| Rates Effective November 1, 2012 |
Plan A | Plan F | Plan G | Plan N |
|---|---|---|---|---|
| UCT | $138.25 | $202.51 | $168.61 | $141.76 |
| Benefits | Plan A | Plan F | Plan G | Plan N |
| Medicare Part A Coinsurance and Hospital Benefits |
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| Medicare Part A Deductible | — |
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| Medicare Part B Coinsurance or Co-payment |
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| Medicare Part B Deductible | — |
|
— | — |
| Medicare Part B Excess Charges | — |
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— |
| Blood (First Three Pints) |
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| Hospice Care Coinsurance or Co-payment |
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| Skilled Nursing Coinsurance | — |
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| Foreign Travel Emergency (Up to Plan Limits) | — |
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| Medicare Preventive Care Part B Coinsurance |
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- Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,110 in 2013) 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 2013) 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)
- 2013 Out of Pocket Limit for Plan K is $4,800.
- 2013 Out of Pocket Limit for Plan L is $2,400.
