| 10 Standard Medigap Plans |
| Plans |
| Basic Benefits |
A |
B |
C |
D |
F |
G |
K |
L |
M |
N |
Part A Hospital
(Days 61-90) |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
| Lifetime Reserve Days (91-150) |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
| 365 Life Hosp. Days-100% |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
| Parts A and B Blood |
X |
X |
X |
X |
X |
X |
50% |
75% |
X |
X |
| Part A Hospice Care Coinsurance or Co-Pay |
X |
X |
X |
X |
X |
X |
50% |
75% |
X |
X |
| Part B Coinsurance-20% |
X |
X |
X |
X |
X |
X |
50% |
75% |
X |
X |
| Additional Benefits |
A |
B |
C |
D |
F |
G |
K |
L |
M |
N |
Skilled Nursing Facility
Coinsurance (Days 21-100) |
|
|
X |
X |
X |
X |
50% |
75% |
X |
X |
| Part A Deductible |
|
X |
X |
X |
X |
X |
50% |
75% |
50% |
X |
| Part B Deductible |
|
|
X |
|
X |
|
|
|
X |
|
| Part B Excess Charges |
|
|
|
|
100% |
100% |
|
|
|
|
| Foreign Travel Emergency |
|
|
X |
X |
X |
X |
|
|
X |
X |
| Annual Out-of-Pocket Limit |
|
|
|
|
|
|
$4,640 |
$2,320 |
|
|
|