Plan G

Medicare Supplement Insurance Plan*G offers the most comprehensive protection available to Texas seniors looking to enhance Original Medicare. This plan from Blue Cross and Blue Shield of Texas, A Division of Health Care Service Corporation can offer deserving seniors the peace of mind they deserve with a plan they can depend on from a trusted provider.

Benefits

This Plan offers 100 percent coverage for your Part A deductible ($1,316) as well as total coverage for the remaining charge for days 61-90 in the hospital after Medicare pays ($329 a day). For days 91 and beyond, this plan pays for 100 percent of Medicare eligible expenses and 365 extra days of coverage after Lifetime Reserve are used up. This plan also pays for all costs of receiving skilled nursing care until day 101, 100 percent of the costs of the first three pints of blood and your Medicare copayment/coinsurance for hospice care.

Medical expenses that you incur in or out of the hospital and outpatient hospital treatment can be costly. With this plan you can count on coverage for the remainder of any Medicare approved amount (after your Part B deductible is paid in full), 100 percent of Part B excess charges.

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Summary of Benefits

  • Part A coinsurance for hospitalization services plus coverage for an additional 365 days hospitalization after Medicare benefits end
  • Part B coinsurance for medical expenses or copayments for hospital outpatient services
  • First three pints of blood each year
  • Part A coinsurance for hospice care
  • Skilled nursing facility coinsurance
  • Part A deductible
  • 100 percent of Part B excess charges
  • Foreign travel emergency care

What You Can Expect to Pay 

With comprehensive coverage from Medicare Supplement Insurance Plan G, you can expect to pay your Part B deductible, all hospitalization costs after an additional 365 days after the lifetime Reserve are used, all costs of skilled nursing facility care after 101 days and a foreign travel deductible of $250 annually plus 20 percent of costs within the first $50,000. This plan is also eligible for the Medicare Select option. However, if you are enrolled in a Medicare Select plan and If you agree to use a hospital in the Medicare Select Network for non emergency services, you will be eligible for a reduced premium.

Blue Cross and Blue Shield of Texas will never terminate or refuse to renew your policy because of the condition of your health. As long as you continue to pay your premium.

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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