Medicare Plan F was once the most popular Medigap policy in the country, and for good reason. It covered virtually every out-of-pocket cost that Original Medicare left behind — the Part A deductible, the Part B deductible, Part B excess charges, hospital coinsurance, skilled nursing facility coinsurance, and even foreign travel emergency care up to plan limits. For beneficiaries who wanted to see any doctor who accepted Medicare and never worry about a surprise bill, Plan F was the answer. But a federal law passed in 2015 changed everything, and if you became eligible for Medicare on or after January 1, 2020, Plan F is simply not available to you — no matter how much you're willing to pay for it.
The law that closed Plan F to newer beneficiaries is the Medicare Access and CHIP Reauthorization Act of 2015, known as MACRA. Congress decided that first-dollar coverage — meaning insurance that pays your deductibles so you never pay anything out of pocket before coverage kicks in — was contributing to overuse of medical services and driving up Medicare costs overall. The logic was that when patients have no financial skin in the game, they're more likely to seek care they may not need, which raises costs for the entire program. Whether or not you agree with that reasoning, the result is clear: Plan F and Plan C (which also covered the Part B deductible) were grandfathered for existing enrollees but closed to anyone newly eligible for Medicare starting in 2020. If you were already enrolled in Plan F before 2020, or if you were eligible for Medicare before January 1, 2020 but hadn't yet enrolled in a Medigap plan, you may still be able to get Plan F — but you'll want to act carefully and compare premiums, because Plan F rates have been rising as its enrollee pool ages and shrinks.
For the majority of Medicare beneficiaries today — particularly the wave of Baby Boomers turning 65 — Plan G has become the de facto replacement for Plan F. Plan G covers everything Plan F does with one exception: it does not pay the Medicare Part B deductible, which is $257 in 2025. That means in any given year, you'll pay the first $257 of your outpatient medical costs before Plan G kicks in. After that, Plan G covers 100% of Medicare-approved costs, including Part B excess charges (the extra amount some doctors charge above what Medicare approves, up to 15% more). In practical terms, the difference between Plan F and Plan G comes down to whether the premium savings on Plan G exceed $257 annually. In most markets, Plan G premiums run meaningfully lower than Plan F premiums for the same age and health profile, which means many beneficiaries actually come out ahead financially with Plan G even after paying the deductible themselves.
Plan N is the third major option worth understanding, and it's designed for beneficiaries who are generally healthy and want solid catastrophic protection without paying for comprehensive first-dollar coverage. Like Plan G, Plan N does not cover the Part B deductible. But it also introduces modest cost-sharing: you'll pay up to $20 for doctor office visits and up to $50 for emergency room visits that don't result in an inpatient admission. Critically, Plan N does not cover Part B excess charges, which means if you see a doctor who doesn't accept Medicare assignment — meaning they charge more than Medicare's approved amount — you could owe that extra amount out of pocket. Before choosing Plan N, it's worth checking whether your primary care doctor and specialists accept Medicare assignment. You can verify this at Medicare.gov's Care Compare tool. For beneficiaries who stick to assignment-accepting providers and don't visit the doctor frequently, Plan N's lower premiums can represent real savings over time.
Premium differences between these plans vary significantly by age, gender, location, and the insurance company offering the policy. In 2025, a 65-year-old woman in a mid-sized metro area might find Plan G premiums ranging from roughly $100 to $200 per month depending on the insurer and the pricing method used. That pricing method matters more than many people realize. Medigap insurers use one of three approaches: community-rated (everyone pays the same regardless of age), issue-age-rated (your premium is based on your age when you first enroll and doesn't increase just because you get older), or attained-age-rated (your premium increases as you age, which tends to be the most common and the one that can become expensive in your 70s and 80s). When comparing plans, always ask the insurer which rating method they use — a lower premium today on an attained-age policy may cost significantly more in ten years than a slightly higher community-rated or issue-age-rated plan.
The best time to enroll in any Medigap plan is during your six-month Medigap Open Enrollment Period, which begins the month you turn 65 and are enrolled in Medicare Part B. During this window, insurers cannot deny you coverage or charge you more based on pre-existing health conditions — this is your guaranteed issue right under federal law. Once that window closes, insurers in most states can use medical underwriting, meaning they can reject your application or charge higher premiums based on your health history. Conditions like diabetes, heart disease, COPD, or a history of cancer can make it difficult or expensive to get Medigap coverage outside of this initial enrollment window. Missing your open enrollment period is one of the most consequential mistakes a new Medicare beneficiary can make.
A handful of states offer additional protections that give beneficiaries more flexibility to switch Medigap plans later in life without medical underwriting. The so-called birthday rule — which allows you a 30-day window around your birthday each year to switch to an equal or lesser Medigap plan without health questions — is available in California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, and Oregon. If you live in one of these states, you have more options to reconsider your coverage as your health and financial situation evolve. New York and Connecticut go even further, requiring insurers to offer Medigap plans on a guaranteed-issue basis year-round, regardless of health status. If you're in one of these states, you have considerably more flexibility than beneficiaries elsewhere.
For beneficiaries who are still enrolled in Plan F and wondering whether to stay, the calculus is personal. If you have complex health needs, frequent specialist visits, or conditions that generate significant Medicare cost-sharing, the comprehensive coverage of Plan F may still be worth its premium — especially if you've held the policy for years and your insurer hasn't dramatically raised rates. However, if your Plan F premium has climbed steeply and you're in good health, it may be worth requesting a quote for Plan G from the same or a competing insurer. In states with birthday rule protections, you may be able to make that switch without underwriting. Elsewhere, switching from Plan F to Plan G typically requires answering health questions, so your current health status matters.
One more option worth knowing about is the Medicare SELECT version of Medigap plans, which generally offers lower premiums in exchange for using a network of preferred hospitals and sometimes doctors for non-emergency care. SELECT plans are available in some states and can be a cost-effective choice for beneficiaries who live near in-network facilities and don't anticipate needing care while traveling frequently. If you later want to switch from a SELECT plan to a standard Medigap plan, federal law gives you a one-time right to do so within the first year of enrollment — after that, medical underwriting may apply depending on your state.
The bottom line for anyone navigating Medigap today is this: Plan F may be off the table, but Plan G provides nearly identical protection for most beneficiaries, and the annual out-of-pocket difference is often smaller than the premium savings. Use your six-month open enrollment window, compare pricing methods — not just monthly premiums — and check your state's specific protections before assuming you have no options to adjust coverage later. The Medicare Plan Finder at Medicare.gov and your State Health Insurance Assistance Program (SHIP) counselor, available at no cost in every state, can help you run side-by-side comparisons tailored to your zip code and health situation.