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Standardized Medicare Supplement Plans for Most States (excluding MA, MN and WI )

Every company offering Medicare Supplement insurance must offer Plan A. In addition, companies may have some, all, or none of the other plans.

Basic Benefits (Included in Plans A - G):

Inpatient Hospital Care: Covers the cost of Part A coinsurance and the cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends.

For medicare supplement plans, Medical Costs: Covers the Part B coinsurance (generally 20% of Medicare-approved payment amount) or copayment amount which may vary according to the service. For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Blood: Covers the first 3 pints of blood each year.

Options A B C D F* G
Basic Benefits Basic Benefits - Plan A - Covered Basic Benefits - Plan B - Covered Basic Benefits - Plan C - Covered Basic Benefits - Plan D - Covered Basic Benefits - Plan F - Covered Basic Benefits - Plan G - Covered
Part A: Inpatient Hospital Deductible Part A: Inpatient Hospital Deductible - Plan A - Not Covered Part A: Inpatient Hospital Deductible - Plan B - Covered Part A: Inpatient Hospital Deductible - Plan C - Covered Part A: Inpatient Hospital Deductible - Plan D - Covered Part A: Inpatient Hospital Deductible - Plan F - Covered Part A: Inpatient Hospital Deductible - Plan G - Covered
Part A: Skilled-Nursing Facility Coinsurance Part A: Skilled-Nursing Facility Coinsurance - Plan A - Not Covered Part A: Skilled-Nursing Facility Coinsurance - Plan B - Not Covered Part A: Skilled-Nursing Facility Coinsurance - Plan C - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan D - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan F - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan G - Covered
Part B: Deductible Part B: Deductible - Plan A - Not Covered Part B: Deductible - Plan B - Not Covered Part B: Deductible - Plan C - Covered Part B: Deductible - Plan D - Not Covered Part B: Deductible - Plan F - Covered Part B: Deductible - Plan G - Not Covered
Foreign Travel Emergency Foreign Travel Emergency - Plan A - Not Covered Foreign Travel Emergency - Plan B - Not Covered Foreign Travel Emergency - Plan C - Covered Foreign Travel Emergency - Plan D - Covered Foreign Travel Emergency - Plan F - Covered Foreign Travel Emergency - Plan G - Covered
Part B: Excess Charges Part B: Excess Charges - Plan A - Not Covered Part B: Excess Charges - Plan B - Not Covered Part B: Excess Charges - Plan C - Not Covered Part B: Excess Charges - Plan D - Not Covered 100% 100%

* Plan F also has a high deductible option. If you choose this option, in 2017 you must pay $2,200 out-of-pocket per year before the plans pay anything. Insurance policies with a high deductible option generally cost less than those with lower deductibles. Your out-of-pocket costs for services may be higher if you need to see your doctor or go to the hospital.

Basic Benefits (Plans K- N):

Basic Benefits for Plans K, L and N include similar services as Plans A through G and M, but cost sharing for the basic benefits is at different levels.

Options K** L** M N
Basic Benefits 100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 50% Hospice cost-sharing 50% of Medicare eligible expenses for the first three pints of Blood 50% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services 100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 75% Hospice cost-sharing 75% of Medicare eligible expenses for the first three pints of Blood 75% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services Basic Benefits - Plan M - Covered Basic, Including 100% co-insurance, except up to $20 copayment for office visit, and up to $50 copayment for ER
Skilled Nursing Coinsurance 50% Skilled Nursing Facility Coinsurance 75% Skilled Nursing Facility Coinsurance Skilled Nursing Coinsurance - Plan M - Covered Skilled Nursing Coinsurance - Plan N - Covered
Part A: Deductible 50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A: Deductible - Plan N - Covered
Part B: Deductible Part B: Deductible - Plan K - Not Covered Part B: Deductible - Plan L - Not Covered Part B: Deductible - Plan M - Not Covered Part B: Deductible - Plan N - Not Covered
Part B: Excess (100%) Part B: Excess (100%) - Plan K - Not Covered Part B: Excess (100%) - Plan L - Not Covered Part B: Excess (100%) - Plan M - Not Covered Part B: Excess (100%) - Plan N - Not Covered
Foreign Travel Emergency Foreign Travel Emergency - Plan K - Not Covered Foreign Travel Emergency - Plan L - Not Covered Foreign Travel Emergency - Plan M - Covered Foreign Travel Emergency - Plan N - Covered
At-Home Recovery At-Home Recovery - Plan K - Not Covered At-Home Recovery - Plan L - Not Covered At-Home Recovery - Plan M - Not Covered At-Home Recovery - Plan N - Not Covered
Preventive Care NOT Covered by Medicare Preventive Care NOT Covered by Medicare - Plan K - Not Covered Preventive Care NOT Covered by Medicare - Plan L - Not Covered Preventive Care NOT Covered by Medicare - Plan M - Not Covered Preventive Care NOT Covered by Medicare - Plan N - Not Covered
  $4,960.00 Out of Pocket Annual Limit (2017) *** $2,480.00 Out of Pocket Annual Limit (2017) *** Out of Pocket Annual Limit - Plan M - Not Available Out of Pocket Annual Limit - Plan N - Not Available

**Plans K and L provide for different cost-sharing for items and services than Plans A through G and M. 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.

***The out-of-pocket annual limit will increase each year for inflation.

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