Priority Health Medigap Plan N
For complete details of what this plan covers, read the Plan N certificate (85KB PDF).
This chart shows 2012 Original Medicare dollar amounts.
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*If you are in your Medigap Open Enrollment Period or have a Guaranteed Issue Right, your application can't be turned down and you will pay the lowest premium. If you are not, your application can be turned down for health reasons, or it may be accepted but at a higher monthly premium. See the Outline of Coverage for details.
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| Medicare Part A |
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Hospitalization: Coverage per benefit period for semi-private room and board, general nursing and miscellaneous services and supplies. | Original Medicare pays | Plan N pays | You pay |
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| 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 N pays | You pay |
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| 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 N 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 N pays | You pay |
|---|
| Hospice care |
100% |
Nothing |
Nothing |
| Outpatient prescription drugs |
All but $5 per prescription |
$5 per prescription |
Nothing |
| Inpatient respite care |
95% |
5% of Medicare-eligible expenses |
Nothing |
| Medicare Part B |
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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 N pays | You pay |
|---|
| First $140 of Medicare-approved amounts |
Nothing |
Nothing |
$140 (Part B deductible) |
| Remainder of Medicare-approved amounts after first $140 |
80% |
20% except up to a $20 copay per office visit and up to a $50 copay per emergency room visit |
Up to $20 copay per office visit Up to $50 copay per emergency room visit Emergency visit copay waived if you are admitted to any hospital (hospital visit covered as a Medicare Part A benefit) |
| Part B excess charges: Charges above Medicare-approved amounts |
Nothing |
Nothing |
All costs |
| Medicare preventive care | Original Medicare pays | Plan N pays | You pay |
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First $140 of Medicare-approved amounts when applicable
|
Nothing |
Nothing |
$140 (Part B deductible) |
Medicare-approved amounts when applicable after first $162
|
80%
|
20%
|
Nothing |
| Blood | Original Medicare pays | Plan N 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 N pays | You pay |
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| Tests for diagnostic services |
100% |
Nothing |
Nothing |
| Medicare Parts A & B |
|---|
| Home health care: Medicare-approved services | Original Medicare pays | Plan N pays | You pay |
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| 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 |
Nothing |
$140 (Part B deductible) |
| Remainder of Medicare-approved amounts for durable medical equipment |
80% |
20% |
Nothing |
| Other benefits: Services not covered by Medicare |
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| Foreign travel: Emergency care services beginning during the first 60 days of each trip outside the U.S. | Original Medicare pays | Plan N pays | You pay |
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| $250 foreign travel deductible that must be met once each calendar year |
Nothing |
Nothing |
$250 |
| Remainder of charges up to a lifetime maximum of $50,000 (member pays all amounts over $50,000) |
Nothing |
80% |
20% |
**When you exhaust your Medicare Part A benefits, Priority Health then pays whatever amount Medicare would have paid for, for an additional 365 days. During this time the hospital can't bill you for any difference between its billed charges and the amount Medicare would have paid.
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 plan details for the PriorityMedicare Rx plan.
