Is it a bad idea to drop Medicare Supplement Plan F?

8 answers | Last updated: Oct 21, 2016
Coleman asked...

I currently have a Medicare supplement plan F, which I cannot afford. It is causing me great hardship to keep. Would I be making a big mistake to drop it, even though my health is reasonably good?

Expert Answers

If you're having trouble paying your Medigap supplemental insurance premiums, dropping your supplemental coverage altogether is not a good idea because trying to get new insurance later, when you're older and may have health problems, can be much more difficult. That's because after an initial period following your original enrollment in Medicare, the insurance companies that sell Medigap policies do not have to automatically sell you a policy if they think you are too great a health risk. Because you're relatively healthy now, you may be able to switch supplemental insurance more easily than you would later. Here are some of your options.

  1. You can shop for another Plan F Medigap policy from another insurance company but at a lower premium. This would allow you to keep the same coverage. But the odds of finding a much more affordable Plan F policy aren't great because all Plan F policies tend to be expensive due to their extensive coverage.

  2. You can shop for a different Medigap supplemental insurance policy in a different plan category. The most important part of Medigap for most people is coverage for the 20 percent of doctor and other outpatient fees that Medicare Part B doesn't pay. But almost all plans cover this outpatient coinsurance amount, so you may be able to find a Medigap policy in a different plan category that is considerably less expensive than your current Plan F policy but that still gives you good supplemental coverage. Because you are now relatively healthy, you may be able to find several less expensive Medigap policies. But you'll have to shop around, and you'll probably have to permit the insurance companies to examine your medical records before they'll sell you a policy.

  3. You could consider switching from Medigap to a Medicare Part C Medicare Advantage plan. These are usually some type of managed care plan (like an HMO) which would directly control (instead of Medicare itself) how you receive care. They usually have restrictions on the doctors and other providers you can use. However, they tend to be a little bit less expensive than traditional Medicare plus a Medigap policy. If you shop for a Medicare Advantage plan, be aware that the new federal health reform law is going to cut payments to these plans, so that their monthly premiums are likely to rise over the new few years.

Community Answers

A fellow caregiver answered...

I would add to this answer that you should check with your state to see what laws they have regarding medigap coverage. Some states allow you to switch between plans A-J as you need to, so go to the medicare website and find the link for your state regarding coverage for medigap or supplement plans. Its called the The State Health Insurance Assistance Program (SHIP). There is also a website called medicare rights, that has good information about this.

If you can't afford F, its probably still better to have some kind of supplement plan rather than an advantage plan, as word is the advantage plans are fine when you are well, but don't cover much once you get sick. Its really pay now or pay later regarding both types of plans--they are going to get your money one way or the other. So do the math and figure out how much you will be on the hook for for any plan--that is the only way to figure out which one is best for you. That said, remember that when you do an advantage plan you give up your medicare, so be careful and don't let anyone talk you into anything. When I was looking into medigap and advantage plans, the medigap people never would get back to me--like they were doing me a favor selling me a policy. The advantage plans reps called night and day trying to get me to sign with them. That's all I needed to know about why I needed to pay more, and sign up for a medigap plan.

Cmacp answered...

I am wrestling with this same problem. My husband collapsed suddenly the very first day his medicare had become active. I was still shopping for a Medigap plan at the time. He has a pre-existing disability which made the Medigap payments about $350 + his $96.40. His SSDI puts him slightly over the medicaid poverty limit, but not high enough to allow us to pay about $500 a month just on his Medicare insurance (including part D). Throw in another $250 + for my coverage. Our total income from SSDI and SS is $1,700, but our total medicare premiums would take $700+ - about 40%. That's a hardship. Unfortunately, medicare is not prorated based on income. It should be. However, now I have 20% of 80 days in a skilled facility that I am responsible for. So, i don't have an answer. just ask yourself, how much do you have to loose if you do get an uncovered bill ($10,500 for us, and can you afford to take the risk?

Whocanihelp answered...

