United of Omaha

Application (PDF) | Plan Description & Rate Sheet | Medicare and You | Choose Medigap

Medicare Supplement Rates

Rates effective 6/1/2010	Plan A	Plan F	Plan G	Plan M	Plan N
Male / 65yr / Non-tobacco / zip codes 970-972	$59.50	$86.81	$73.79	$69.02	$64.67
Female / 65yr / Non-tobacco / zip codes 970-972	$56.90	$82.46	$70.09	$65.56	$61.43
Male / 65yr / Tobacco / zip codes 970-972	$68.85	$99.78	$84.81	$79.33	$74.33
Female / 65yr / Tobacco / zip codes 970-972	$65.40	$94.79	$80.57	$75.35	$70.61
Male / 65yr / Non-tobacco / zip codes 973-979	$57.50	$83.34	$70.83	$66.25	$62.08
Female / 65yr / Non-tobacco / zip codes 973-979	$54.62	$79.16	$67.29	$62.93	$58.98
Male / 65yr / Tobacco / zip codes 973-979	$66.10	$95.79	$81.42	$76.15	$71.36
Female / 65yr / Tobacco / zip codes 973-979	$62.78	$90.99	$77.34	$72.34	$67.79
Benefits	Plan A	Plan F	Plan G	Plan M	Plan N
Medicare Part A Coinsurance and Hospital Benefits
Medicare Part A Deductible				50%
Medicare Part B Coinsurance or Co-payment					2
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)3
Medicare Preventive Care Part B Coinsurance
2010 out-of-pocket limit4

**** If you and the person you are living with on the same application, you are each eligible for a 7% discount from the normal rate/ If the person you are living with currently has a Mutual of Omaha plan, you are eligible for a 7% discount from the normal rate****

¹Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,000 in 2010) before your Medigap policy pays anything
²100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
³You must also pay a separate deductible for foreign travel emergency ($250 per year).
⁴After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010) the plan pays 100% of covered services for the rest of the calendar year