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Plan G 2024 Coverage Details

Services Benefit Details Medicare Pays Plan Pays You Pay
Hospitalization

(Semiprivate room and board, general nursing and miscellaneous services and supplies)

 First 60 days All but $1,632 $1,632 (Part A Deductible) $0
Days 61-90 All but $408 a day $408 a day $0
91st day and after

(while using 60 lifetime reserve days)

 All but $816 a day $816 a day $0
91st day and after

(once lifetime reserve days are used — additional 365 days)

 $0 100% of Medicare eligible expenses $0Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Basic Benefits." During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
91st day and after

(once lifetime reserve days are used — beyond the additional 365 days)

 $0 $0 All costs
Skilled Nursing Facility Care

(You must meet Medicare's requirements, including having been in a hospital for at least three days and entered a Medicare approved facility within 30 days after leaving the hospital)

 First 20 days All approved amounts $0 $0
Days 21-100 All but $204 a day Up to $204 a day $0
101st day and after $0 $0 All costs
Blood First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care You must meet Medicare's requirements, including doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance insurance $0
Services Benefit Details Medicare Pays Plan Pays You Pay
Medical Expenses

(In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment)

 First $240 of Medicare approved amounts $0 $0 $240 (Part B deductible)
Remainder of Medicare approved amounts Generally 80% Generally 20% $0
Part B Excess Charges Beyond Medicare approved amounts  $0 100% $0
Blood First 3 pints $0 All costs $0
Next $240 of Medicare approved amounts $0 $0 $240 (Part B deductible)
Remainder of Medicare approved amounts 80% 20% $0
Clinical Laboratory Services Tests for diagnostic services 100% $0 $0
Services Benefit Details Medicare Pays Plan Pays You Pay
Home Health Care

Medicare approved services

 Medically necessary skilled care services and medical supplies 100% $0 $0
Durable medical equipment — first $240 of Medicare approved amounts $0 $0 $240 (Part B deductible)
Durable medical equipment  — remainder of Medicare approved amounts 80% 20% $0
Services Benefit Details Medicare Pays Plan Pays You Pay
Foreign Travel

Not covered by Medicare

 Medically necessary skilled care services beginning during the first 60 days of each trip outside the USA — first $250 each calendar year $0 $0 $250
Medically necessary skilled care services beginning during the first 60 days of each trip outside the USA — remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

Medicare benefits are subject to change. Please visit Medicare.gov and consult the latest Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

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