The previous posters all had great ideas, but as a person who works in this field daily (Medigap Insurance) I know that prices for a Plan F can vary wildly from company to as much as 40% - 50% in some cases! And ALL Plan F's are identical. Check around first with SEVERAL insurers, I suspect you'll be pleasantly surprised. If that doesn't work for you, and if you can hold on to your Plan F until June 1, there's a new "Plan N" becoming available then (for the first time) that may be priced affordably for you. Dropping Medigap coverage altogether would not work to your financial advantage in the long-term. Doing this comparison shopping may sound like a bit of work, but I bet you'll be glad you did. Good Luck in your search!

Cmacp answered...

I would add that the $350 for my husband's Medigap insurance was by far the lowest after getting quotes from several insurers. It was from AARP. He is permanently disabled and after the required 2 yrs/5mos wait finally became eligible for Medicare - at 58. The insurance costs for under 65 disabled are vastly higher than for the rest of us who can wait until 65. Last year I started the merry go round for our State's SHIP program. Was finally told that I needed to call our local Senior Center. Finally got a call back from a volunteer (!), who left me with no additional info, and more confused than ever. Thank you for the reminder. I'll recheck SHIP again, but It's absolutely appalling the lack of co-ordination/knowledge between our government agencies. It's so pervasive that it almost seems deliberate. A way to control costs through keeping people ignorant. By the way, I asked Social Security and our County Dept of health and Human Services. Either of these agencies should have told me about SHIP. Neither one did. I am my husband's sole care giver. I am 'retired' but do not have any extra time on my hands. When I call an agency and connect, I need and expect to be given the info I need or directed to the appropriate person. The fact that our State is farming out it's SHIP information to Senior Center volunteers is unbelievable.

Muddigger in oregon answered...

My 90/yr old mother and I both have Medicare and Regence Blue Cross med advantage. Since last Nov she has been hospitalized a total of 21 days with 3 heart attacks and a stroke. The first stay cost $27,000, of which she had to pay $900. (the 2nd and 3rd stays were last month and we havent seen the bills yet). She had excellent care and all she needed. We thought $900 was a fair deal even though we had to scrape to pay it. I've had 2 breast cancer surgeries, radiation etc and had no problems re: coverage or payment. On the other hand, my friend has been battleing cancer and dealing with SECURE HORIZONS. It has been a NIGHTMARE with no end in sight! I think failure or success in dealing with supplemental coverage depends on the company. Ask your friends what kind of luck they've had with theirs.

Gregory judd answered...

Several interesting and helpful replies here, but none have suggested that for most people, estimating your TOTAL cost of coverage can be good for both your medical and your financial health.

That's because most people, most of the time, are mostly reasonably healthy - even people who are Medicare eligible. 3/4 of Medicare eligible individuals who are not in Medicare Advantage plans spend an average of under $6,000 annually on their health care and coverage - and even then, over half of that average is spent on Medicare Supplement insurance premiums or contributions for original Medicare coverage. Abundant evidence demonstrates this. Here's one such chart: .

Some people do obtain a measure of peace of mind from health coverage that focuses on lowering or entirely eliminating their bills for routine doctor's visits. That's fine as long as they understand they may be spending thousands of dollars annually that might otherwise be prudently used for dental care, vision treatment, and other practical, budgetable health services that no Medicare coverage option pays much if any of the bills for.

Prescription drug coverage is probably the most dynamic component of most Medicare beneficiaries' health treatment budgets year in and year out - and Medicare Supplement policies cover little or no Rx expenses outside of in-facility or clinician administered medications.

Evaluating your prescription drug coverage annually makes sense - and Medicare Advantage PDP and MAPD plan coverage enables you to make Rx-driven coverage changes without concern that an insurer might deny you coverage. If you're eligible for Medicare, you're eligible.

Gregory judd answered...

Oh, drat: apparently my chart image formatting was defective in my post above - and the editing function appears to be on the fritz.

Here's the link again: Percentile estimates for Medicare beneficiaries out of pocket spending 2010[] and another attempt at displaying the chart: