Plan C

 

CLICK ON ANY MEDICARE SUPPLEMENT PLAN TO SEE THE FULL OUTLINE OF COVERAGE…

A
B
C
D
F
G
K
L
M
N

 

PLAN C

Medicare (Part A) — Hospital Services — Per Benefit Period*

SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and suppliesFirst 60 days All but $1,156 $1,156 (Part A deductible) $0
61st through 90th day All but $289 a day $289 a day $0
91st day and after: While using 60 lifetime reserve days All but $578 a day $578 a day $0
Once lifetime reserve days are used — Additional 365 days $0 100% of Medicare eligible expenses $0**
Beyond the additional 365 days $0 $0 All costs
SKILLED NURSING FACILITY CARE* You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare Approved facility within 30 days after leaving the hospitalFirst 20 days All approved amounts $0 $0
21st through 100th day All but $144.50 a day Up to $144.50 a day $0
101st day and after $0 $0 All costs
BLOOD First three pints $0 3 pints $0
Additional amounts 100% $0 $0
HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness. All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance $0

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

 

Medicare (Part B) — Medical Services — Per Calendar Year

SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
MEDICAL EXPENSES — IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT Such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipmentFirst $140 of Medicare Approved Amounts*** $0 $140 (Part B Deductible) $0
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
PART B EXCESS CHARGES (Above Medicare Approved Amounts) $0 $0 All costs
BLOOD First three pints $0 All costs $0
Next $140 of Medicare Approved Amounts*** $0 $140 (Part A Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0
CLINICAL LABORATORY SERVICES Tests for Diagnostic Services 100% $0 $0

 

Medicare Parts A and B

HOME HEALTH CARE MEDICARE APPROVED SERVICES Medically necessary skilled care services and medical supplies 100% $0 $0
Durable medical equipmentFirst $140 of Medicare Approved Amounts*** $0 $140 (Part B Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0

 

Other Benefits Not Covered By Medicare

FOREIGN TRAVEL — NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

*** Once you have been billed $140 of Medicare Approved amounts for covered services your Part B Deductible will have been met for the calendar year.