Outline of Supplemental Coverage (2024)

Outline of Medicare Supplement Coverage Washington State Health Care Authority See Outlines of Coverage sections for details about all plans. This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Only applicants before 2020 may purchase Plans C, F, and high deductible F. Note: A  means 100% of the benefit is paid. Medicare Plans Available to All Applicants first eligible Benefits before 2020 only 1 2 2 3 1 A B D G K L M N C F Medicare Part A coinsurance and Hospital coverage (up to an           additional 365 days after Medicare benefits are used up) Medicare Part B coinsurance or  copayment     50% 75%  copays   apply Blood (first three pints)     50% 75%     Part A hospice care coinsurance     50% 75%     or copayment Skilled nursing facility   50% 7     coinsurance 5% Medicare Part A deductible    50% 75% 50%    Medicare Part B deductible   Medicare Part B excess charges   Foreign travel emergency (up to       plan limits) Out-of-pocket limit $7,060 $3,530 1 Plan F and G also have a high deductible option which require first paying a plan deductible of $2,800 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G does not cover the Medicare Part B deductible. However, high deductible F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 2 Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit. 3 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 do not result in an inpatient admission. 021605 (08-10-2021) 021777 (10-15-2023) An Independent Licensee of the Blue Cross Blue Shield Association