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Minnesota Standardized Medicare Supplement Plans

Basic Benefits - Included in all plans:

Inpatient Hospital Care: Covers the Part A coinsurance.

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.

Medicare Supplement Benefits Basic Extended Basic
Basic Benefits
Part A: Inpatient Hospital Deductible  
Part A: Skilled-Nursing Facility Coinsurance
Part B: Deductible  
Foreign Travel Emergency 80% 80%
Outpatient Mental Health 50% 50%
Usual and Customary Fees   80%
Preventive Care
Prescription Drugs   80%
At-home recovery  
Physical Therapy 20% 20%
Coverage While in a Foreign Country   80%

Optional Riders:

Insurance companies are permitted to offer six additional riders that can be added to a Basic plan. You may choose any one of all of the riders to design a Medicare Supplement plan that meets your needs.

Optional Riders Covers
Part A: Inpatient Hospital Deductible
Part A: Deductible
Usual and Customary Fees
Preventive Care
Prescription Drugs
At-Home Recovery

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