| Benefits |
A |
B |
C |
D |
F* |
G |
K |
L |
M |
N |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Part B coinsurance or copayment |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes*** |
| Blood (first 3 pints) |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Part A hospice care coinsurance or copayment |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Skilled nursing facility care coinsurance |
No |
No |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Part A deductible |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
50% |
Yes |
| Part B deductible |
No |
No |
Yes |
No |
Yes |
No |
No |
No |
No |
No |
| Part B excess charges |
No |
No |
No |
No |
Yes |
Yes |
No |
No |
No |
No |
| Foreign travel exchange (up to plan limits) |
No |
No |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
| Out-of-pocket limit** |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
$4,940 |
$2,470 |
N/A |
N/A |
| * Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,140 in 2014 ($2,180 in 2015) before your Medigap plan pays anything.** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission. |
