--- title: "First-Dollar Coverage Explained: What It Is and Why It Matters in Medicare" description: "First-dollar coverage means the plan pays from the very first claim with no deductible to satisfy. Here is what first-dollar coverage means in Medicare and why the 2020 MACRA rule changed it." url: https://unlockedcrm.ai/blog/first-dollar-coverage-explained canonical: https://unlockedcrm.ai/blog/first-dollar-coverage-explained category: "Industry Education" published: 2026-05-14 updated: 2026-05-14 author: "Jacob Lock" source: unLocked CRM — AI CRM for insurance agents --- # First-Dollar Coverage Explained: What It Is and Why It Matters in Medicare ## TL;DR First-dollar coverage means a plan pays from the first claim with no deductible. In Medicare, Plans F and C historically offered first-dollar coverage but were closed to new enrollees on/after January 1, 2020 under MACRA. Plan G is now the closest equivalent for newly eligible beneficiaries, with the $257 Part B deductible (2026) being the only out-of-pocket cost. ## Key data points - MACRA closed Medicare Supplement Plans F and C to anyone newly eligible for Medicare on or after January 1, 2020 because they covered the Part B deductible. - In 2026, the Medicare Part B deductible is $257 — the only difference in coverage between Plan F (closed to new enrollees) and Plan G (the modern equivalent). "**First-dollar coverage**" is one of the most-misunderstood terms in Medicare and supplemental health insurance — partly because the rules quietly changed in 2020 and most agents still get the explanation wrong. ## What Is First-Dollar Coverage? First-dollar coverage means an insurance plan pays from the first dollar of qualifying expenses — the insured does not have to satisfy a deductible before benefits begin. In contrast, a high-deductible plan requires the insured to spend out of pocket up to the deductible amount before the plan starts paying. ## First-Dollar Coverage in Medicare Supplements The most common context for "first-dollar coverage" is **Medicare Supplement Plan F** — historically the most popular Medigap plan because it covered: - The Medicare Part A deductible - The Medicare Part B deductible - Part B excess charges - 100% of Medicare-approved coinsurance and copays With Plan F, a beneficiary walked into a doctor's office, the doctor billed Medicare and Plan F, and the beneficiary paid nothing — true first-dollar coverage. ## The 2020 MACRA Rule Change The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 prohibited the sale of any new Medigap plan that covered the **Part B deductible** to anyone newly eligible for Medicare on or after **January 1, 2020**. This eliminated first-dollar Medigap coverage for new beneficiaries. The affected plans: - **Plan F** — closed to new enrollees on/after Jan 1, 2020 - **Plan C** — closed to new enrollees on/after Jan 1, 2020 - **High-Deductible Plan F** — closed to new enrollees on/after Jan 1, 2020 Beneficiaries already enrolled in Plan F, Plan C, or HD-Plan F before Jan 1, 2020 can keep them — and these plans are still being sold to grandfathered enrollees. ## What Replaced First-Dollar Plans? For beneficiaries newly eligible on/after Jan 1, 2020, the closest equivalent to Plan F is **Plan G**: | Coverage Element | Plan F | Plan G | |---|---|---| | Part A deductible | Covered | Covered | | Part B deductible | Covered | NOT covered | | Part B coinsurance | Covered | Covered | | Part B excess charges | Covered | Covered | | Foreign travel emergency | Covered | Covered | In 2026, the Part B deductible is **$257**. Plan G enrollees pay this once per calendar year; everything else is covered as it was under Plan F. ## High-Deductible Plan G For new beneficiaries who want the lowest premium, HD-Plan G is available: - Annual deductible (2026): $2,870 - Once met, full Plan G benefits apply - Premium typically 60-70% lower than standard Plan G ## Why First-Dollar Coverage Still Matters For agents: - **Pre-2020 eligibles** can still buy Plan F — and many should consider it - **2020+ eligibles** should understand Plan G is the new standard - **Plan G + the $257 Part B deductible** is functionally close to first-dollar from the client's perspective - "First-dollar coverage" remains a useful selling phrase for Plan F (grandfathered) and a useful contrast for Plan G ## How unLocked CRM Quotes Medicare Supplements The unLocked Quote AI Medicare Supplement engine: - Detects whether a beneficiary is eligible for Plan F (pre-2020 eligible) or restricted to Plan G/N (2020+) - Quotes all available Medigap plans across 80+ MedSupp carriers - Compares Plan G vs Plan N vs HD-Plan G out-of-pocket cost over a 5-year window - Generates client-ready quote PDFs with first-dollar coverage explanations built in For more on Medicare quoting, see our [Medicare Advantage](/medicare-advantage) and [Medicare Supplement](/medicare-supplement) workflows. ## FAQ ### undefined ### undefined ### undefined ### undefined ### undefined ## Related - https://unlockedcrm.ai/blog/scope-of-appointment-explained - https://unlockedcrm.ai/blog/ichra-compliance-guide - https://unlockedcrm.ai/blog/rebc-rhu-clu-designation-guide --- Source: [First-Dollar Coverage Explained: What It Is and Why It Matters in Medicare](https://unlockedcrm.ai/blog/first-dollar-coverage-explained) — unLocked CRM, the AI CRM built for insurance agents. Citation permitted with attribution and a link to https://unlockedcrm.ai/blog/first-dollar-coverage-explained.