Switching Medigap plans is a financial decision. In most cases, the overall cost of Medigap Plan G is lower than Plan F, making the switch a good decision.
This article will explain the difference between Medicare Supplement Plan F and Plan G and why Plan F rates are skyrocketing. If you have been wondering if you should make the switch, we’ll also help you answer that important question.
- Plan F is the most comprehensive supplemental plan available, providing coverage for all of the cost gaps in Original Medicare.
- Plan G covers all the same benefits as Plan F, except for the Part B deductible.
- Plan F has an annual premium higher than Plan G plus the annual deductible.
- Medigap Plans F and G cover the Part A coinsurance and hospital costs up to 365 additional days after Medicare benefits are used up.
- Plans F and G cover the 20% Medicare Part B coinsurance for doctor visits, tests, medical supplies, and durable medical equipment.
- Plans F and G cover Part B excess charges, which are charges above the Medicare-approved amount for services.
- Plans F and G cover up to 80% of foreign travel emergency care after a deductible.
The three most comprehensive supplemental insurance policies available are C, F, and G. Whereas an F plan covers all cost gaps in Original Medicare, both C, and G plans are missing coverage on a single out-of-pocket cost. Plan C does not cover Part B excess charges, and Plan G does not cover the annual Part B deductible.
You can visualize these cost gaps by having a look at the following Medigap comparison chart:
The chart shows the nine cost gaps built into Medicare Part A (hospital insurance) and Part B (medical insurance).
The annual Medicare Part B deductible ($240 in 2024) is the smallest out-of-pocket cost in Medicare, giving Plans F and G very similar coverage. So, what makes one plan better than the other?
It really comes down to cost and convenience.
Since the only difference between a Plan F and Medigap Plan G policy is a minor deductible, these supplemental plans are easy to compare. We pulled AARP Medicare Supplement Plan rates, for both F and G plans, from a dozen cities The rates are for a 68-year-old, no-smoking woman. We used age 68 because that is the youngest age to qualify for a Plan F policy.
|Little Rock, Arkansas
The cities we used represent a good balance of low-cost, moderate, and high-cost areas. Rates do not include any applicable household discounts. The annualized savings was calculated by taking the annual rate for both plans and subtracting the Part B deductible from the Plan G annualized rate.
What the table shows is that, depending on where you live, Medicare Plan G can offer big savings. In our experience, in all areas, it offers some savings. Comparing Medigap insurance companies by rate increases is the best way to predict savings over time.
When Does an F Plan Make Sense?
To answer this question, you need to divide the Part B deductible over a 12-month period, which comes to $18.83 per month.
If your Plan F costs less than Plan G plus $18.83, you will save money with a Plan G policy compared to Plan F. And, a Plan G policy will most likely have lower rate increases.
Why Does an F Plan Cost So Much?
There are a few reasons that Medigap Plan F costs more than Plan G. In general, more unhealthy people have Plan F than Plan G. This is the number one reason rates are higher and increasing faster.
Another reason has to do with the first-dollar coverage aspect of Medigap Plan F. Because it covers all gaps, insurance companies have to manage, handle, and pay the deductible payment claims for you. This costs them more money.
With a Plan F policy, what you’re really paying for is convenience. Plan F pays 100% of all of your doctor visits, even during the deductible period, so you don’t pay anything out of pocket.
Medicare Plan F and Plan G are the two most popular Medicare Supplements sold. The reason has to do with their comprehensive coverage.
Savvy people understand that insurance is the best way to protect your money and other assets. There’s a lot less risk in paying a few hundred dollars per month for complete gap coverage than there is in a high out-of-pocket maximum like most Medicare Advantage plans have.
Think about it, if you have a Plan G policy that costs you $200 per month, all you will ever pay in a year for your major medical costs is $2,400 (after you’ve paid the $240) deductible. Compare that to your average Medicare Advantage plan. Let’s use the city of Atlanta as an example.
The average maximum out-of-pocket limit in Atlanta (Henry County, GA) is $6,470 per year. That means your Plan G premiums would need to be $517 per month (we subtracted the Part B deductible) to have an equivalent level of coverage on Part A and Part B services. However, as we showed in the table above, a 68-year-old woman in 2023 is only paying about $139 per month.
That’s $139 per month to know all of your big costs are covered.
Let’s compare coverage to the UnitedHealthcare Medicare Advantage Choice PPO plan in Atlanta. It has a $6,700 maximum out-of-pocket limit. It covers all of your Medicare Part A and Part B service. However, you pay copayments and coinsurance with most services until your out-of-pocket costs reach the limit.
For example, if you have a 4-day inpatient stay for a fall, and you need two weeks of skilled nursing facility care to convalesce, you’ll pay $1,580 in hospitalization costs and $3,150 in skilled nursing costs. Plus, you’ll pay $25 to $45 for each bedside doctor visit, 55% of your durable medical equipment costs, up to $175 per radiology service, and up to 20% of the cost of all drugs administered to you.
