January 1, 2014
|Plan A||Plan F||Plan F High Ded||Plan N|
|Premera Blue Cross||$136.00||$170.00||$70.00||$134.00|
|Benefits||Plan A||Plan F||Plan F High Ded||Plan N|
|Medicare Part A Coinsurance and Hospital Benefits|
|Medicare Part A Deductible||—|
|Medicare Part B Coinsurance or Co-payment|
|Medicare Part B Deductible||—||—|
|Medicare Part B Excess Charges||—||—|
|Blood (First Three Pints)|
|Hospice Care Coinsurance or Co-payment|
|Skilled Nursing Coinsurance||—|
|Foreign Travel Emergency (Up to Plan Limits)||—|
|Medicare Preventive Care Part B Coinsurance|
- Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,180 in 2015) before your Medigap policy pays anything
- 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
- You must also pay a separate deductible for foreign travel emergency ($250 per year).
- After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)
- Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)
- 2015 Out of Pocket Limit for Plan K is $4,940.
- 2015 Out of Pocket Limit for Plan L is $2,470.