Zip Code* Age* Gender


Stonebridge Medicare Supplement Rates
Rates Effective
December 1, 2014
Plan A Plan F Plan G Plan N
Stonebridge $104.31 $178.61 $158.01 $135.83
Benefits Plan A Plan F Plan G 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
  1. 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
  2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
  3. You must also pay a separate deductible for foreign travel emergency ($250 per year).
  4. 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)
  5. 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.