It isn’t difficult to see how a single bad fall can run up your costs to the limit on a Medicare Advantage plan. However, with Medicare Plan F and Plan G, you’re covered on all of these costs, no matter how high they go.
High Deductible Plans
Both Plan F and Plan G are available in a high-deductible version. It works as follows.
A high deductible plan works exactly the same as the regular plan once your Part A and Part B out-of-pocket costs reach the annual deductible. In 2024 the high deductible amount is $2,800.
Using the fall hospitalization cost example earlier in the article, you can see how quickly you could reach the annual deductible amount. That’s what makes these plans an alternative for healthy people to consider. If you don’t have chronic health issues, you might want to discuss this option with your insurance agent.
Pros and Cons
Medicare Plan F and Plan G are not perfect. Just like the Medicare Advantage plan we highlighted above, they have some disadvantages. Here’s what you need to know.
Pros of Medicare Plan F vs G
- Medicare Plan F and Plan G cover the gaps in Original Medicare, including deductibles, copays, coinsurance, blood, and foreign travel emergencies.
- Plan F covers the Part B deductible. Plan G does not. So, you get first-dollar coverage on all Medicare expenses with Plan F.
- During a Medicare beneficiary’s guaranteed issue period, they cannot be denied coverage.
- Medicare Plan F and Plan G cover you throughout the continental United States and its territories.
- Medicare Plan F and Plan G cover up to 80% of foreign travel emergencies.
- You are free to use your choice of healthcare providers that accept Medicare.
- You are not required to get a referral to see a specialist or other healthcare providers. Most Medicare Advantage health insurance plans require referrals and pre-approval before receiving care.
- You are not required to get pre-approval to receive Medicare-approved services and treatment.
Cons of Medicare Plan F vs G
- Medicare Plan F and Plan G are indemnity insurance, not health insurance. Health insurance laws do not apply.
- Plans cannot include extra health benefits, such as dental, vision, hearing, or prescription drug plans.
- Once your Medigap protections expire, insurance carriers can ask health questions and deny coverage.
- Insurance carriers can raise their rates but cannot change the coverage.
- Plan F is not available to anyone who qualified for Medicare as of January 1, 2020.
- Medigap plans are expensive in some areas.
All but three states have 10 standardized Medigap plans. However, Minnesota, Wisconsin, and Massachusetts have their own standard. Although these states do not have a standardized Plan F and Plan G, you can get essentially the same coverage.
Find Plans in your area with your ZIP Code
With monthly premiums on Plan F skyrocketing, many seniors are looking for more cost-effective alternatives, particularly healthy seniors. If this sounds like you, you have a couple of options.
The first option is Medigap Plan N. This is a great option for healthy people. Here’s why.
When you compare Medicare Plan N vs Plan G you will see that the most significant difference is that Plan N does not cover excess charges. These are additional costs (up to 15%) your doctor and other healthcare providers are allowed to add to your bill if they don’t accept Medicare’s standard rates.
If you are healthy, excess charges are likely to be a minimal expense, as are Plan N’s copays. Unlike Plans F and G, Plan N has a $20 copay when you see your doctor, and a $50 copay to use the emergency room.
Another alternative for healthy seniors is Medicare Advantage plans. This is particularly true if you live in a major urban area with a lot of competition. That’s because the plans available in urban areas tend to have much lower maximum out-of-pocket (MOOP) limits and significantly more extra benefits.
Just remember that nearly all Medicare Advantage plans use provider networks and have provider network restrictions. If you are okay with this trade-off, you can find the best Medicare Advantage plans where you live using our finder tool.
To qualify for any Medicare Supplement plan you must be enrolled in both Medicare Part A and Medicare Part B. Most of us qualify for Medicare at age 65, but some people qualify due to their Social Security disability status. However, the federal government does not mandate that guaranteed coverage for people under age 65.
When you turn age 65, you have Medigap protections. Your guaranteed issue rights give you a 6-month period of time to buy a Medigap policy. During this time you can’t be turned down and you can’t be charged more due to pre-existing conditions. However, once your Medigap protections expire, you can be turned down.
There’s an exception to this rule.
People turning age 65 do not qualify for Plan F or Plan C. The reason has to do with a law passed by Congress in 2015 that took effect on January 1, 2020. The new law prohibits coverage of the Part B deductible. Plan F covers it, but Plan G does not.
That makes Plan G the best coverage new Medicare beneficiaries can get. Plan F is the best coverage people can get if they turned age 65 before January 1, 2020.
Find Plans in your area with your ZIP Code
Can I Get an F or G Plan If I have Medicaid?
No. You don’t need Medigap insurance if you qualify for Medicaid. Most out-of-pocket costs for seeing a provider are covered by Medicaid.
By law, an insurance agent cannot sell you a Medigap policy if you have Medicaid benefits.
Can I Get Prescription Drug Coverage?
Medicare Supplements are no longer allowed to provide prescription drug coverage. In the past, some plans did.
To get prescription drug coverage with Medicare Plan F or Plan G, add a Medicare Part D plan. They are available in most states starting at less than $20 per month.
