Priority Health 2010 Medigap Plan F
The Medigap (Medicare Supplement insurance) Plan F benefits shown below apply if your plan's effective date (the starting date of your coverage) was between January 1 and May 31, 2010. If your effective date was on or after June 1, 2010, your plan is different. See those plans.
For complete details of what this plan covers, read the Plan F certificate (293KB PDF).
This chart shows 2012 Original Medicare dollar amounts.
| Medicare Part A benefits |
|---|
Hospitalization:
Coverage per benefit period for semi-private room and board, general nursing and miscellaneous services and supplies. |
Original Medicare pays |
Plan F pays |
You pay |
| First 60 days |
All but $1,156 |
$1,156 (Part A deductible) |
Nothing |
| Days 61-90 |
All but $289 a day |
$289 a day |
Nothing |
Day 91 and after (while using 60 lifetime reserve days)
|
All but $578 a day |
$578 a day |
Nothing |
| Once lifetime reserve days are used, additional 365 days |
Nothing |
100% of Medicare-eligible expenses |
Nothing |
| Beyond the additional 365 days |
Nothing |
Nothing |
All costs |
Skilled nursing facility care:
Coverage per benefit period. 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 the hospital. |
Original Medicare pays |
Plan F pays |
You pay |
| First 20 days |
All approved amounts |
Nothing |
Nothing |
| Days 21-100 |
All but $144.50 a day |
Up to $144.50 a day |
Nothing |
| Day 101 and after |
Nothing |
Nothing |
All costs |
| Blood |
Original Medicare pays |
Plan F pays |
You pay |
| First 3 pints |
Nothing |
100% |
Nothing |
Additional blood after first 3 pints
|
100% |
Nothing |
Nothing |
Hospice care:
Available as long as your doctor certifies you are terminally ill and you elect to receive these services. |
Original Medicare pays |
Plan F pays |
You pay |
| Hospice care |
All but very limited coinsurance for outpatient drugs and inpatient respite care |
Nothing |
Balance |
| Medicare Part B benefits |
|---|
Physician and outpatient services:
You must meet your Part B deductible once each calendar year (Jan. 1 - Dec. 31). Once you have been billed $140 in Medicare-approved amounts for covered services, you have met your Part B deductible for the calendar year.
Medical expenses: 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. |
Original Medicare pays |
Plan F pays |
You pay |
First $140 of Medicare-approved amounts
|
Nothing |
$140 (Part B deductible) |
Nothing |
| Remainder of Medicare-approved amounts after first $140 |
80% |
20% |
Nothing |
| Part B excess charges: Charges above Medicare-approved amounts |
Nothing |
100% |
Nothing |
| Medicare preventive care |
Original Medicare pays |
Plan F pays |
You pay |
| First $140 of Medicare-approved amounts when applicable |
Nothing |
$140 (Part B deductible) |
Nothing |
| Medicare-approved amounts when applicable after first $140 |
80% |
20% |
Nothing |
| Blood |
Original Medicare pays |
Plan F pays |
You pay |
First 3 pints
|
Nothing |
100% |
Nothing |
Next $140 of Medicare-approved amounts (Part B deductible)
|
Nothing |
Nothing |
$140 (Part B deductible) |
| Remainder of Medicare-approved amounts |
80% |
20% |
Nothing |
| Clinical laboratory services |
Original Medicare pays |
Plan F pays |
You pay |
| Tests for diagnostic services |
100% |
Nothing |
Nothing |
| Medicare Parts A & B benefits |
|---|
Home health care:
Medicare-approved services |
Original Medicare pays |
Plan F pays |
You pay |
| Medically necessary skilled care services and medical supplies |
100% |
Nothing |
Nothing |
First $140 of Medicare-approved amounts for durable medical equipment (Part B deductible)
|
Nothing |
$140 (Part B deductible) |
Nothing |
| Remainder of Medicare-approved amounts |
80% |
20% |
Nothing |
| Other benefits: Services not covered by Medicare |
|---|
| Foreign travel |
Original Medicare pays |
Plan F pays |
You pay |
| Emergency care received outside the U.S. |
Nothing |
80% of the lifetime maximum of $50,000, after you pay your $250 deductible |
$250 deductible, then 20% of the lifetime maximum of $50,000; then 100% of amounts over $50,000
|
Add prescription drug coverage
Original Medicare and Medigap plans don't cover prescription drug costs. You may want to add PriorityMedicare Rx, which would give you Medicare Part D prescription drug benefits.
Go to prioritymedicare.com for plan details for the PriorityMedicare Rx plan.
