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Health & Wellness / Your Medicare Advisor

Medicare Supplements: Plan F or Plan G ?

medicare-slider-no-wordsBy – Christopher Shyide

Shopping for Medicare Supplements is no simple task. With 11 different supplements[i] that each fill in the gaps Medicare leaves you responsible for, it can all seem very overwhelming. Agents often start with Plan F or Plan G. These two plans look very similar and trying to choose one over the other can cause indecision.  What is the difference? Why Choose Plan F over Plan G, or Plan G over Plan F?

Let’s start with Plan F. Plan F is the most comprehensive of the Medicare supplements. It is the only plan that is designed to cover the full 20% Medicare leaves you responsible for; providing it is a Medicare covered service. The gaps that Medicare leaves you responsible for can be broken down into 9 Categories and Plan F is the plan that covers them all.

  1. Part A Coinsurance and Hospital Costs- After your first 60 days in a hospital Part A leaves you responsible for $322 per day for days 60-90. For Days 91-150 (Your Life time reserve days) you pay $644 per day. After day 150 you are responsible for 100% of the cost. Plan F will pay your cost from day 60 to day 150 and cover you at 100% for an additional 365 days.
  2. Part B Coinsurance or Copayment- Medicare generally covers 80% leaving you responsible for 20%. Plan F will pay that 20%.
  3. First 3 Pints of Blood– Medicare covers anything over 3 pints, but you would pay the full cost for the first 3- Plan F will cover those first pints.
  4. Part A Hospice Care Coinsurance or Copayment- Medicare will cover all costs except a very limited copayment/coinsurance for outpatient drugs and inpatient respite care. Plan F will pay the Medicare copayment/coinsurance.
  5. Skilled Nursing Facility Care- Medicare pays for the first 20 days in skilled nursing facility when you have met Medicare’s requirements. Days 21-100 Medicare makes you pay $161 per day. Days 101 and on you would be responsible for the full cost. Plan F will cover your $161 per day, for days 21-100.
  6. Part A Deductible- This year the deductible per benefit period is $1,288 for the first 60 days. Plan F pays your deductible.
  7. Part B Deductible- This year the deductible is $166. This is an annual deductible on Part B Medical Expenses. Plan F will cover your $166.
  8. Part B Excess charges- An Excess charge is an amount over what Medicare pays a doctor that a doctor can charge you. If you go to a doctor who does not accept Medicare payment in full, they may charge you up to 15% over what Medicare pays them. Plan F will cover this.
  9. Foreign Travel Emergency- Medicare does not cover you out of the country except for limited circumstance near the U.S. Border. Plan F will cover you in the event of an emergency. You will have a $250 deductible and be responsible for 20% up to a lifetime limit of $50,000.

Plan G covers everything Plan F covers except for one thing, The Part B Deductible. This means in a Plan G you will be responsible for the first $166 of Part B Expenses. That is the one and only difference, everything else is the same.

Why take Plan F over Plan G?

People take Plan F over Plan G for many reasons. The biggest reason would be knowing that you are fully covered. As long as you are seeing a doctor for a Medicare approved service you would have no out of pocket expenses. This makes budgeting monthly easier because you don’t have to worry about out of control medical bills.

Why Plan G over Plan F?

Taking Plan G over Plan F often comes down to cost. Depending on where you live there can be a large difference between Plan F and Plan G. It may make paying the deductible the smarter of the two options. While it is important to know that the deductible can change every year, this year being $166. This means that unless the difference is less than $14 you may be paying more than $166 a year to cover the deductible.

In the end both Plans are good and will help fill in your 20%. What’s most important is deciding what you want and what coverage will fit your needs best.

[i] MA, MN and WI have separate state guidelines. Please call AMAC’s licensed Agents for information on these states.

If you have any questions please call AMAC’s Medicare Department to speak to one of our Trusted, Licensed Insurance Agents

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source: medicare.gov

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PaulO

I selected plan F because the insurance company I wanted to go with doesn’t offer Plan G. Otherwise I would have preferred Plan G as it was more cost effective for me.

Why I chose the insurance company I did was because they are community-rated (also called Not-Age-Rated) which means premiums might go up because of inflation and other factors but do not increase because you’re getting older every year.

Jim H

If you are on a medicare advantage plan that is accepted by your doctor and want to switch to a supplemental plan BE CAREFUL. To subscribe to a supplemental plan your primary plan MUST be Medicare and not all doctors accept Medicare. If you switch first and then find out that your doctor doesn’t take medicare you will have to find a new doctor who not only takes Medicare patients but also accepts the insurance plan you switched to, or if you want to keep your doctor you will have to go back to your advantage plan.

Chures Ragan

One correction, medicare pays 78.+% of what they allow the provider to charge medicare patients; the law changed in 2014, from 80% to 78.+%. I called them, because my portion of my bills seemed to be more than 20%. I have a supplement, I chose plan F, and have a deductible of $2600, it will end in 3 years. I pray nothing happens between now and then. I don’t think medicare is good. Not too many doctors will take new medicare patients. If you need to see a specialist you will need a referral from your pcp. I am talking about dermatologist. And then you either wait for weeks even months to see the md or you are referred to a pa. Oh, and the first thing you are asked is if you are on medicare. Then when you are finally at the office you are given a stack of… Read more »

LWri

This article is very out of date, and should be replace with Eileen MacNalish article “Which is Best for Me? Don’t you think?

dan

plan F is being discontinued Jan 1, 2020. for new enrollments

Jan Moore

Does your plan have silver sneakers?

Gerry Bradley

What about Plan F – High deductible?

Dennis Swanson

Be careful about joining Plan F. After 2020, the plan can no longer be sold. That means each year after that the pool will get smaller and that means the prices will go up much faster than Plan G. Going to Plan F will cost you much more after 2020 in additional premiums that will far exceed the Part B deductible.

Bob

Number 7, Part B Deductible above says “Plan F will cover your $166”. I believe this information is incorrect as Plan F does NOT cover the $166 deductible.

Nancy Powell

The question is “what is the difference between all the F plans of various insurance companiec? that is where one can save money…i.e.: Is Blue Cross/Blue Shield ‘s F plan better than the various other companies? There is a salesman who tells me the coverage is the same if I switch and can save $500 a year. I’m leary about changing coverage…any thoughts?

Les

I’ll be continuing my FEHB, Blue Cross Blue Shield into retirement. The federal retirement seminars all tell me that once I have Medicare I should select part B and BCBS will waive copays etc. But if this plan F pays for everything else that Part A doesn’t why should I even keep the BCBS? Other than for the fact that my experience with parents and grandparents has shown that people with additional private insurance are treated more promptly and courteously than medicare only folks?