an elder law attorney in your area.

References:

Boomer Benefits. “What Does Part F Cover?” (accessed October 24, 2019) https://boomerbenefits.com/faq/what-does-plan-f-cover/

 

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