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Medicare

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). With Medicare, you have options in how you get your coverage.

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WHAT IS MEDICARE?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

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MEDICARE PART A (HOSPITAL INSURANCE)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

MEDICARE PART B (MEDICAL INSURANCE)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

MEDICARE PART C (MEDICARE ADVANTAGE PLANS)

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

MEDICARE PART D (PRESCRIPTION DRUG COVERAGE)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

MEDICARE SUPPLEMENT PLANS F AND G

Protection against high out-of-pocket costs

Plans F and G are the only Medicare Supplement insurance plans that cover costs known as Medicare Part B excess charges. An excess charge is the difference between what a doctor or provider charges and the amount Medicare will pay. These plans will help protect you from additional out-of-pocket expenses should you need treatment that exceeds what Medicare will approve. Plan F also has a high-deductible option*. Plans F and G cover 100% of the Medicare Part B excess charges.

MEDICARE SUPPLEMENT PLAN F

With Medicare Supplement Plan F, you get the most complete coverage available. Because the plan covers costs in excess of Medicare-approved amounts, you may have no out-of-pocket costs for hospital and doctor’s office care with this plan.

Medicare Supplement Plan F covers:

Basic Medicare benefits including

Hospitalization: pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
Medical Expenses: pays Part B coinsurance — generally 20% of Medicare-approved expenses — or copayments for hospital outpatient services
Blood: pays for the first three pints of blood each year
Hospice care: pays Part A coinsurance

In addition to the basic benefits, Plan F also provides coverage for:

Skilled nursing facility care
Medicare Part A deductible for hospitalization
Medicare Part B deductible for medical and hospital outpatient expenses
Medicare Part B excess charges (this is the difference between what a doctor or provider charges and the amount Medicare will pay up to Medicare’s limiting amount)
Travel-abroad medical emergency help

*Plan F also has a high-deductible option. If you choose the high-deductible option on Medicare Supplement Plan F, you have to pay a deductible of ${Amount} for {Year} before the plan pays anything. This amount can go up each year. High-deductible policies have lower premiums, but if you become sick, you’ll have higher out-of-pocket costs. Depending on where you live, you may be eligible for Medicare Select Plan F.

MEDICARE SUPPLEMENT PLAN G

Available from Humana only in Connecticut, Medicare Supplement Plan G is a good fit for people who want some coverage for hospitalization, but are willing to pay the Part B deductible on their own.

Medicare Supplement Plan G covers:

Basic Medicare benefits including

Hospitalization: pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
Medical Expenses: pays Part B coinsurance — generally 20% of Medicare-approved expenses — or co-payments for hospital outpatient services
Blood: pays for the first three pints of blood each year
Hospice: pays Part A coinsurance

In addition to the basic benefits, Plan G also provides coverage for:

Skilled nursing facility care
Medicare Part A deductible for hospitalization
Medicare Part B excess charges — 100% (this is the difference between what a doctor or provider charges and the amount Medicare will pay)
Travel-abroad medical emergency help

MEDICARE SUPPLEMENT PLANS K, L AND N

Help manage your expenses
Plans K, L and N offer the same basic benefits as other Medicare Supplement insurance plans, but provide you with a lower monthly premium. In exchange for a lower premium, these cost-sharing plans cover less of the coinsurance and copayments than other Medicare Supplement insurance plans. Plans K and L do offer an out-of-pocket maximum, which limits the amount you will have to pay each year.

In general, Plan K offers a lower monthly premium than Plan L, but offers higher coinsurance amounts and a higher annual out-of-pocket limit.

MEDICARE SUPPLEMENT PLAN K

With Medicare Supplement Plan K, the plan covers services similar to other Medicare Supplement insurance policies. However, instead of paying all your costs, the plan pays a percentage. If you have a serious illness or injury, you have the protection of an out-of-pocket annual limit. Once you reach this “cap” on your out-of-pocket costs, the plan pays 100% of Medicare-approved costs for the rest of the year. This plan is a good option if you prefer a lower premium but still want a fair amount of coverage for a wide variety of services.

Medicare Supplement Plan K coverage:

100% coverage for Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end
50% Hospice coverage for Part A coinsurance
50% of Medicare-eligible expenses for the first three pints of blood
50% Part B coinsurance, except for preventive care services, which are covered 100%

In addition to the basic benefits, Plan K also provides coverage for:

50% coverage for Skilled Nursing Facility coinsurance
50% coverage for your Medicare Part A deductibles
${Amount} out-of-pocket annual limit (the out-of-pocket annual limit will increase each year for inflation)

MEDICARE SUPPLEMENT PLAN L

Medicare Supplement Plan L is another option if you want a Medicare Supplement insurance policy with an affordable premium, but still want a reasonable amount of coverage for a wide variety of services.

This plan is similar to Plan K, except it:

Covers a higher percentage of your costs
Offers a lower annual out-of-pocket amount and out-of-pocket limit
Has a slightly higher monthly premium
Medicare Supplement Plan L covers:
100% coverage for Part A hospitalization coinsurance, plus coverage for 365 days after Medicare benefits end
75% Hospice coverage for Part A coinsurance
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%

In addition to the basic benefits, Plan L also provides coverage for:
75% coverage for Skilled Nursing Facility coinsurance
75% coverage for your Medicare Part A deductibles
${Amount} out-of-pocket annual limit(the out-of-pocket annual limit will increase each year for inflation)

MEDICARE SUPPLEMENT PLAN N

Medicare Supplement Plan N provides more coverage than Plans K and L while still maintaining a lower premium than Plans A through G. The only out-of-pocket expenses incurred (after the plan’s monthly premium) are a $20 copay for office visits and a $50 copay for ER.

Plan N covers basic Medicare benefits including

Hospitalization: pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
Medical Expenses: pays Part B coinsurance excluding $20 copay for office visits and $50 copay for ER — generally 20% of Medicare-approved expenses — or copayments for hospital outpatient services
Blood: pays for the first three pints of blood each year
Hospice: pays Part A coinsurance

In addition to the basic benefits, Plan N also provides coverage for:
Skilled nursing facility care
Medicare Part A deductible for hospitalization
Travel-abroad medical emergency help

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