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Medicare Supplement Plan C Details

Part A

Services Medicare Pays This Plan Pays You Pay
Hospitalization
First 60 Days All But $1676 $1676 (Part A Deductible) $0
61st Through 90th Day All But $419 a Day $419 a Day $0
91st Day and After (60 Reserve Days) All But $838 a Day $838 a Day $0
After Reserve (Additional 365 Days) $0 100% of Additional Expenses $0
Beyond the Additional 365 Days $0 $0 All Costs
Skilled Nursing Facility Care
First 20 Days All Approved Amounts $0 $0
21st Through 100th Day All But $209.50 a Day Up to $209.50 a Day $0
101st Day and After $0 $0 All Costs
Blood
First Three Pints $0 100% $0
Additional Amounts 100% $0 $0
Hospice Care
Must Meet Medicare's Requirements All but very limited coinsurance, coinsurance for outpatient drugs and inpatient respite care. Pays Copayments and Coinsurance $0

Part B

Services Medicare Pays This Plan Pays You Pay
Medical Expenses
1st $257 of Approved Amounts $0 $257 (Part B Deductible) $0
Remainder of Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charge $0 $0 All Costs
Blood
First Three Pints $0 100% $0
Next $257 of Approved Amounts $0 $257 (Part B Deductible) $0
Remainder of Approved Amounts Generally 80% Generally 20% $0
Clinical Laboratory Services
Tests for Diagnostic Services 100% $0 $0

Parts A & B

Services Medicare Pays This Plan Pays You Pay
Home Health Care
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment
1st $257 of Medicare approved amounts $0 $257 (Part B deductible) $0
Remainder of medicare approved amounts 80% 20% $0

Other Benefits

Services Medicare Pays This Plan Pays You Pay
Foreign Travel
First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum of $50,000 20% until the lifetime maximum, then all costs.