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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.