Medicare Supplement - Extend Health

Sub1: 24 pt. / 27pt. Your Leading choiceSun of plans. RegularReversed OutWith Alliance Medicare Supplement, you havea choice of plans — Plan A, Plan C, Plan F andPlan N. The benefits of each of these plans arestandardized by the federal government.Plan A provides basic benefits. Plans C, F and Nprovide coverage in addition to the basicbenefits. You choose the plan that best meetsyour needs. (See pages 8 and 9 for moreinformation about each plan.)All four plans offer the basic benefits.The basic benefits include:• Hospitalization: Coverage for Medicare(Part A) daily copays, plus 365 additionaldays (lifetime) after Medicare benefits end• Medical expenses: Coverage for MedicarePart B coinsurance (20% of Medicareapprovedcosts) or copays for doctors’services, hospital outpatient servicesand other medical services• Blood: First three pints of blood each year• Hospice: Coinsurance for inpatient respitecare and copays for hospice outpatientprescription drugsNote: Plans do not include Medicare Part Dprescription drug benefits. For Part D coverage,you might want to consider our AllianceMedicare Rx (pdp) plan.Alliance Medicare SupplementPlan A Plan C Plan F Plan NPlan A is the mostbasic Medigapplan. It helps fillsome of the gaps inMedicare’s coverage.Plan A covers:• Basic benefits(see the listat the left)Plan C provides moreextensive coveragethan Plan A. It maybe the right plan foryou if most of yourdoctors acceptMedicare.Plan C covers:• Basic benefits,plus:• Skilled nursingfacility copay• Part A deductible• Part B deductible• Worldwideemergencycoverage**Plan F may be a goodchoice if some ofyour doctors do notaccept Medicare’sapproved amount aspayment in full.Plan F covers:• Basic benefits,plus:• Skilled nursingfacility copay• Part A deductible• Part B deductible• Worldwideemergencycoverage**• Part B excesscharges (theamount a doctorcharges in excessof the Medicareapprovedamount)Plan N* has a lowmonthly premiumand copays for visitsto the doctor’soffice and theemergency room.Plan N covers:• Basic benefits,plus:• Skilled nursingfacility copay• Part A deductible• Worldwideemergencycoverage***Plan N pays 100% of Part B services except the $162 (in 2011) deductible. Member pays up to $20copay for doctor’s office visits and up to $50 for emergency room visits.**$250 deductible each year. Lifetime maximum of $50,000. Subscriber pays all amounts over $50,000.7