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2017 MEDICARE SUPPLEMENT COMPARISON GUIDE

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Medicare Part B Medical

Medicare Part B Medical Insurance-Covered Services for 2017 Services Benefit Medicare Pays You Pay Medical Expense - Physician’s services, inpatient and outpatient medical services and supplies, physical and speech therapy, ambulance, etc. Medicare pays for medical services in or out of the hospital 80% of approved amount (after $183 deductible) $183 deductible* plus 20% of approved amount (plus any charge up to 15% above approved amount)** 20% for all outpatient physical, occupational, and speech-language therapy services Home Health Care (If you don’t have Part A) Visits limited to medically necessary skilled care 100% of approved amount; 80% of approved amount for durable medical equipment Nothing for services; 20% of approved amount for durable medical equipment Outpatient Hospital Treatment Unlimited if medically necessary at hospitals and community mental health centers A Medicare-approved amount for covered services after $183 deductible A coinsurance or fixed co-payment amount that may vary according to the service Blood *** Blood 80% of approved amount (after $183 deductible and starting with fourth pint) First three pints plus 20% of approved amount (after $183 deductible) * Once you have incurred $183 of Medicare approved charges for covered services in 2017, the Part B deductible does not apply to any further covered services you receive for the rest of the year. ** You pay for charges higher than the amount approved by Medicare up to the legal charge limit unless the doctor or supplier agrees to accept Medicare’s approved amount as full payment for services rendered. This is known as “accepting assignment.” *** To the extent the blood deductible is met under one part (either Part A or Part B) of Medicare during the calendar year, it does not have to be met under the other part. 4

The 10 Standard Medicare Supplement Plans The following is a list of the 10 standard plans and benefits provided by each. 1 PLAN A - (the basic policy) consists of these core benefits: • Coverage for the Part A coinsurance amount ($329 per day in 2017 for the 61st through the 90th day of hospitalization in each Medicare period. • Coverage for the Part A lifetime reserve days coinsurance amount ($658 per day in 2017) for the 91st through the 150th day of Medicare’s 60 non-renewable lifetime hospital inpatient reserve days used. • After all Medicare hospital benefits are exhausted, coverage for 100% of the Medicare Part A eligible hospital expenses. Coverage is limited to a maximum of 365 days of additional inpatient hospital care during the policyholder’s lifetime. This benefit is paid either at the rate Medicare pays hospitals under its Prospective Payment System (PPS) or under another appropriate standard of payment for hospitals not subject to the PPS. Beneficiaries may be responsible for payment when Medigap hospital benefits are exhausted. • Coverage under Medicare Parts A & B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells as defined under federal regulations) unless replaced in accordance with federal regulations. • Coverage for the coinsurance amount for Part B services (generally 20% of approved amount) after the $183 annual deductible; 50% coverage of approved charges for outpatient mental health services after Part B deductible is met. 2 3 PLAN B - includes the core benefits in Plan A PLUS: • Coverage for the Medicare Part A inpatient hospital deductible • Plan B Select – Same as Plan B but restricted to network of hospital PLAN C - Includes the core benefits in Plan A PLUS: • Coverage for the Medicare Part A deductible • Coverage for the skilled nursing facility coinsurance • Coverage for the Medicare Part B deductible • 80% coverage for the medically necessary emergency care in a foreign country after a $250 deductible for the year. • Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000. 4 PLAN D - includes the core benefits in Plan A PLUS: • Coverage for the Medicare Part A deductible • Coverage for the skilled nursing facility care daily coinsurance amount • 80% coverage for the medically necessary emergency care in a foreign country after a $250 deductible for the year. 5

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