Fax completed applications to: (847) 220-9280 or email [email protected]
BCBSWI Medicare Supplement Plan G
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Plan G covers:
- Your $1,316 Part A deductible and coinsurance
- The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends
- Your Part B coinsurance and the cost of the first three pints of blood
- 80% of Part B physician charges that are in excess of the Medicare-approved amount (By law no physician may charge more than 115% of Medicare-approved amounts).
- Skilled nursing facility copayment
- Foreign travel emergency care
Plan G does NOT cover:
- Your $183 Medicare Part B deductible
There is also a BCBSWI Medicare-Select Plan G that offers the same benefits as Standard Plan G but provides costs savings by agreeing to use a Medicare Select particpating hospital for non-emergencies. You may still see any doctor you choose with Medicare-Select plans. If your hospital is part of the Medicare Select network, the Med-Select plan is a good option to consider.
Benefit Summary
Benefit |
What Plan G Covers |
|---|---|
| Part A Deductible You may need this benefit if you have to stay in the hospital. The Part A deductible for 2017 is $1,316. This amount can change every year. You have to pay this deductible for each benefit period. |
Plan G covers 100% of the $1,316 deductible. |
| Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible (which is $147 in 2012) before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. |
Plan G does NOT cover the $183 Part B deductible, you must pay out of pocket. |
| Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. |
Plan G covers 100% of the 20% remainder costs |
| 365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. |
Plan G covers all of the costs for an additional 365 additional hospital days |
| 3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. |
Plan G covers all of the costs of 3 pints of blood per calendar year |
| Part B Excess Charges Under federal law, doctors who don’t accept “assignment ” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. |
Plan G covers 100% of the excess charges |
| Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. |
Plan G covers 80% (after a $250 deductible) to a lifetime maximum benefit of $50,000. |
| Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. |
Plan G covers up to $137.50 per day for days 21-100. |
| Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. |
Plan G covers the 20% remainder not paid by Medicare Part B. |
Plan G Rates
Eligibility
• Wisconsin Resident age 65 and over
• Must have Medicare Parts A & B
• May not duplicate an inforce Medicare Supplement
Area is determined by the first 3 digits of your zipcode.
Area 1:
754-759; 763-769;
778-792; 795-799; 885
Area 2:
750-753; 760-762;
770-777; 793-794
Area 3:
out-of-state
| Plan | Ages | Area 1 | Area 2 | Area 3 | |
|---|---|---|---|---|---|
|
Plan G
|
65-66 | $137.00 | $146.00 | $163.00 | |
| 67-69 | $156.00 | $168.00 | $185.00 | ||
| 70-74 | $183.00 | $197.00 | $217.00 | ||
| 75-79 | $204.00 | $222.00 | $244.00 | ||
| 80-84 | $231.00 | $250.00 | $279.00 | ||
| 85+ | $250.00 | $272.00 | $299.00 | ||