Standardized Plan Description
12 Standard Medicare Supplement Benefit Plans
CORE BENEFITS
PLAN A
PLAN B
PLAN C
PLAN D
PLAN E
PLAN F
PLAN G
PLAN H
PLAN I
PLAN J
PLAN K
PLAN L
Part A Hospital
Days 61-90
X
X
X
X
X
X
X
X
X
X
X
X
Lifetime Reserve
Days 91-150
X
X
X
X
X
X
X
X
X
X
X
X
365 Life Hospital
Days 100%
X
X
X
X
X
X
X
X
X
X
X
X
Parts A and B
Blood
X
X
X
X
X
X
X
X
X
X
50%
75%
Part B Coinsurance
20%
X
X
X
X
X
X
X
X
X
X
50%
75%
ADDED BENEFITS
PLAN A
PLAN B
PLAN C
PLAN D
PLAN E
PLAN F
PLAN G
PLAN H
PLAN I
PLAN J
PLAN K
PLAN L
Skilled Nursing Facility Coinsurance
Days 21-100
X
X
X
X
X
X
X
X
50%
75%
Deductibles
Part A
X
X
X
X
X
X
X
X
X
50%
75%
Deductibles
Part B
X
X
X
Excess Charges
Part B
100%
80%
100%
100%
Foreign Travel
Emergency
X
X
X
X
X
X
X
X
Recovery
At Home
X
X
X
X
Preventative Medical
Care
X
X
X
X
Hospice Cost-sharing Part A
50%
75%
Out-of-pocket Annual Limit
$4000
$2000
**
Plans K and L provide for different cost-sharing for items and services than Plans A - J.
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.
September 02, 2010
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