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Medicare Supplement Plans – Overview
Why You Need Medicare Supplement Insurance
Medicare is a federal program to help older Americans and some disabled Americans pay for the high cost of health care. However, Medicare was never intended to cover all your health care costs. So even if you’re covered by Medicare, you are still responsible for a large portion of your health care costs. Without Medicare Supplement insurance, your out-of-pocket costs could add up to more than $51,700 this year alone.
What Medicare Doesn’t Cover
Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).
Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:
- Part A hospital deductible ($1,686)
- Part B deductible ($240)
- Copayments for hospital stays over 60 days
- Care in a skilled nursing facility after 20 days
- Twenty percent coinsurance for doctor bills and other medical expenses
By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. While the benefits must be the same, each company’s rates, reputation, membership features and quality of service can vary. You don’t have to sacrifice comprehensive benefits or freedom-of-choice for affordability. Their Medicare Supplement plans provide substantial benefits at rates that can save you money over other plans.
Member Benefits
All Medicare Supplement plans give you:
- Guaranteed Acceptance with no health questions asked
- Freedom to choose any doctors or specialists (unless a Med-Select plan is chosen)
- Coverage with domestic travel (Plans G, F, and N cover foreign travel)
- Guaranteed renewability regardless of changes in your health
- Coverage guaranteed to match Medicare’s cost increases year after year
- Value Added Services that include discounts on wellness products and services including vision, fitness clubs, weight management, complementary alternative medicine, hearing and more
- No claim forms, in most cases
Medicare Supplement Basic Benefits
Basic benefits included in all plans include:
- Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses), or in the case of hospital outpatient department services under a prospective payment system, applicable copayments.
- Blood – First three pints of blood each year.
*Plans K and L include benefits at different levels of cost sharing (see outline of coverage).
Premier Plans
- Of all available standardized plans, Plan F offers the most complete protection for uncovered Medicare Part B excess charges. These are the most popular plans because they also pay the Medicare Part A hospital deductible and copayments, skilled nursing facility copayment and foreign travel emergency care.
- Plan F also covers the Medicare Part B deductible.
Budget-Conscious Plans
Plan K, Plan L and Plan N include cost-sharing features that allow you to save on premiums while still receiving dependable coverage.
- Plan N features an office visit and emergency room copayment applicable to each visit
- Plans K and L feature cost sharing for covered services under Medicare Part A and Part B. Once your annual out-of-pocket expenses reach the required limit, the plan pays 100% of covered expenses for the remainder of the calendar year.
If you are seeking the most basic benefit plan with the lowest cost, they offer Medicare Supplement Plan A. For more detailed explanations on all the available Medicare Supplement plans and benefits, you can Compare Medicare Supplement Plans.
Medicare Supplement Plans – Quick Comparison Table
| Plans | A | F* | K** | L** | N |
|---|---|---|---|---|---|
| Basic Benefits | X | X | X | X | X |
| Skilled Nursing Coinsurance | – | X | 50% | 75% | X |
| Part A Deductible | X | X | 50% | 75% | X |
| Part B Deductible | – | X | – | – | – |
| Part B Excess (100%) | – | X | – | – | – |
| Foreign Travel Emergency | – | X | – | – | X |
| At Home Recovery | – | – | – | – | – |
| Annual Out-of-Pocket Cost | – | $0 | $6,620 | $3,310 | $0 |
*Plan F has a Med-Select plan option that offer you the same solid benefits as the “standard” plans, but cost less. You save on premiums simply by agreeing to use any of the Med-Select participating hospitals for non-emergency elective admissions. If you do not use one of these hospitals for your non-emergency admissions, you pay the $1,686 Part A deductible. Med-Select is not an HMO. With Med-Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists.
**Plans K and L provide for different cost-sharing than plans A-F. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You will be responsible for paying excess charges.
Tivity Health SilverSneakers® Fitness program
Medicare Supplement Insurance members in some states can now take advantage of the SilverSneakers Fitness program as a value-added service at no additional cost. With SilverSneakers, members have free access to fitness center amenities such as treadmills, weights, heated pools and group exercise classes that are included with a basic membership. (Amenities and classes vary by location.) Members can take signature SilverSneakers classes designed specifically for older adults and taught by certified instructors. SilverSneakers members have access to more than 13,000 participating fitness center locations (gyms, community centers, Curves, etc.). Log on to silversneakers.com to find the nearest location. SilverSneakers Steps® is available to members living 15 miles or more from a participating SilverSneakers fitness center location. Members can select one of four fitness kits each year (general fitness, walking, strength or yoga) that they can use at home or on the go.
Steps kits can be ordered online at silversneakers.com or by calling SilverSneakers Customer Service at 1-888-423-4632 Monday through Friday, 8 a.m. to 8 p.m. EST. The SilverSneakers Fitness Program is currently available in the state of Illinois.
MyVision Care provided through EyeMed*
Medicare Supplement Insurance members can save up to 30% on prescription glasses and up to 20% on contact lenses at participating stores, including LensCrafters, Pearle Vision, Sears Optical, Target Optical and JCPenney Optical stores.
Also, Medicare Supplement members pay only $50 for routine eye exams. Members can find a participating provider in the EyeMed Network by calling 1-800-872-2295 or visiting their website.
Reduced Premium Medicare Select Option
Med-Select Options
The Plan F Med-Select option offers you the same solid benefits as the “standard” plans, but cost less. You save on premiums simply by agreeing to use any of the Med-Select participating hospitals for non-emergency elective admissions. If you do not use one of these hospitals for your non-emergency admissions, you pay the $1,686 Part A deductible. Med-Select is not an HMO. With Med-Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists.
Med-Select is available in specific geographic areas only. You must live within a 30 mile radius of a Med-Select participating hospital.
Medicare Supplement Plans
Plan F
Our Rating: 
Plan F is the most comprehensive Illinois Medicare Supplement plan. No other standardized Medicare Supplement plan offered in Illinois offers more complete protection for your uncovered Part B medical expenses than Plan F. It covers:
- Your Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
- Medicare Part A hospital deductible and copayments
- Skilled nursing facility copayment
- Foreign travel emergency care
- $240 Part B Medicare deductible
- Part B doctor charges that are in excess of Medicare-approved amounts
There is also a Medicare-Select Plan F that offers the same benefits as Standard Plan F but provides costs savings by agreeing to use a Medicare Select participating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Plan F Benefits
| Benefit | What Plan F Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible is $1,686. This amount can change every year. You have to pay this deductible for each benefit period. | Plan F covers 100% of the $1,686 deductible. |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan F covers 100% of the $240 deductible. |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan F covers all of the 20% remainder costs |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan F covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan F covers all of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment ” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan F covers 100% of the excess charges |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan F covers 80% (after a $250 deductible) to a lifetime maximum benefit of $50,000. |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan F covers up 100% per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan F covers the 20% remainder not paid by Medicare Part B. |
Plan G
Our Rating:
Plan G is the most popular Illinois Medicare Supplement plan. No other standardized Medicare Supplement plan offered in Illinois offers more complete protection for your uncovered Part B medical expenses than Plan F. It covers:
- Your Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
- Medicare Part A hospital deductible and copayments
- Skilled nursing facility copayment
- Foreign travel emergency care
- Part B doctor charges that are in excess of Medicare-approved amounts
Plan G does NOT cover
- Your $240 Part B annual deductible
There is also a Medicare-Select Plan G that offers the same benefits as Standard Plan F but provides costs savings by agreeing to use a Medicare Select participating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Plan K
Our Rating: 
Plan K covers:
- Fifty percent of your Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Preventive benefits for Medicare-covered services usually leave you with 25% to pay — plan K pays that 25%
- 50% of the cost of the first three pints of blood
- Fifty percent of the skilled nursing facility copayment
- Once you’ve reached your $6,620 annual out-of-pocket limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year.
There is also a Medicare-Select Plan K that offers the same benefits as Standard Plan K but provides costs savings by agreeing to use a Medicare Select particpating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Plan K Benefits
| Benefit | What Plan K Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2012 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period. | Plan K covers 100% of the $1,216 deductible |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2012) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan K does not cover the Medicare Part B $147 deductible |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan K covers 10% of the remaining costs after you pay the $147 Part B deductible |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan K covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan K covers 50% of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan K does not covers Part B Excess Charges |
| Hospice Care Hospice is a special way of caring for people who are terminally ill and for their families. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness. | Plan K covers 50% of your copay |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan K does not cover foreign travel emergencies |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan K covers up to 50% of $141.50 per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan K covers 10% of the remainder after the $147 Medicare Part B deductible. |
| Out of Pocket Limit The maximum costs you are responsible for in a calendar year. | Plan K will cover 100% of all costs if you reach the $4,640 out of pocket limit |
Plan L
Our Rating:
Plan L covers:
- Seventy-five percent of your Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Preventive benefits for Medicare-covered services usually leave you with 25% to pay — plan L pays that 25%
- Fifteen percent of your 20% Part B coinsurance and the 75% of the cost of the first three pints of blood
- Seventy-five percent of the skilled nursing facility copayment
- Once you’ve reached your $3,310 annual out-of-pocket limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year.
There is also a Medicare-Select Plan L that offers the same benefits as Standard Plan L but provides costs savings by agreeing to use a Medicare Select participating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Plan L Benefits
| Benefit | What Plan L Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2012 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period. | Plan L covers 100% of the $1,216 deductible |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2012) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan L does not cover the Medicare Part B $147 deductible |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan L covers 15% of the remaining costs after you pay the $147 Part B deductible |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan L covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan L covers 75% of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan L does not covers Part B Excess Charges |
| Hospice Care Hospice is a special way of caring for people who are terminally ill and for their families. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness. | Plan L covers 75% of your copay |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan L does not cover foreign travel emergencies |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan L covers up to 75% of $141.50 per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan L covers 15% of the remainder after the $147 Medicare Part B deductible. |
| Out of Pocket Limit The maximum costs you are responsible for in a calendar year. | Plan L will cover 100% of all costs if you reach the $2,320 out of pocket limit |
Plan N
Our Rating:
Plan N is identical to Plan G except there is a $20 copay for office visits and a $50 copay for emergency room visits. Like Plan G, Plan N does not cover the $240 Medicare Part B deductible.
Plan N covers:
- Your $1,686 Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
- 80% of Part B physician charges that are in excess of the Medicare-approved amount (By law no physician may charge more than 115% of Medicare-approved amounts).
- Skilled nursing facility copayment
- Emergency care for foreign travel
Plan N does NOT cover:
- Your $240 Medicare Part B deductible
There is also a Medicare-Select Plan N that offers the same benefits as Standard Plan N but provides costs savings by agreeing to use a Medicare Select participating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Plan N Benefits
| Benefit | What Plan N Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2012 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period. | Plan N covers 100% of the $1,216 deductible. |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2012) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan N does NOT cover the $147 Part B deductible, you must pay out of pocket. |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan N covers 100% of the 20% remainder costs after a $20 office visit copay and $50 emergency room copay |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan N covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan N covers all of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment ” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan N covers 100% of the excess charges |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan N covers 80% (after a $250 deductible) to a lifetime maximum benefit of $50,000. |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan N covers up to $141.50 per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan N covers the 20% remainder not paid by Medicare Part B. |
Basic Plan A
Our Rating: 
Basic Plan A covers:
- Your Part A coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
Plan A Benefits
| Benefit | What Plan A Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2012 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period. | Plan A does not cover the $1,216 deductible |
| Part A Coinsurance Hospital Benefits Medicare requires you to pay your coinsurance on hospital expenses. This benefit generally pays all or part of your coinsurance for hospital stay. | Medicare pays for days 1- 60. Plan A covers
|
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2012) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan A does not cover the Medicare Part B $147 deductible |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan A covers 20% of the remaining costs after you pay the $147 Part B deductible |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan A covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan A covers 100% of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan A does not covers Part B Excess Charges |
| Hospice Care Hospice is a special way of caring for people who are terminally ill and for their families. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness. | Plan A does not cover hospice care |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan A does not cover foreign travel emergencies |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan A does not cover skilled nursing |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan A covers 20% of the remainder after the $147 Medicare Part B deductible. |
| Out of Pocket Limit The maximum costs you are responsible for in a calendar year. | There is not out of pocket limit for Basic Plan A |
Medicare Select Plans
Medicare Select Plan options offer you the same solid benefits as the standard Medicare Standard Supplement Plans, but cost less. You save on premiums simply by agreeing to use any of the Medicare Select participating hospitals for non-emergency elective admissions as defined by the admitting hospital.
If you do not use one of these hospitals for your non-emergency admissions, you pay the full Part A deductible. Medicare Select is not an HMO. With Medicare Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists.
Medicare Select Plan options include Plan F and are available in specific geographic areas only. You must live within a 30 mile radius of a Medicare Select participating hospital.
Medicare Select Plan F
Our Rating:
Plan F is the most popular Medicare Supplement plan. No other standardized Medicare Supplement plan offered in Illinois offers more complete protection for your uncovered Part B medical expenses than Plan F. It covers:
- Your Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
- Medicare Part A hospital deductible and copayments
- Skilled nursing facility copayment
- Foreign travel emergency care
- $240Part B Medicare deductible
- Part B doctor charges that are in excess of Medicare-approved amounts
Medicare Select Plan F Benefits
| Benefit | What Plan F Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2012 is $1,216. This amount can change every year. You have to pay this deductible for each benefit period. | Plan F covers 100% of the $1,216 deductible. |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2013) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. | Plan F covers 100% of the $147 deductible. |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. | Plan F covers all of the 20% remainder costs |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. | Plan F covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. | Plan F covers all of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. | Plan F covers 100% of the excess charges |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. | Plan F covers 80% (after a $250 deductible) to a lifetime maximum benefit of $50,000. |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. | Plan F covers up to $141.50 per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. | Plan F covers the 20% remainder not paid by Medicare Part B. |
MedicareRx Plans
MedicareRx offers 3 plan designs, the Saver Plan, Preferred Plan, and Enhanced Plan. Below is an overview of each plan.
2019 MedicareRx Plans
| MedicareRx Saver Plus Plan | MedicareRx Preferred Plan | MedicareRx Enhanced Plan | |||
|---|---|---|---|---|---|
Monthly Premium* | $18.00 | $35.15 | $86.60 | ||
Deductible | $310 | $0 | $0 | ||
| Copays | |||||
Tier 1 – Commonly Used Generic Drugs | $1 | $3 | $2 | ||
Tier 2 – Most Generic Drugs | $2 | $5 | $5 | ||
Tier 3 – Brand Drugs | $25 | $40 | $40 | ||
Tier 4 – Non-Preferred Brand Drugs | $45 | $85 | $76 | ||
Tier 5 – Specialty Drugs | 25% | 33% | 33% | ||
| Coverage Levels | |||||
Initial Coverage | You pay the regular copays/coinsurance above and MedicareRX pays for the remaining drug cost until the total combined yearly drug costs reach $4,430. | ||||
Gap Coverage | Once you and your MedicareRx Part D drug plan have spent $4,430 for covered drugs, you will be in the donut hole. You pay 79% of the total cost for generic drugs and 47.5% of the total cost for brand name drugs. The donut hole continues until your total out-of-pocket cost reaches $7,400. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts. | Once you and your MedicareRx Part D drug plan have spent $2,970 for covered drugs, You pay 79% of the total cost for generic drugs and 47.5% of the total cost for brand name drugs during the coverage gap, plus additional coverage for Tier 1 and Tier 2 drugs and select brand name drugs in Tiers 3, 4 and 5. The donut hole continues until your total out-of-pocket cost reaches $7,400. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts. | |||
After the Gap | When you spend more than $7,400out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year. You will then be responsible for whichever is greater: | ||||
Tier 1 – Generic Drugs: $2.65 copay or 5% coinsurance for your drug | |||||
Tier 2 – Non-Preferred Generic: $2.65 copay or 5% coinsurance for your drug | |||||
Tier 3 – Preferred Brand: $6.60 copay or 5% coinsurance for your drug | |||||
Tier 4 – Non-Preferred Brand: $6.60 copay or 5% coinsurance for your drug | |||||
Tier 5 – Specialty Drugs: 5% coinsurance for your drug | |||||
| Summary of Benefits | |||||
Medicare Part D Financial Help
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for up to 100% of drug costs, including monthly prescription drug premiums, annual deductibles and copays/coinsurance. (An enrollee’s premium will generally be lower once he or she receives extra help from Medicare.)
Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it.
Best Available Evidence Policy
Low Income Subsidy Premium
The premiums listed do not include the amount you pay for your Medicare Part B premium.
| Your level of extra help | Monthly premium for MedicareRx Saver plan | Monthly premium for MedicareRx Preferred Plan |
|---|---|---|
| 100% | $8.10 | $65.00 |
| 75% | $15.80 | $72.70 |
| 50% | $23.50 | $80.40 |
| 25% | $31.10 | $88.20 |
To learn if you qualify for extra help, contact:
- Medicare
1-800-MEDICARE (1-800-633-4227)
Hearing and speech impaired 1-877-486-2048
24 hours a day, 7 days a week - Social Security Administration
1-800-772-1213
Hearing or speech impaired 1-800-325-0778
7 a.m. – 7 p.m., Monday – Friday - Your local Medicaid office
Resources include savings and stocks, but not your home or car. Qualifications are established by the federal government and subject to change annually.