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Your plan benefits coverage for what Medicare does not pay

Monthly Premium
Inpatient hospital deductible each benefit period
Copayment for days 61-90 in hospital
Copayment for days 91-150 in hospital
Additional 365 hospital days after Medicare hospital benefits end
Calendar year blood deductible
Copayment for days 21-100 in skilled nursing facility
Part B Deductible
20% of Part B coinsurance after deductible is met
Excess charges
At home recovery
Emergency care in a foreign country
Additional preventive care benefits
Plan C
$121.50
Plan G
$116.40
80%
Plan J
$117.20
100%

More Information
Review all of our Medi-Pak plans
Use our Plan Finder to find a plan
SilverSneakers®
When Should I Apply (Enrollment Guidelines)?
Call a Benefits Specialist

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.

The benefit information provided above is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information, contact a benefits specialist.



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