Medicare Supplement Plan F: Complete Guide for Grandfathered Beneficiaries

Plan F: The Legacy of First-Dollar Coverage

Medicare Supplement Plan F was once the most popular Medigap policy in America, offering the most comprehensive coverage available with zero out-of-pocket costs for Medicare-approved services. However, due to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, Plan F became unavailable to new Medicare beneficiaries on January 1, 2020.

According to the Centers for Medicare & Medicaid Services, millions of beneficiaries remain enrolled in Plan F under grandfather rules. If you have Plan F or enrolled in Medicare before 2020, this comprehensive guide explains everything you need to know about this legacy plan.

Who Can Still Enroll in Plan F?

Grandfather Rules Explained

You can enroll in or keep Plan F if you became eligible for Medicare before January 1, 2020. Specifically, you qualify if:

• You turned 65 before January 1, 2020
• You qualified for Medicare due to disability before January 1, 2020
• You qualified for Medicare due to End-Stage Renal Disease before January 1, 2020

If you meet any of these criteria, you can enroll in Plan F at any time (subject to medical underwriting outside your Medigap Open Enrollment Period or guaranteed issue situations).

What About Current Plan F Holders?

If you currently have Plan F, you can keep it indefinitely as long as you continue paying premiums. Your coverage cannot be cancelled due to the phase-out. According to Medicare.gov, you have the right to maintain your Plan F policy for life.

New Medicare Beneficiaries (After 2020)

If you became eligible for Medicare on or after January 1, 2020, you cannot purchase Plan F or Plan C. Your best alternative is Plan G, which offers nearly identical coverage minus the Part B deductible. Read our guide: Medicare Supplement Plan G: Complete 2025 Guide.

What Does Medicare Supplement Plan F Cover?

Comprehensive First-Dollar Coverage

Plan F is the most comprehensive Medigap policy ever offered, covering 100% of all Medicare cost-sharing with no deductibles, copayments, or coinsurance for Medicare-approved services.

Part A Coverage (100%)

• Part A coinsurance and hospital costs: Full coverage for hospital stays up to an additional 365 days after Medicare benefits end
• Part A deductible: The full $1,632 hospital deductible per benefit period (2025)
• Part A hospice coinsurance or copayment: Full coverage for hospice care cost-sharing
• Skilled nursing facility coinsurance: Full coverage for days 21-100 ($204 per day in 2026)

Part B Coverage (100%)

• Part B deductible: The $240 annual deductible (2025), covered by Plan F, NOT covered by Plan G
• Part B coinsurance or copayment: The 20% coinsurance for Medicare Part B services
• Part B excess charges: When doctors charge up to 15% more than Medicare-approved amounts

Additional Benefits

• First three pints of blood: Full coverage for blood needed for medical procedures
• Foreign travel emergency: 80% coverage for emergency care during foreign travel (after $250 deductible, up to $50,000 lifetime maximum)

The “First-Dollar Coverage” Advantage

Plan F is called “first-dollar coverage” because you pay nothing out-of-pocket for Medicare-approved services. From your first dollar of healthcare costs, Plan F covers everything that Medicare doesn’t pay.

This means:

• No deductibles to meet
• No copayments at doctor visits
• No coinsurance for hospital stays
• No bills for covered services (after Medicare processes the claim)
• Complete predictability of healthcare costs

What Plan F Does NOT Cover

Like all Medigap plans, Plan F doesn’t cover:

• Prescription drugs (requires separate Part D plan)
• Dental care, dentures
• Vision care, eyeglasses
• Hearing aids
• Long-term care (nursing home care)
• Private-duty nursing
• Services not approved by Medicare

Plan F Costs in 2026

Average Plan F Premiums

Plan F premiums are typically higher than Plan G because Plan F covers the Part B deductible ($240). However, as the Plan F risk pool ages without new enrollees, premiums have been increasing faster than other plans:

• Age 65: $150-$250 per month
• Age 70: $175-$290 per month
• Age 75: $205-$335 per month
• Age 80: $240-$395 per month

These are national averages. Actual premiums vary significantly by state, ZIP code, insurance carrier, and pricing method.

Why Plan F Premiums Are Rising Faster

Plan F faces a unique challenge: since new enrollees are prohibited, the existing risk pool ages without younger, healthier beneficiaries joining. This creates adverse selection, where the risk pool becomes progressively older and sicker, driving up costs.

According to insurance industry analyses:

• Plan F annual rate increases: 6-10% on average
• Plan G annual rate increases: 3-7% on average
• This gap will likely widen over time

Total Annual Cost Example

Plan F Costs for a 70-year-old:

• Plan F premium: $210/month = $2,520 annually
• Part B premium: $174.70/month = $2,096 annually
• Out-of-pocket costs: $0 for Medicare-covered services
• Part D plan: ~$45/month = $540 annually
• Total: $5,156 per year

While this seems expensive, you have virtually zero healthcare costs beyond these premiums for all Medicare-covered services.

