Priority Health Pre-2010 Medigap Plan F

The Medigap Plan F benefits shown below apply if your plan's effective date was between January 1 and May 31, 2010. If your effective date was on or after June 1, 2010, your plan is different. See that plan.

For complete details of what this plan covers, read the Plan F certificate (PDF). 


Annual changes

The chart below shows 2016 Original Medicare dollar amounts. These amounts change every year on Jan. 1.

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 $1,288
Original Medicare pays
$1,288
Plan F Pre-2010 pays
Nothing
You pay

Part A deductible is $1,288.

Days 61-90

All but $322 a day
Original Medicare pays
$322 a day
Plan F Pre-2010 pays
Nothing
You pay

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

All but $644 a day
Original Medicare pays
$644 a day
Plan F Pre-2010 pays
Nothing
You pay

Once lifetime reserve days are used, additional 365 days

Nothing
Original Medicare pays
100%
Plan F Pre-2010 pays
Nothing
You pay

Plan A pays 100% of Medicare-eligible expenses.

Beyond the additional 365 days

Nothing
Original Medicare pays
Nothing
Plan F Pre-2010 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 F Pre-2010 pays
Nothing
You pay

Days 21-100

All but $161 a day
Original Medicare pays
Up to $161 a day
Plan F Pre-2010 pays
Nothing
You pay

Day 101 and after

Nothing
Original Medicare pays
Nothing
Plan F Pre-2010 pays
All costs
You pay

Blood

First 3 pints

Nothing
Original Medicare pays
100%
Plan F Pre-2010 pays
Nothing
You pay

Additional blood after first 3 pints

100%
Original Medicare pays
Nothing
Plan F Pre-2010 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

All but very limited coinsurance

Original Medicare pays
Nothing
Plan F Pre-2010 pays
Balance
You pay

Original Medicare pays all, but a very limited coinsurance for outpatient drugs and inpatient respite care.

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 $166 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 $166 of Medicare-approved amounts

Nothing
Original Medicare pays
$166
Plan F Pre-2010 pays
Nothing
You pay

Part B deductible is $166.

Remainder of Medicare-approved amounts after first $166

80%
Original Medicare pays
20%
Plan F Pre-2010 pays
Nothing
You pay

Part B excess charges: Charges above Medicare-approved amounts

Nothing
Original Medicare pays
100%
Plan F Pre-2010 pays
Nothing
You pay

Medicare preventive care

First $166 of Medicare-approved amounts when applicable

Nothing
Original Medicare pays
$166
Plan F Pre-2010 pays
Nothing
You pay

Part B deductible is $166.

Medicare approved amounts (after deductible is met) when applicable)

80%
Original Medicare pays
20%
Plan F Pre-2010 pays
Nothing
You pay

Blood

First 3 pints

Nothing
Original Medicare pays
100%
Plan F Pre-2010 pays
Nothing
You pay

Next $166 of Medicare-approved amounts (Part B deductible)

Nothing
Original Medicare pays
$166
Plan F Pre-2010 pays
Nothing
You pay

Part B deductible is $166.

Remainder of Medicare-approved amounts

80%
Original Medicare pays
20%
Plan F Pre-2010 pays
Nothing
You pay

Clinical laboratory services

Tests for diagnostic services

100%
Original Medicare pays
Nothing
Plan F Pre-2010 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 F Pre-2010 pays
Nothing
You pay

First $166 of Medicare-approved amounts for durable medical equipment

Nothing
Original Medicare pays
$166
Plan F Pre-2010 pays
Nothing
You pay

Part B deductible is $166.

Remainder of Medicare-approved amounts for durable medical equipment

80%
Original Medicare pays
20%
Plan F Pre-2010 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.

Emergency care received outside the U.S.

Nothing
Original Medicare pays
80%
Plan F Pre-2010 pays
$250
You pay

Plan A pays 80% of the lifetime maximum of $50,000, after you pay your $250 deductible.
You pay your $250 deductible, then 20% of the lifetime maximum of $50,000; then 100% of amounts over $50,000.