Medicare Supplement Plans

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Standardized Medicare Supplement Plans for Most States (excluding MA, MN, and WI)

Every company offering Medicare Supplement insurance must offer Plan A. In addition, companies may have some, all, or none of the other plans.

Basic Benefits - Included in all plans:

Inpatient Hospital Care: Covers the cost of Part A coinsurance and the cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends.

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.

Options	A	B	C	D	E	F*	G	H	I	J*
Basic Benefits
Part A: Inpatient Hospital Deductible
Part A: Skilled-Nursing Facility Coinsurance
Part B: Deductible
Foreign Travel Emergency
At-Home Recovery
Part B: Excess Charges						100%	80%		100%	100%
Preventive Care

* Plans F and J also have a high deductible option. If you choose this option, in 2009 you must pay $2,000 out-of-pocket per year before the plans pay anything. Insurance policies with a high deductible option generally cost less than those with lower deductibles. Your out-of-pocket costs for services may be higher if you need to see your doctor or go to the hospital.

BASIC BENEFITS: Basic Benefits for Plans K and L include similar services as Plans A through J, but cost sharing for the basic benefits is at different levels.

	K**	L**
Basic Benefits	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 50% Hospice cost-sharing 50% of Medicare eligible expenses for the first three pints of Blood 50% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 75% Hospice cost-sharing 75% of Medicare eligible expenses for the first three pints of Blood 75% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services
Skilled Nursing Coinsurance	50% Skilled Nursing Facility Coinsurance	75% Skilled Nursing Facility Coinsurance
Part A Deductible	50% Part A Deductible	75% Part A Deductible
Part B Deductible
Part B Excess (100%)
Foreign Travel Emergency
At-Home Recovery
Preventive Care NOT Covered by Medicare
	$4,620 Out of Pocket Annual Limit (2009) ***	$2,310 Out of Pocket Annual Limit (2009) ***

**Plans K and L provide for different cost-sharing for items and services than Plans A through 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.