Medicare Plan F: Who Qualifies and What to Do If You Don't

For decades, Medicare Supplement Plan F was the plan that Medicare beneficiaries pointed to when they wanted to explain what 'complete coverage' looked like. It paid the Part A deductible, the Part B deductible, Part B excess charges, hospital coinsurance, skilled nursing facility coinsurance, and even the 20% coinsurance that original Medicare leaves behind on most outpatient services. In short, if Medicare approved a service, Plan F paid whatever Medicare didn't. Your out-of-pocket cost was essentially zero beyond your monthly premium. That made it enormously popular — and enormously expensive for the insurance industry.

Congress changed the rules with the Medicare Access and CHIP Reauthorization Act of 2015, commonly called MACRA. The law prohibited insurers from selling 'first-dollar coverage' Medigap plans — meaning plans that pay the Part B deductible — to newly eligible Medicare beneficiaries starting January 1, 2020. The reasoning was that when beneficiaries have no cost-sharing at the point of care, they tend to use more services, which drives up costs across the entire Medicare program. Whether or not you agree with that logic, the practical result is clear: if you became eligible for Medicare on or after January 1, 2020, Plan F is simply not available to you, regardless of your health, income, or how much you're willing to pay.

So who can still get Plan F? If you were eligible for Medicare Part A before January 1, 2020 — meaning you turned 65 before that date, or you qualified for Medicare due to disability before that date — you can still enroll in Plan F today, as long as an insurer in your state offers it. Many still do. But 'can enroll' and 'should enroll' are two different questions. If you already have Plan F and are happy with it, there's generally no reason to leave. Your coverage is grandfathered, and you can keep it as long as you continue paying premiums. The concern arises when you look at the long-term premium trajectory.

Because Plan F is a closed pool — no new, younger, healthier enrollees are entering — the risk pool ages every year. Actuarially, that means insurers are likely to raise Plan F premiums faster than they raise premiums on open plans like Plan G. This isn't speculation; it's a predictable consequence of how insurance pricing works. Some Plan F enrollees have already seen this play out, with annual increases running several percentage points above what Plan G holders in the same market experienced. If you're currently on Plan F and your premium has climbed significantly, it may be worth requesting a quote for Plan G from your current insurer or a competitor. You'd take on the Part B deductible — $257 in 2025 — but if the premium difference exceeds that amount annually, you come out ahead financially.

For beneficiaries who became eligible for Medicare after January 1, 2020, Plan G is the most comprehensive option available. It mirrors Plan F in almost every way: it covers the Part A hospital deductible ($1,676 per benefit period in 2025), Part B excess charges (the amount a non-participating provider can charge above Medicare's approved amount), skilled nursing facility coinsurance, and the 20% Part B coinsurance on outpatient services. The only gap is that $257 Part B deductible, which you pay once per calendar year. After that, Plan G functions identically to Plan F for the rest of the year. For most people, Plan G premiums run meaningfully lower than Plan F premiums — often $30 to $60 per month less, depending on your age, gender, location, and the insurer. Do the math: if Plan G costs you $40 less per month, that's $480 per year in premium savings against a $257 deductible. You're $223 ahead before you see a single doctor.

There's also a high-deductible version of Plan G, sometimes called Plan G-HD, which deserves mention for healthier beneficiaries who want catastrophic protection without paying high monthly premiums. In 2025, the high-deductible threshold is $2,870 — meaning you pay all Medicare-covered costs out of pocket until you've spent that amount in a calendar year, after which the plan covers everything Plan G normally covers. Premiums for high-deductible Plan G can run as low as $30 to $60 per month in many markets, making it an option worth considering if you rarely use medical services but want protection against a major illness or hospitalization. Similarly, there was a high-deductible version of Plan F for those who qualify — Plan F-HD — which works the same way with the same 2025 deductible threshold.

One important variable that many beneficiaries overlook is how an insurer prices its Medigap plans over time. There are three pricing methods: community-rated (everyone pays the same premium 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), and attained-age-rated (your premium increases as you age, in addition to general rate increases). Attained-age-rated plans often have the lowest initial premiums, which makes them look attractive at enrollment — but they can become significantly more expensive in your 70s and 80s. When comparing Plan G quotes, always ask the insurer which rating method they use. This single question can save you thousands of dollars over a decade.

Enrollment timing matters enormously with Medigap. Your best window is the six-month Medigap Open Enrollment Period that 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 conditions — this is called guaranteed issue. Outside this window, most states allow insurers to use medical underwriting, which means they can reject your application or charge higher premiums based on your health history. There are specific Guaranteed Issue Rights that apply in other situations — for example, if you lose employer coverage or if your Medicare Advantage plan leaves your area — but these are narrow and time-limited. Missing your initial enrollment window and then developing a health condition can leave you locked out of the Medigap plan you want.

A handful of states offer additional protections worth knowing about. If you live in California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, or Oregon, you have what's called a 'birthday rule' — a 30-day window each year around your birthday during which you can switch to a Medigap plan with equal or lesser benefits without medical underwriting. New York and Connecticut go further, requiring guaranteed issue year-round. If you're in one of these states and you've been stuck on a plan that no longer fits your needs, your birthday window may be your opportunity to make a change without health questions.

Finally, if you're not eligible for Plan F and you're evaluating Plan G, don't just call one insurer. The same Plan G benefits are standardized by federal law — meaning the coverage is identical regardless of which company sells it — but premiums vary dramatically. A 65-year-old woman in the same zip code might find Plan G quotes ranging from $110 to $220 per month depending on the insurer. Use Medicare's official Plan Finder at medicare.gov or work with an independent insurance broker who represents multiple carriers. Your state's State Health Insurance Assistance Program, known as SHIP, also offers free, unbiased counseling — find your local SHIP counselor through shiphelp.org. These resources exist specifically to help you compare options without sales pressure, and using them before you enroll can prevent years of overpaying for coverage you could have gotten for less.