Your Medicare Supplement Benefits

Medicare Part A Hospital Coverage

**Below are 2021 prices

Deductible – Plans F and G cover the $1,484 inpatient hospital deductible for each benefit period.

First 60 Days – After the Medicare Part A deductible, Medicare pays all eligible expenses for services from your first through 60th day of hospital confinement. Services include semiprivate room and board, general nursing, and miscellaneous hospital services and supplies.

Coinsurance – Plans A, F and G pay $371 a day when you are hospitalized from the 61st through the 90th day. And, when you are in the hospital from the 91st day through the 150th day, you receive $742 a day for each Lifetime Reserve day used.

Extended Hospital Coverage – When you are in the hospital longer than 150 days during a benefit period, and you have exhausted your 60 days of Medicare Lifetime Reserve, Plans A, F and G pay the Medicare Part A eligible expenses for hospitalization, paid at the Prospective Payment System (PPS) rate or other appropriate standard of payment, subject to a lifetime maximum benefit of an additional 365 days.

Benefit for Blood – Medicare has one calendar- year deductible for blood that is the cost of the first three pints needed. Plans A, F and G pay this deductible.

Skilled Nursing Facility Care

First 20 Days – Medicare pays all eligible expenses.

Coinsurance – Plans F and G pay up to $185.50 a day from the 21st through the 100th day during which you receive skilled nursing care. You must enter a Medicare-certified skilled nursing facility within 30 days of being hospitalized for at least three days.

Medicare Part B Physician’s Services and Supplies

What you’ll pay for Part B medical coverage
In contrast to Part A, everyone pays a monthly premium for medical coverage under Medicare Part B, which covers doctor visits and most outpatient procedures and services. The standard premium is $148.50 per month in 2021. A small number of participants will pay less than this if the increases in their Social Security benefits in recent years have been insufficient to keep up with the rising cost of Medicare premiums. However, Medicare estimates that only about 1 in 30 people on Medicare will pay premiums less than the $148.50 amount.

Higher monthly premiums apply to those who are considered to be high-income individuals. The table below shows you how much extra you’ll pay every month, depending on your level of income.

_{SOURCE: MEDICARE.GOV. *EXCLUDES MARRIED PERSONS FILING SEPARATELY IF THEY LIVED TOGETHER AT ANY TIME DURING THE YEAR.}

 

Deductible – $203 calendar-year deductible (only Plan F pays this)

Coinsurance – After the Medicare Part B deductible, Plans A, F and G pay 20% of eligible expenses for physician’s services and supplies, physical and speech therapy, and ambulance service.

For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Excess Benefits – Your bill for Medicare Part B services and supplies may exceed the Medicare eligible expense. When that occurs, Plan F pays 100% and Plan G pays 80% of the difference, up to the charge limitation established by Medicare.

Benefit for Blood – Medicare has one calendar- year deductible for blood that is the cost of the first three pints needed. Plans A, F and G pay this deductible.

 

Additional Benefits

Emergency Care Received Outside the U.S. – After you pay a $250 calendar-year deductible, Plans F and G pay you 80% of eligible expenses incurred during the first 60 days of a trip up to a lifetime maximum of $50,000. Benefits are payable for health care you need because of a covered injury or illness.

At-home Recovery Visits – Plan G pays for seven visits a week, up to $40 a visit up to a maximum of $1,600 a year for assistance with activities of daily living. Benefits are payable for services necessary for your continuing recovery from an illness, injury or surgery.

 

The Facts About Your Medigap (Medicare Supplement) Plan

Your Medicare supplement insurance policy helps pay some eligible expenses not paid for by Medicare Part A and Medicare Part B. There may be charges above what Medicare and your plan pay.

Medicare Part A Eligible Expenses for Hospital/ Skilled Nursing Facility Care include expenses for semiprivate room and board, general nursing, and miscellaneous services and supplies.

Medicare Part B Eligible Expenses for Medical Services include expenses for physicians’ services, hospital outpatient services and supplies, physical and speech therapy, and ambulance service.

“Medicare Eligible Expenses” means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

A Benefit Period begins the first full day you are hospitalized and ends when you have not been in a hospital or skilled nursing facility for 60 days in a row.

Coinsurance is the portion of the eligible expense not paid by Medicare and paid by your plan.

As Medicare deductibles and coinsurance increase, your Medicare supplement benefits will automatically increase. Benefits are not paid for any expense paid by Medicare.

Benefits are paid to you or to your hospital or doctor.

You have 31 days from your renewal date to pay your premium. Your policy will stay in force during this 31-day grace period.

Your policy is guaranteed renewable. Your policy cannot be canceled. It will be renewed as long as the premiums are paid on time and the information is correct on the application.

You cannot be singled out for a rate increase, no matter how many times you receive benefits. Your premium changes: (a) each year on the renewal date coinciding with or following the anniversary of your Policy Date until you reach age 90; and (b) when the same premium change is made on all in-force Medicare supplement policies of the same form issued to persons of your classification in the same ZIP code. Your policy’s two-person household premium discount ends if the person you live with terminates his or her policy or moves to a different residence.

You are covered immediately. There is no waiting period for preexisting conditions. Benefits will be paid from the time your policy is in force.

Your Medicare supplement insurance policy will not pay for:

• any expense incurred before your Policy Date
• hospital or skilled nursing facility confinement incurred during a Medicare Part A benefit period that begins while this policy is not in force
• expense paid for by Medicare
• services for non-Medicare eligible expenses
• services for which no charge is made when there is no insurance
• loss or expense that is payable under any other Medicare supplement insurance policy or certificate

Neither The Advisor Group USA, llc nor its Medicare supplement insurance policies are connected with or endorsed by the U.S. government or the federal Medicare program.