Standardized Medigap – Medicare
Supplement Plans and Benefits
A
B
C
D
E
F
G
H*
I*
J
K**
L**
Hospital Coinsurance Coinsurance
for days 61-90 ($267) and days 91-150 ($534) in hospital; Payment
in full for 365 additional lifetime
days.
Part B coinsurance Coinsurance for Part B services such as doctor's
services, laboratory and x-ray services, durable medical equipment,
and hospital outpatient services.
50%*
75%*
First three pints of blood
50%*
75%*
Hospital Deductible
Covers the first $1068 of hospital charges for
each benefit period.
50%*
75%*
Skilled Nursing Facility (SNF) Daily Coinsurance
Covers $133.50 per
day for days 21 to 100 of skilled care in a nursing home per benefit
period.
50%*
75%*
Part B Annual Deductible
Pays the first $135 of covered physician
and other Part B services per calendar year.
Part B Excess Charges Benefits
80% or 100% of Part B excess charges.
(Under Federal law, the excess limit is 15% more than Medicare's
approved charge when provider does not take assignment; Under New
York State
law the excess limit is 5% for most services.)
100%
80%
100%
100%
Emergency Care Outside the US
Covers 80 percent of emergency care
during the first two months of a trip after a $250 per calendar year
deductible, up to a $50,000 lifetime maximum.
At-Home Recovery Benefit
Up to $40 each visit for custodial care after
an illness, injury, or surgery, up to a maximum benefit of $1,600
a year.
Preventive Medical Care
Covers $120 per year for
health care screenings ordered by a physician but not covered by
Medicare, such as a physical examination, cholesterol test and diabetes
screening.
100% coinsurance for Part B-covered preventive
care services after the Part B deductible has been paid.
Hospice Care Coinsurance for respite care and
other Part A-covered services.
50%*
75%
Outpatient Prescription Drugs
*Out-of-Pocket Maximum
Pays 100% of Part A and
Part B coinsurance after annual maximum has been spent.
$4620
$2310
*Effective 1/1/06, plans H, I, and J can no longer be sold with
prescription drug benefits. Plans F & J have a high deductible option - $2000.00 in 2009
** Plan K covers 100% of cost sharing for Medicare Part B preventive
services and 100% of all cost sharing under Medicare Parts A and
B for the balance of the calendar year once an individual has reached
the out-of-pocket limit on annual expenditures of $4,620 in 2009.
** Plan L covers 100% of cost sharing for Medicare Part B preventive
services and 100% of all cost sharing under Medicare Parts A and
B for the balance of the calendar year once an individual has reached
the out-of-pocket limit on annual expenditures of $2,310 in 2009.
*** See Medicare and You and choosing a Medigap Policy publications
for a detailed explanation of Medicare and Medigap Supplement policies.