Plan F vs. Plan G: Should You Switch?

The Key Difference

The only coverage difference between Plan F and Plan G is the Part B deductible ($240 in 2026):

Benefit	Plan F	Plan G
Part A deductible	Covered	Covered
Part B deductible ($240)	Covered	You pay
All other Medicare costs	Covered	Covered

Cost Comparison Analysis

Example for a 70-year-old:

Plan F:

• Annual premium: $2,520
• Part B deductible: $0 (covered by plan)
• Other costs: $0
• Total: $2,520

Plan G:

• Annual premium: $2,040
• Part B deductible: $240
• Other costs: $0
• Total: $2,280
• Savings: $240 per year

In this example, Plan G costs $240 less annually despite making you pay the Part B deductible out-of-pocket.

When Switching to Plan G Makes Sense

Consider switching if:

• Significant premium difference: If Plan G costs $300+ less annually than your current Plan F
• Good health: You can pass medical underwriting (required in most states)
• Long-term savings: Plan G rate increases will likely be more moderate over time
• Younger age: The earlier you switch, the more you save over your lifetime

Keep Plan F if:

• Small premium difference: If Plan G saves less than $250-300 annually
• Health issues: You might not qualify for Plan G due to medical underwriting
• Good rate history: Your current Plan F has had moderate rate increases
• Value first-dollar coverage: You highly value never paying any deductible
• Older age: If you’re over 80, the hassle may outweigh potential savings

The Medical Underwriting Challenge

The biggest obstacle to switching from Plan F to Plan G is medical underwriting. Outside your Medigap Open Enrollment Period or guaranteed issue situations, insurance companies can:

• Require detailed health questionnaires
• Request medical records
• Deny coverage based on health conditions
• Charge higher premiums for health issues

Common conditions that may result in denial:

• Recent cancer diagnoses or treatment
• Heart disease or recent cardiac events
• Stroke or TIA
• COPD or severe respiratory conditions
• Diabetes with complications
• Kidney disease

Before attempting to switch, consult with a licensed Medicare advisor who can help you understand your underwriting prospects based on your health history.

High-Deductible Plan F

What is High-Deductible Plan F?

High-Deductible Plan F offers the same coverage as standard Plan F, but you must pay a $2,800 deductible (2025) before the plan starts covering costs. After meeting the deductible, it covers 100% of all Medicare cost-sharing.

Important: High-Deductible Plan F is also closed to new Medicare beneficiaries as of January 1, 2020. Only those who were Medicare-eligible before that date can enroll.

How High-Deductible Plan F Works

1. You receive care: Visit any Medicare provider
2. You pay costs until deductible is met: Pay all Medicare cost-sharing until you’ve paid $2,800
3. Plan F covers everything after: Once the deductible is met, 100% coverage for all Medicare costs
4. Deductible resets annually: On January 1, the $2,800 deductible starts over

Cost Comparison

High-Deductible Plan F premiums: Typically $45-$90 per month ($540-$1,080 annually)

Standard Plan F premiums: Typically $150-$280 per month ($1,800-$3,360 annually)

Example: Low Healthcare Utilization ($600 in Medicare cost-sharing)

Standard Plan F:

• Annual premium: $2,520
• Out-of-pocket: $0
• Total: $2,520

High-Deductible Plan F:

• Annual premium: $780
• Out-of-pocket: $600
• Total: $1,380
• Savings: $1,140

Example: High Healthcare Utilization ($4,000 in Medicare cost-sharing)

Standard Plan F:

• Annual premium: $2,520
• Out-of-pocket: $0
• Total: $2,520

High-Deductible Plan F:

• Annual premium: $780
• Out-of-pocket: $2,800 (deductible met)
• Total: $3,580
• Higher cost: $1,060

Who Should Consider High-Deductible Plan F?

High-Deductible Plan F works best for:

• Generally healthy beneficiaries with minimal healthcare needs
• Those with emergency savings to cover the $2,800 deductible
• Beneficiaries wanting catastrophic coverage protection
• Those willing to self-insure for routine care

Plan F for Special Situations

Plan F for Snowbirds and Travelers

Plan F is ideal for beneficiaries who travel extensively:

• Works anywhere in the U.S. with any Medicare provider
• No networks or referrals
• Foreign travel emergency coverage included
• Complete predictability regardless of where you receive care

Plan F for Those with Chronic Conditions

Beneficiaries with chronic conditions benefit from Plan F’s:

• Zero out-of-pocket costs for all Medicare-covered care
• No financial barriers to seeing specialists
• Access to any Medicare provider nationwide
• No prior authorization requirements
• Complete predictability of healthcare costs

Plan F for Peace of Mind

Some beneficiaries value Plan F’s first-dollar coverage for the psychological benefit:

• Never worry about affording needed care
• Never avoid specialists due to cost concerns
• Never face surprise medical bills
• Focus on health, not finances

The Future of Plan F

What Happens to Existing Plan F Policies?

