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Review our plans for:
ZIP code , County
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Your plan benefits coverage for what Medicare does not pay
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With Plan A,
You Pay
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With Plan F,
You Pay
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With Plan G,
You Pay
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With Plan N,
You Pay
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Monthly Premium
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$91.50
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$122.80
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$111.30
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$92.00
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Inpatient hospital deductible each benefit period
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Inpatient hospital deductible
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$0
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$0
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$0
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Copayment for days 61-90 in hospital
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$0
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$0
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$0
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$0
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Copayment for days 91-150 in hospital
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$0
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$0
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$0
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$0
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Additional 365 days after Medicare hospital benefits end
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$0
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$0
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$0
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$0
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Calendar year blood deductible
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$0
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$0
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$0
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$0
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Hospice care
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$0
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$0
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$0
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$0
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Days 21-100 in a skilled nursing facility
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Copayments
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$0
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$0
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$0
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Part B Deductible
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Part B
Deductible
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$0
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Part B
Deductible
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Part B
Deductible
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Part B
coinsurance for:
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Health care provider visits
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$0
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$0
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$0
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Lesser of a
$20 copayment
or the Part B coinsurance
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Emergency room visits
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$0
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$0
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$0
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Lesser of a
$50 copayment
or the Part B coinsurance
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All other Part B services
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$0
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$0
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$0
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$0
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Excess charges
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100%
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$0
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$0
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100%
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Emergency care in a foreign country*
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100%
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$250 deductible
then 20%
coinsurance
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$250 deductible
then 20%
coinsurance
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$250 deductible
then 20%
coinsurance
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SilverSneakers®
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$0
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$0
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$0
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$0
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*$50,000 lifetime maximum applies.
Prescription drug plans are not covered under Medi-Pak®. If you would like to learn more about our Medicare Part D prescription drug plan, view Medi-Pak Rx (PDP)® options.
Medicare enrollees with Medi-Pak® coverage may receive services from any provider that participates with Medicare.
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The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is an advertisement; for more information, contact a benefits specialist.
Web Page Last Updated: 8/30/2011
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