High Deductible Plan F

Medicare Supplement Insurance High Deductible Plan F* has the same benefits as Medicare Supplement Insurance Plan F* after you pay an annual $2,200 deductible. The deductible amount represents the annual out-of-pocket expenses (excluding premiums) that you must pay before the policy begins paying benefits.
Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy, which includes the Medicare deductibles for Part A and Part B, but not the separate foreign travel emergency deductible.

By having a high deductible, your premiums are significantly lower.

Costs you can expect to pay with this plan that count towards the $2,200 deductible:

  • Medicare Part A deductible
  • Medicare Part B deductible

Benefits

  • Your Part A deductible and coinsurance
  • Your Part B coinsurance and the cost of the first three pints of blood
  • Benefits from this plan will not begin until your out-of-pocket expenses total $2,200 Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy.
  • Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy, which includes the Medicare deductibles for Part A and Part B, but not the separate foreign travel emergency deductible.
  • The Medicare deductibles for Part A and B.
  • Medicare Part A hospital deductible and copayments
  • Skilled nursing facility copayment
  • $183 Part B Medicare deductible
  • Part B doctor charges that are in excess of Medicare-approved amounts
  • The cost of 365 extra days of hospital care during your lifetime after Medicare coverage
  • These expenses do NOT include the separate $250 foreign travel emergency deductible.

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Basic Benefit
Options
Comprehensive Plan
Options
Budget-Conscious Plan Options
Click on each
plan
to view details**
Plan A Plan F Plan G High Deductible
Plan F
Plan K Plan L Plan N
Reduced
Premium
Medicare Select
Option
Available*‡
(eligibility based
on ZIP code)
Basic Benefits 100% 100% 100% 100% 100%
/50%
100%
/75%

copay
applies
Skilled Nursing
Coinsurance
50% 75%
Part A Deductible 50% 75%
Part B Deductible
Part B Excess 100% 100%
Foreign Travel
Emergency Care†
Annual Out of
Pocket Limit††
$5,120 $2,560

 

* Network restrictions apply.
** Policy forms UWMSP(A)-2010, UWMSP(F)-2010, UWMSP(F-HD)-2010, UWMSP(G)-2010, UWMSP(K)-2010, UWMSP(L)-2010, UWMSP(N)-2010, UWMSP-SEL(F)-2010, UWMSP-SEL(G)-2010, UWMSP-SEL(K)-2010, UWMSP-SEL(L)-2010, UWMSP-SEL(N)-2010.

† Plans cover medically necessary emergency care services needed immediately because of an injury or illness of sudden and unexpected onset, beginning during the first 60 days of each trip outside the USA.

†† The out of pocket annual limit may increase each year for inflation (2017 limits shown).

‡ You must live within 30 miles of a participating Medicare Select hospital to be eligible.

BCBSTX is not connected with or endorsed by the United States Government, the Federal Medicare Program or any other governmental agency.
TXMEDWEB02-REV 08/12

*Not connected with or endorsed by the U.S. Government or Federal Medicare Program

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