If you currently have Plan F, your policy will continue indefinitely as long as you pay premiums. According to the Medicare.gov guidance on discontinued plans:

• Your Plan F cannot be cancelled due to the phase-out
• You can keep it for life
• Insurance companies must continue offering it to grandfathered beneficiaries
• You have the same consumer protections as any Medigap policy

Expected Premium Trends

Plan F premiums are expected to increase faster than other Medigap plans because:

• Aging risk pool: No new, younger enrollees joining
• Adverse selection: Only those who value comprehensive coverage keep Plan F
• Higher utilization: Plan F enrollees tend to be older with higher healthcare utilization
• First-dollar coverage effect: No cost-sharing may lead to higher utilization

Industry projections suggest Plan F rate increases may be 1-3 percentage points higher annually than Plan G increases.

Long-Term Viability

Despite faster premium growth, Plan F will remain viable because:

• Millions of beneficiaries still have Plan F
• Insurance companies are legally required to continue offering it
• The risk pool, while aging, remains substantial
• Regulatory oversight ensures plans remain solvent

Common Plan F Questions

Can I switch back to Plan F if I dropped it?

Yes, if you were Medicare-eligible before January 1, 2020, you can apply for Plan F even if you previously had it and switched away. However, you’ll face medical underwriting unless you have guaranteed issue rights.

What happens if my insurance company stops offering Plan F?

If your insurance company leaves the Medigap market or stops offering Plan F in your state, you have guaranteed issue rights to buy Plan F from another carrier without medical underwriting.

Can I switch Plan F carriers?

Yes, you can switch to Plan F from another carrier at any time (subject to medical underwriting outside guaranteed issue periods). This can be worthwhile if you find significantly lower premiums elsewhere.

Does Plan F cover prescription drugs?

No, Plan F doesn’t cover prescription drugs. You need a separate Medicare Part D plan. The only exception is very old Plan F policies sold before 2006 that included limited prescription coverage.

Is Plan F better than Medicare Advantage?

Neither is objectively “better,” it depends on your needs. Plan F offers more provider freedom and predictable costs but higher premiums. Medicare Advantage offers lower premiums and extra benefits but has network restrictions. Read our comparison: Medigap vs Medicare Advantage: Which is Right for You?

Maximizing Value from Plan F

Take Advantage of Complete Coverage

With Plan F, you have no financial barriers to care:

• See specialists without cost concerns
• Get second opinions freely
• Access top providers anywhere in the U.S.
• Never delay needed care due to costs

Shop Your Rate Annually

Even with Plan F, compare rates from other carriers annually. If you’re in good health, switching carriers can save hundreds per year while maintaining identical coverage.

Consider Switching to Plan G

If Plan G offers significant savings and you’re in good health, calculate whether switching makes financial sense. The savings often exceed $2,000-$3,000 over 10 years.

Coordinate with Part D

Since Plan F doesn’t cover prescriptions, review your Part D coverage annually during Annual Enrollment Period (October 15 - December 7) to ensure your medications are covered cost-effectively.

Conclusion: Making the Right Decision About Plan F

Medicare Supplement Plan F represents the pinnacle of comprehensive Medicare coverage, offering true first-dollar protection with zero out-of-pocket costs for Medicare-approved services. While it’s no longer available to new Medicare beneficiaries, those grandfathered in can maintain this valuable coverage indefinitely.

Keep Plan F if:

• You highly value having no deductibles or copays whatsoever
• Your current premiums are competitive
• You have health conditions that would prevent approval for other plans
• The premium difference compared to Plan G is minimal
• You want maximum simplicity and predictability

Consider switching to Plan G if:

• Plan G saves $300+ annually
• You’re in good health and can pass medical underwriting
• You’re comfortable paying the $240 Part B deductible
• You want to lock in lower long-term premiums

For personalized guidance on Plan F and whether switching makes sense for your situation, schedule a free consultation with our licensed Medicare advisors.

Additional Resources

• Medicare.gov - Official Medicare website
• Discontinued Medigap Plans
• Medicare Supplement Plan G Guide
• All About Medicare Supplement Insurance
• Medicare Enrollment Calculator