Medi-Pak Plan G
Plan costs
Premium $165.80 monthly
Benefits
Coverage Overview | |
---|---|
Rating Method | Community Rated |
Basic Benefit Amount You Pay | |
---|---|
Hospitalization - Medicare Part A coinsurance (up to an additional 365 days after Medicare benefits are used) | You pay $0 |
Medical Expenses - Part B coinsurance or copay | You pay $0 |
Blood - first three pints each year | You pay $0 |
Hospice - Part A coinsurance or copay | You pay $0 |
Skilled Nursing Facility (SNF) coinsurance | You pay $0 |
Medicare Part A Deductible ($1,556 in 2022) | You pay $0 |
Medicare Part B Deductible ($233 in 2022) | Not Covered |
Part B Excess Charges | You pay $0 |
Foreign travel emergency (up to plan limits) | $250 deductible, then you pay 20% |
Out-of-Pocket Limit (2022) | n/a |
Plan Deductible (2022) | n/a |
Plan Documents | |
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2021 Medi-Pak Buck Slip Post-MACRA | 2021 Medi-Pak Buck Slip Post-MACRA |
2021 Medi-Pak Buck Slip Pre-MACRA | 2021 Medi-Pak Buck Slip Pre-MACRA |
Enrollment Application (PostMACRA) | Enrollment Application (PostMACRA) |
Enrollment Application (PreMACRA) | Enrollment Application (PreMACRA) |
Learn More about Applying Online | Learn More about Applying Online |
Learn More About Medicare Supplement Plans | Learn More About Medicare Supplement Plans |
Outlines Of Coverage (PostMACRA) | Outlines Of Coverage (PostMACRA) |
Outlines Of Coverage (PreMACRA) | Outlines Of Coverage (PreMACRA) |
Post-MACRA Brochure | Post-MACRA Brochure |
Pre-MACRA Brochure | Pre-MACRA Brochure |
Silver Sneakers Member Value Flyer | Silver Sneakers Member Value Flyer |
Limitations, copayments, and restrictions may apply. See above or contact the plan for more details.
*Enrollee must continue to pay the Medicare Part B premium.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. 24 hours a day, 7 days a week.
- The Social Security Office at 800-772-1213. TTY users should call 1-800-325-0778. Monday through Friday, 7 a.m. to 7 p.m.
- Your State Medicaid Office.