Plan A

Hospitalization Medical Expenses Blood Hospice

Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.

Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services.

First three pints of blood each year.

Part A coinsurance

*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Hospitalization Medicare Pays strong Plan Pays You Pay
Semiprivate room and board, general nursing and miscellaneous services and supplies   strong    
First 60 Days All but $1556 strong $0 $1556(Part A deductible)
61st thru 90th day All but $389 a day strong $389 a day $0
91st day and after: -While using 60 lifetime reserve days All but $778 a day strong $778 a day $0
Once lifetime reserve days are used: -Additional 365 days $0 strong 100% of Medicare eligible expenses $0**
-Beyond additional 365 days $0 strong $0 All costs
Skilled Nursing Facility Care Medicare Pays strong Plan Pays You Pay
You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving hospital   strong    
First 20 days All approved amounts strong $0 $0
21st thru 100th day All but $194.50 a day strong $0 Up to $194.50 a day
101st day and after $0 strong $0 All costs
Blood Medicare Pays strong Plan Pays You Pay
First 3 pints $0 strong 3 pints $0
Additional amounts 100% strong $0 $0
Hospice Care Medicare Pays strong Plan Pays You Pay
You must meet Medicare’s requirements, including a doctor’s certification of terminal illness All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care strong Medicare copayment/ coinsurance $0

*Once you have been billed $198 of Medicare approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

Medical Expenses Medicare Pays strong Plan Pays You Pay
IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment   strong    
First $233 of Medicare Approved Amounts $0 strong $0 $233 (Part B deductible)
Remainder of Medicare Approved Amounts Generally 80% strong Generally 20% $0
Part B Excess Charges Medicare Pays strong Plan Pays You Pay
(ABOVE MEDICARE APPROVED AMOUNTS) $0 strong $0 All costs
Blood Medicare Pays strong Plan Pays You Pay
First 3 pints $0 strong All costs $0
Next $198 of Medicare Approved Amounts* $0 strong $0 $233 (Part B deductible)
Remainder of Medicare Approved Amounts 80% strong 20% $0
Clinical Laboratory Services Medicare Pays strong Plan Pays You Pay
Tests For Diagnostic Services 100% strong $0 $0
Home Healthcare Medicare Pays strong Plan Pays You Pay
MEDICARE APPROVED SERVICES - Medically necessary skilled care services and medical supplies 100% strong $0 $0
Durable medical equipment - first $233 of Medicare Approved Amounts $0 strong $0 $233 (Part B deductible)
Remainder of Medicare Approved Amounts 80% strong 20% $0
** NOTICE: When your Medicare Part A hospital benefits are exhausted, the Plan stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

Medicare benefits are subject to change. Please consult the latest Choosing a Medigap 2022.

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  • Insured by Members Health Insurance Company, Columbia, TN.
  • Not connected with or endorsed by the U.S. or state government.
  • This is a solicitation of insurance. A representative of Members Health Insurance Company may contact you.
  • Benefits not provided for expenses incurred while coverage under the group policy/certificate is not in force, expenses payable by Medicare, non- Medicare eligible expenses or any Medicare deductible or copayment/coinsurance or other expenses not covered under the group policy/certificate.
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