Should I Switch Plans?
In 2023, if your Plan F monthly premium is more expensive than Plan G by $18.83 (the Part B deductible divided by 12) or more, then Plan G is the better deal. Also, consider that Plan G premiums are not increasing as fast as Plan F premiums.
How to Switch Plans
Some states have different rules you need to consider before making the switch. Some states, like New York, let you switch at any time. In other states, like California, there’s a birthday rule that allows you to switch plans around your birthday.
The best place to start is with your insurance agent or insurance agency. Let them shop rates with different carriers for you. If you’d like to see rates in your area before speaking with an agent, ask us for a free rate report.
In some cases, your application for a Plan G policy will require you to answer health questions. Once submitted, your application will go through a medical underwriting process. Don’t be surprised if they also want you to get a full physical exam.
Based on your health history, how you answer the health questions, and your physical exam, the insurance company you applied with will approve or disapprove your application. They may also offer a policy with less coverage or require you to take a policy with a 6-month waiting period on recent health issues.
However, every state has different rules worth considering before making the switch.
In some states, such as New York City, you can switch your Medigap plan at any time. There’s a birthday rule in California that allows you to switch Medigap plans around your birthday. Both of these states may automatically approve any applications to switch plans, even if you have pre-existing health conditions.
In some other states, you may need to apply for a Plan G policy. If you apply during a time when you don’t have guaranteed issue rights, private insurance companies can use medical underwriting to determine your premium costs or to even deny you coverage altogether. In these states, sticking with your Plan F coverage may be your best Medigap option, or you may want to wait until you can switch to Plan G
First Time Enrollment
Before you can buy a Medigap policy, you will need to be enrolled in both Medicare Part A and Medicare Part B. If you retired before the age of 65, or if you are receiving Social Security Disability Insurance (SSDI) benefits when you turn age 65, enrollment may be automatic.
You signup for Medicare through the Social Security Administration. You can call them at +1 800-772-1213 or visit the enrollment page online. It’s best to start the process three months prior to turning age 65. That way your benefits will start on the first day of your birthday month.
Once enrolled, you will get a Medicare number with your new Medicare card. You will need to give your insurance agent this number so they can verify your qualification.
If you have not already done so, the next step is to get a list of all of the companies that sell Medicare Plan F and Plan G in your area. We make it easy to get companies and rates. Click the link below and complete our request form.
If you’re not sure which Medigap plan is right for you, check out our 9 Medicare Plan G Pros and Cons before you decide.
If you’d like to speak with a licensed insurance agent about your best options, give HealthCompare a call at 1-855-728-0510 (TTY 711). They’re happy to answer all of your questions without obligation.
Frequently Asked Questions
Are Medicare supplements worth it? It might seem as if Medigap plans are expensive. But, going with Original Medicare alone is not wise. The coverage gaps in Medicare add up fast, particularly if you have an emergency. Paying 20% of all your outpatient coverage might not seem so bad, but getting slapped with a $1,400 hospital bill really smarts. And that's just for the deductible! We answer this question in more detail here.
Your specific healthcare needs, lifestyle, and budget will determine which Medicare Supplement Plan is best for you. Plan G is now the most popular Medicare Supplement Plan for new Medicare enrollees. It covers more Medicare costs than any other plan, with the exception of Plan F which is no longer available to new beneficiaries. Plan G enrollees pay only their Medicare Part B deductible. After that, the plan covers 100% of all Medicare-approved services. Read Find the Best Medicare Supplement Plan for You in 2023 to learn more.
Medigap insurance policies are designed to fill the gaps (e.g., deductibles and copays) in Medicare Part A and Part B coverage, however, they do not offer additional benefits. Medicare Advantage plans replace Part A and B coverage and often include additional benefits, including prescriptions, dental, vision, and hearing. Click here to learn more about how Medigap plans work.
One of the best features of Medicare supplement insurance is that you can apply for a plan anytime. To enroll, you must first be enrolled in both Medicare Part A and Part B. However, an insurance carrier doesn't have to accept your application unless you have guaranteed-issue rights. This is also true if you want to change Medicare supplements to get a better rate or different coverage. Learn more about enrollment rules on this page.
Citations and References
- 2022: Guide To Choosing A Medigap Policy, Medicare.gov, Accessed January 30, 2023
- Original Medicare (Part A and B) eligibility and enrollment, CMS.gov, Accessed January 30, 2023
- How to compare Medigap policies, Medicare.gov, Accessed January 29, 2023
- Costs of Medigap policies, Medicare.gov, Accessed January 28, 2023
- How to get prescription drug coverage, Medicare.gov, Accessed January 28, 2023
- When can I buy Medigap?, Medicare.gov, Accessed January 28, 2023
- Switching Medigap policies, Medicare.gov, Accessed January 26, 2023
- What’s Medicare Supplement Insurance (Medigap)?, Medicare.gov, Accessed January 26, 2023
- Medigap & Medicare Advantage Plans, Medicare.gov, Accessed January 26, 2023