WHAT IS MEDICARE PART F AND G?


There’s a lot of Medicare lingo to learn when you first enroll in Medicare, and one of the most confusing terms is “parts” versus “plans.” Used incorrectly, you could be talking about a whole different aspect of Medicare than the one you meant to.

“Parts” versus “Plans” in Medicare

That’s the case with “Part F” and “Part G.” When people refer to these, they actually mean “Plan F” and “Plan G.”

Parts refer to four aspects of Medicare. Part A refers to inpatient hospital coverage, and Part B refers to outpatient coverage. Together, Parts A and B make up Original Medicare. Part C is comprised of Medicare Advantage plans, and Part D includes all prescription drug plans. Those are the four “parts” of Medicare.

Plans, when used with a letter of the alphabet (like Plan F or G), refer to Medigap plans. The ten Medigap plans currently on the market are Medigap Plans A, B, C, D, F, G, K, L, M, and N. (There are also high-deductible versions of Plans F and G.)

What Is a Medigap Plan?

First, we need to know what a Medigap plan is. Medigap plans were designed to fill in the “gaps” left by Parts A and B of Original Medicare. Neither Part A nor Part B covers your medical expenses at 100%. There are always out-of-pocket expenses associated with Original Medicare, whether that comes from a deductible, copay, or coinsurance cost. Medigap plans help cover those leftover expenses.

Medigap plans (also called Medicare supplements) are standardized plans sold by private insurance companies. Standardization means that no matter which company you purchase the plan from, the coverage remains the same. The only thing that insurance companies have control over is the monthly premiums.

Anyone who is enrolled in Original Medicare is eligible to enroll in a Medigap plan. However, once your initial enrollment passes (when you first turn 65), you may not have guaranteed issue rights for a plan. After a certain point, insurance companies can deny coverage based on pre-existing conditions.

Let’s talk about the differences between Medigap Plan F and Medigap Plan G, the two most popular plans on the market.

Medigap Plan F

Medigap Plan F is the most comprehensive Medigap plan on the market. Medicare beneficiaries who enroll in Plan F will pay the monthly premium for Plan F and the monthly premium for Medicare Part B but will have nearly no other out-of-pocket costs for medical services.

Plan F benefits include:

  • Part A coinsurance costs with an additional 365 days of hospital costs after the Part A benefits have been depleted

  • Part A hospice coinsurance and copayment

  • Part B coinsurance and copayment

  • Blood (3 pints)

  • Skilled nursing facility coinsurance

  • Part A and B deductibles

  • Part B excess charge

  • 80% of foreign travel emergency expenses

Medigap Plan G is almost exactly the same as Plan F, with one small exception. Plan G does not cover the Part B deductible.

Medigap Plan G

Medigap Plan G is almost exactly the same as Plan F, with one small exception. Plan G does not cover the Part B deductible. However, it is the second most comprehensive coverage of all Medigap plans.

Plan G benefits include:

  • Part A coinsurance with an additional 365 days of hospital costs after the Part A benefits have been depleted

  • Part A hospice coinsurance and copayment

  • Part B coinsurance and copayment

  • Blood (3 pints)

  • Skilled nursing facility coinsurance

  • Part A deductible

  • Part B excess charge

  • 80% of foreign travel emergency expenses

How to Choose Between Plan F and Plan G

If Plan F has better coverage, why would anyone choose Plan G over Plan F? There are two main considerations when making this decision: eligibility and premiums.

The only Medicare beneficiaries who are eligible for Plan F are those who turned 65 prior to January 1, 2020. This is due to changes made by MACRA (Medicare Access and CHIP Reauthorization Act) in 2015. Changes made prohibit any Medicare supplement from covering the Part B deductible. Since Plan F does offer this benefit, it is no longer an option for any individual who turned 65 after MACRA went into effect. (This also applies to high-deductible Plan F.) Any beneficiary who was already enrolled in Plan F gets to keep their plan, and it is also available to those who turned 65 prior to January 1, 2020, but delayed enrollment. So, not everyone is eligible to enroll in Plan F.

Second, you’ll need to take a look at the premiums. Since Plan F offers better coverage, the premiums are higher than those for Plan G. Plus, Plan F premiums will likely begin to increase significantly since the number of beneficiaries enrolled in Plan F will start to dwindle.

The Part B deductible is set at $233 for 2022. If you look at the differences in premiums between Plan F and Plan G, it may actually be cheaper to enroll in Plan G over the course of the year. The higher premiums for Plan F may actually outweigh the benefit of having the Part B deductible covered.

If you’re considering one of these plans, you should work with a trusted independent agent. We can help you compare rates for each plan and give you an idea of how rates are expected to increase in both plans over the course of your future. Give our office a call today and schedule a free consultation with one of our agents.

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