Medigap Plan A Policy

• Basic Benefits,
  as listed above.
   
  
  Medigap Plan B Policy
   
• Basic Benefits
• Medicare Part A Deductible
   

  Medigap Plan C Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Medicare Part B Deductible
• Foreign Travel Emergency
   

  Medigap Plan D Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Foreign Travel Emergency
• At-Home Recovery
   

  Medigap Plan E Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Foreign Travel Emergency
• Preventive Care
   

  Medigap Plan F Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Medicare Part B Deductible
• Medicare Part B Excess (100%)
• Foreign Travel Emergency
   
• Note:
  Plan F has a high deductible option.
   

  Smart Choice Plan F (covered under $1,620 Deductible)

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Medicare Part B Deductible
• Medicare Part B Excess (100%)
• Coinsurance for Parts A & B
• Foreign Travel Emergency
  Coinsurance Amount
  ($250 Deductible not eligible)
   
   
  Medigap Plan G Policy
   
• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Medicare Part B Excess (80%)
• Foreign Travel Emergency
• At-Home Recovery

  Medigap Plan H Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Foreign Travel Emergency
• Basic Drug Benefit 
  ($1,250 limit)

  Medigap Plan I Policy

• Basic Benefits
• Skilled Nursing Coinsurance
• Medicare Part A Deductible
• Medicare Part B Excess (100%)
• foreign Travel Emergency
• At-Home Recovery
• Basic Drug Benefit ($1,250 Limit)

  Medigap Plan J Policy

• Basic Benefits
• Medicare Part A Deductible
• Medicare Part B Deductible
• Medicare Part B Excess (100%)
• Foreign Travel Emergency
• At-Home Recovery
• Extended Drug Benefit ($3,000 Limit)
• Preventive Care
   
• Note:
  Plan J has a high deductible option.
  
  Medigap Plan K Policy
  
• 100% coverage for Part A Hospitalization coinsurance plus coverage for 365 days after Medicare benefits end. 
• 50% Hospice out-of-pocket cost sharing.
• 50% of Medicare-eligible expenses for the 1st 3 pints of blood. 
• 50% Part B coinsurance, except for preventive care services, which are 100%. 
• 50% Skilled Nursing Facility coinsurance. 
• 50% Medicare Part A deductibles.
• $4,621 out-of-pocket annual limit (increases each year for inflation). 

          Medigap Plan L Policy

• 100% coverage for Part A Coinsurance and Medigap coverage for hospital benefits.
• 75% Hospice out-of-pocket cost sharing. 
• 75% of Medicare-eligible expenses for the first three pints of blood. 
• 75% Part B coinsurance, except for preventive care services, which are covered 100%. 
• 75% Skilled Nursing Facility
  coinsurance. 
• 75% Medicare Part A deductibles. 
• $2,310 out of pocket annual limit (increases each year for inflation). 

 

 

 


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