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Medicare Main Page

Medicare & You 2010

What Medicare Covers

Choosing a Medigap Policy 2010

Agent John T. Allen, CLU, Texas License # 1283089

Texas 2010 Monthly Rates

Company Plan Plan Plan Plan Plan Plan Plan Plan
A B C D F G M N*
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What Each Plan Covers

Benefits A B C D F G M N*
Home Health Care Yes Yes Yes Yes Yes Yes Yes Yes
Part A Coinsurance Yes Yes Yes Yes Yes Yes Yes Yes
Part B Coinsurance Yes Yes Yes Yes Yes Yes Yes Yes
365 Extra Hospital Days Yes Yes Yes Yes Yes Yes Yes Yes
3 Pints of Blood Yes Yes Yes Yes Yes Yes Yes Yes
Part A Deductible   Yes Yes Yes Yes Yes 50% Yes
Part B Deductible     Yes   Yes      
Part B Excess Charges         Yes Yes    
Foreign Travel Emergency     Yes Yes Yes Yes Yes Yes
Skilled Nursing Coinsurance     Yes Yes Yes Yes Yes Yes

Click here for more information = More information - single click 
Click here for more information  = Company brochure

Yes = Benefit is Covered

*Plan "N" has a Dr. visit Copay of up to $20 per visit and an emergency room Copay of $50 per visit.

Rates are subject to change. Actual rate will be determined upon acceptance into the program based upon eligibility criteria and your medical conditions, if applicable. All policies have a 30 day free look provision from the day  you receive your policy.

Standard Medicare Supplement Benefits

These charts show the benefits included in each of the standard Medicare supplement plans. Every company must make available Plan "A". Some plans may not be available in your state. See Outlines of Coverage sections for details about ALL plans. Plans E, H, I, and J are no longer available for sale.

Basic Benefits are included in all plans. They include:

  • Hospitalization, Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits end.
  • Medical Expenses, Part B coinsurance generally (20% of Medicare approved expenses) or copayments for hospital outpatient services. Plans K, L, and N require insured's to pay a portion of Part B coinsurance or copayments.
  • Blood, first three pints of blood each year.
  • Hospice: Part a coinsurance
A B C D F* G K L M N
Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance* Basic including 100% Part B co-insurance Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Hospitalization and preventive care paid at 100%; other basic benefits paid at 75% Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance, except up to $20 copayment for office visit, and up to $50 copayment for ER
    Skilled Nursing Coinsurance Skilled Nursing Coinsurance Skilled Nursing Coinsurance Skilled Nursing Coinsurance 50% Skilled Nursing Coinsurance 75% Skilled Nursing Coinsurance Skilled Nursing Coinsurance Skilled Nursing Coinsurance
  Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible 50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A Deductible
    Part B Deductible   Part B Deductible          
        Part B Excess Part B Excess        
    Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency     Foreign Travel Emergency Foreign Travel Emergency
              Out-of-pocket limit $4,620; paid at 100% after limit reached Out-of-pocket limit $2,310; paid at 100% after limit reached  

* Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year of $2,000 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy/certificate. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plans' separate foreign travel emergency deductible.


Standard Medicare Supplement Benefits

The basic benefits (also known as the "core benefits" or Plan A) are the minimum coverage you may buy. These are the only benefits in Plan A. Every other plan contains these three benefits as the "core" and then adds one or more additional benefits.

  1. Hospitalization: Medicare Part A pays for hospitalizations for the first 60 days, but only pays a portion of the daily costs from the 61st day through the 150th day. You must pay the coinsurance amounts for those days. This Medicare Supplement benefit pays the coinsurance amount and an additional 365 lifetime days.
  2. Blood: Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year. This Medicare Supplement benefit pays for the first three pints of blood not paid for by Medicare.
  3. Medical Expenses: Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. This Medicare Supplement benefit pays the coinsurance generally (20% of the "Medicare approved" amount) under Medicare Part B.
Note: Plan A contains only these 3 core benefits.  Although Plan A is the least expensive policy, it may not be a good choice for low-income individuals who may not be able to afford the Medicare Part A hospital deductible when they are hospitalized.

There are eight additional benefits that are combined with the basic benefits in various ways to make up the nine remaining plans called Plan B, C, D, F, G, K, L, M and N.

  1. The Part A Deductible: The Medicare Part A deductible is the expense for which you are obligated to pay when you are admitted to a hospital as an inpatient. Medicare pays eligible benefits above that amount. (The Medicare Part A deductible amount may change yearly, so check the current handbook1). This Medicare Supplement benefit reimburses you the deductible amount, no matter what the amount may be. This benefit is included in Plans B through J.
  2. Skilled Nursing Coinsurance: Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization, but requires you to pay a coinsurance beginning on the 21st day through the 100th day. This Medicare Supplement benefit pays the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through J.
  3. Part B Deductible: The Medicare Part B deductible is the amount you must pay each year for medical expenses (such as doctor fees) before Medicare begins paying. (The Part B deductible amount may change per year). This Medicare Supplement benefit reimburses you the deductible amount. This benefit is included in Plan C, Plan F, and Plan J.
  4. Part B Excess Charges: Medicare Part B pays 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure performed by your doctor or other medical care provider. If your doctor accepts Medicare "assignment", the provider may only bill you for the difference between the amount paid by Medicare and the amount approved by Medicare.

If your doctors do not accept Medicare assignment, they may bill you for the difference between the amount paid by Medicare and the amount they can legally charge you (called the "limiting charge"). If you have a Medicare Supplement Policy with the following:

  • Part B Excess Charges (100%) benefit, the policy will pay the full amount billed by your doctors or other providers who do not take Medicare assignment subject to the limiting charge. This benefit is included in Plan F & G.

(Remember that this coinsurance amount is paid by the Medical Expenses part of the Basic Benefits that are part of every Medicare Supplement insurance policy).

  1. Foreign Travel Emergency: The original Medicare plan does not pay for medical care outside of the United States, but some Medicare mantxtAge1d care plans, private Fee-for-Service plans, and some Medicare Supplement plans do. This Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care in a foreign country during the first 60 days of a trip abroad after you pay a $250 deductible. There is a lifetime maximum benefit, so check your current handbook1 for the dollar amount. This benefit is in Plan C, D, F, G, M & N. Check your insurance coverage before you travel.

1 Current handbook on Medicare is available from your local Social Security office or by calling the Social Security Administration toll-free at 800-633-4227 or via the website at http://www.medicare.gov/.

 

NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the Medicare plan's underwriting guidelines.

IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Allen Insurance Agency is not employed by, connected with or endorsed by the State Department of Insurance, United States Government or the Federal Medicare program

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