Medigap Plan F in 2026: Your Guide to Cost and Eligibility

Navigating Medicare supplement options can feel complex, especially with popular plans like Medigap Plan F. You might have heard it offers incredible coverage but also that it’s no longer available to everyone. This guide will clarify everything you need to know about Plan F’s pricing, eligibility rules, and what to expect in 2026.

What Exactly is Medigap Plan F?

Medigap plans, also known as Medicare Supplement Insurance, are sold by private insurance companies to help pay for some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t cover. These “gaps” can include deductibles, copayments, and coinsurance, which can add up quickly.

For many years, Plan F was the most popular Medigap plan because it was the most comprehensive. In simple terms, if Medicare Part A or Part B approved a healthcare service, Plan F would cover the remaining costs. This “first-dollar” coverage meant that beneficiaries with Plan F often had no out-of-pocket expenses for Medicare-approved services, creating predictable and easy-to-manage healthcare budgets.

There is also a high-deductible version of Plan F. With this option, you must pay for Medicare-covered costs up to a certain deductible amount before the plan begins to pay for anything. For 2024, that deductible is $2,800. This results in a much lower monthly premium but requires you to handle more costs upfront.

Plan F's Comprehensive Coverage: What It Pays For

The ad mentioned that Plan F covers gaps other plans don’t. This is because it is one of only two Medigap plans (along with Plan C) that covers the annual Medicare Part B deductible. This single benefit is what sets it apart and made it so popular.

Here is a detailed breakdown of the “gaps” in Original Medicare that a standard Plan F policy covers:

  • Part A Coinsurance and Hospital Costs: Covers the daily coinsurance for extended hospital stays and provides coverage for up to an additional 365 days after Medicare benefits are used up.
  • Part A Deductible: This is a significant expense that you must pay when admitted to a hospital. Plan F covers it completely.
  • Part A Hospice Care Coinsurance or Copayment: Covers the small out-of-pocket costs associated with hospice care.
  • Part B Coinsurance or Copayment: After you meet your Part B deductible, you typically pay 20% of the cost for most doctor services. Plan F covers this 20% for you.
  • Part B Deductible: This is the key benefit. Plan F covers the annual deductible for Part B services, which is $240 in 2024. No other widely available plan does this.
  • Part B Excess Charges: Some doctors who don’t accept Medicare “assignment” can charge up to 15% more than the Medicare-approved amount. Plan F covers these excess charges.
  • Skilled Nursing Facility Care Coinsurance: Covers the daily coinsurance for stays in a skilled nursing facility.
  • Blood (First 3 Pints): Covers the cost of the first three pints of blood needed for a medical procedure.
  • Foreign Travel Emergency: Covers 80% of emergency care costs when you are traveling outside of the United States, up to the plan’s limits.

The Big Change: Understanding the 2020 Eligibility Rules

A federal law called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the rules for Medigap plans. The law stated that as of January 1, 2020, newly eligible Medicare beneficiaries could no longer purchase Medigap plans that cover the Part B deductible. This directly impacted Plan F and Plan C.

Here is how to determine your eligibility:

  • You ARE eligible for Plan F if: You were eligible for Medicare before January 1, 2020. This means your 65th birthday was before this date, or you qualified for Medicare earlier due to a disability. If you meet this condition, you can still purchase Plan F today or in the future, provided an insurance company in your state offers it.
  • You are NOT eligible for Plan F if: You became eligible for Medicare on or after January 1, 2020. If this is you, Plan F is not an option. The most comprehensive plan available to you is typically Medigap Plan G, which is identical to Plan F except that you must pay the annual Part B deductible yourself.

This change was made to encourage beneficiaries to be more mindful of their healthcare usage, as having to pay the Part B deductible might make someone think twice before seeing a doctor for a minor issue.

Decoding Plan F Pricing: Why Costs Vary So Widely

As the ad stated, the price you pay for the exact same Medigap Plan F can vary significantly. This is because while the benefits of each plan are standardized by the federal government, the monthly premiums are set by the private insurance companies that sell them.

Several key factors influence your premium:

  1. Geographic Location: Where you live is one of the biggest factors. Premiums in high-cost-of-living areas like New York City or Los Angeles will be considerably higher than in rural parts of states like Iowa or Alabama. This is tied to the local cost of healthcare.
  2. Insurance Provider: Different companies have different pricing structures. Well-known providers like Aetna, Cigna, Humana, and Mutual of Omaha might all offer Plan F in your area, but their monthly premiums could differ by $50 or more. It is crucial to compare quotes from multiple companies.
  3. Pricing Method: Companies use one of three methods to set your premiums, which affects how your rate changes over time:
    • Community-Rated: Everyone in a specific area pays the same premium, regardless of their age. Rates may still go up due to inflation, but not because you get older.
    • Issue-Age-Rated: Your premium is based on your age when you first buy the policy. It won’t increase just because you age, but it can rise for other reasons like inflation.
    • Attained-Age-Rated: Your premium starts low but increases as you get older. These policies can become very expensive over time and are the most common type.
  4. Other Personal Factors: Your age, gender, and whether you use tobacco can also affect your premium in some states.

A Look Ahead: Medigap Plan F in 2026

For those who are eligible or already have Plan F, it’s important to understand how the plan might evolve by 2026.

The “Closed Risk Pool” Effect: Since no new, younger, and generally healthier people can join the standard Plan F risk pool, the average age of the members in that pool will steadily increase. As people get older, they tend to use more healthcare services. This causes the insurance company to pay out more in claims, which in turn leads to higher and more frequent premium increases for everyone remaining in that plan.

By 2026, it is widely expected that Plan F premiums will have risen at a faster rate than the premiums for plans open to new enrollees, like Plan G. While your coverage will remain excellent, the cost could become a concern.

If you have Plan F, it’s wise to review your premium annually. Compare its cost to the premium for a Plan G policy from the same or a different company. You can calculate your potential savings by taking the annual premium for Plan G, adding the annual Part B deductible, and seeing how that total compares to your annual premium for Plan F. For many, switching to Plan G may become a financially smart move.

Frequently Asked Questions

Is Plan G a good alternative to Plan F? Yes. For new Medicare beneficiaries, Plan G is the most comprehensive option available. For those who are still eligible for Plan F, Plan G is an excellent alternative that often has lower premiums. The only difference in coverage is that with Plan G, you must pay the annual Medicare Part B deductible yourself.

If I have Plan F, can my insurance company force me to switch? No. As long as you continue to pay your premiums, your Medigap Plan F policy is guaranteed renewable. The insurance company cannot cancel your policy or change your benefits, though they can and likely will raise the premium over time.

How do I shop for a Plan F policy if I am eligible? The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. This period starts on the first day of the month in which you’re 65 or older and enrolled in Medicare Part B. During this time, you have a guaranteed issue right, meaning companies cannot deny you coverage or charge you more due to pre-existing health conditions. You can compare plans using Medicare’s official Plan Finder tool or by working with an independent insurance agent.