Priority Health Medigap Plan D

Medigap Plan D is Medicare supplement insurance. It helps pay almost all the health care costs of your basic Original Medicare benefits, except for the Medicare Part B deductible and excess charges. Emergency care is covered anywhere you travel worldwide.

The chart below shows what Original Medicare pays, what this plan pays and what you'll pay in 2019. The amount Original Medicare pays changes every year on Jan. 1. Benefits paid by Medigap plans will automatically change when Original Medicare coverage changes.

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Medicare Part A

Hospitalization

Coverage per benefit period for semi-private room and board, general nursing and miscellaneous services and supplies.

First 60 days

All but $1,364
Original Medicare pays
$1,364
Plan D pays
Nothing
You pay

Part A deductible is $1,364.

Days 61-90

All but $341 a day
Original Medicare pays
$341 a day
Plan D pays
Nothing
You pay

Day 91 and after (while using 60 lifetime reserve days)

All but $682 a day
Original Medicare pays
$682 a day
Plan D pays
Nothing
You pay

Once lifetime reserve days are used, additional 365 days

Nothing
Original Medicare pays
100%
Plan D pays
Nothing
You pay

Plan D pays 100% of Medicare-eligible expenses.

Beyond the additional 365 days

Nothing
Original Medicare pays
Nothing
Plan D pays
All costs
You pay

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.

First 20 days

All approved amounts
Original Medicare pays
Nothing
Plan D pays
Nothing
You pay

Days 21-100

All but $170.50 a day
Original Medicare pays
Up to $170.50 a day
Plan D pays
Nothing
You pay

Day 101 and after

Nothing
Original Medicare pays
Nothing
Plan D pays
All costs
You pay

First 3 pints

Nothing
Original Medicare pays
100%
Plan D pays
Nothing
You pay

Additional blood after first 3 pints

100%
Original Medicare pays
Nothing
Plan D pays
Nothing
You pay

Hospice

Available as long as your doctor certifies you are terminally ill and you elect to receive these services

Hospice care

100%
Original Medicare pays
Nothing
Plan D pays
Nothing
You pay

Outpatient prescription drugs

All but $5 per prescription
Original Medicare pays
$5 per prescription
Plan D pays
Nothing
You pay

Inpatient respite care

95%
Original Medicare pays
5%
Plan D pays
Nothing
You pay

Plan D pays 5% of Medicare-eligible expenses.

Medicare Part B

Physician and outpatient services

You must meet your Part B deductible once each calendar year (Jan. 1 - Dec. 31). Once you have been billed $185 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.

First $185 of Medicare-approved amounts

Nothing
Original Medicare pays
Nothing
Plan D pays
$185
You pay

Part B deductible is $185.

Remainder of Medicare-approved amounts after first $185

80%
Original Medicare pays
20%
Plan D pays
Nothing
You pay

Part B excess charges: Charges above Medicare-approved amounts

Nothing
Original Medicare pays
Nothing
Plan D pays
All costs
You pay

Medicare preventive care

First $185 of Medicare-approved amounts when applicable

Nothing
Original Medicare pays
Nothing
Plan D pays
$185
You pay

Part B deductible is $185.

Medicare approved amounts (after deductible is met) when applicable

80%
Original Medicare pays
20%
Plan D pays
Nothing
You pay

Blood

First 3 pints

Nothing
Original Medicare pays
100%
Plan D pays
Nothing
You pay

Next $185 of Medicare-approved amounts (Part B deductible)

Nothing
Original Medicare pays
Nothing
Plan D pays
$185
You pay

Part B deductible is $185.

Remainder of Medicare-approved amounts

80%
Original Medicare pays
20%
Plan D pays
Nothing
You pay

Clinical laboratory services

Tests for diagnostic services

100%
Original Medicare pays
Nothing
Plan D pays
Nothing
You pay

Medicare Parts A & B

Home health care

Medicare-approved services

Medically necessary skilled care services and medical supplies

100%
Original Medicare pays
Nothing
Plan D pays
Nothing
You pay

First $185 of Medicare-approved amounts for durable medical equipment

Nothing
Original Medicare pays
Nothing
Plan D pays
$185
You pay

Part B deductible is $185.

Remainder of Medicare-approved amounts for durable medical equipment

80%
Original Medicare pays
20%
Plan D pays
Nothing
You pay

Other benefits: Services not covered by Medicare

Foreign travel

Emergency care services beginning during the first 60 days of each trip outside the U.S.

$250 Foreign travel deductible that must be met once each calendar year

Nothing
Original Medicare pays
Nothing
Plan D pays
$250
You pay

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.