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Medicare Plans
Plan J or High Deductible Plan J**
MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD
* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** This high deductible plan pays the same or offers the same benefits as Plan J after you have paid a calendar year $2000 deductible. Benefits from the high deductible Plan J will not begin until out-of-pocket expenses are $2000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency and prescription drug deductibles.
Service: HOSPITALIZATION*
Semiprivate room and board, general nursing and miscellaneous services and supplies:
  MEDICARE PAYS PLAN PAYS YOU PAY
First 60 days All but $1,100 $1,100 (Part A Deductible) $0
61st through 90th day All but $275 a day $275 a day $0
91st day and after:      
While using 60 lifetime reserve days All but $550 a day $550 a day $0
Once lifetime reserve days are used:

 

 

 
Additional 365 days $0 100% of Medicare Eligible Expenses $0**
Beyond the Additional 365 days $0 $0 All costs
Service: SKILLED NURSING FACILITY CARE *
You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital:
First 20 days All approved amounts $0 $0
21st through 100th day

All but $137.50 a day

Up to $137.50 a day

$0

101st day and after $0 $0 All costs
Service: BLOOD
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Service: HOSPICE CARE
Available as long as your doctor certifies you are terminally ill and you elect to receive these services.
  All but very limited coinsurance for outpatient drugs and inpatient respite care $0 Balance
**NOTICE: 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 "Core 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.
 
Plan or High Deductible Plan J**
MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR*
* Once you have been billed $155 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Medicare Part B Deductible will have been met for the calendar year.

** This high deductible plan pays the same or offers the same benefits as Plan J after you have paid a calendar year $2000 deductible. Benefits from the high deductible Plan J will not begin until out-of-pocket expenses are $2000.  Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency and prescription drug deductibles.
Service: 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:
  MEDICARE PAYS PLAN PAYS YOU PAY
First $155 of Medicare Approved Amounts* $0 $155 (Part B Deductible) $0
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charges (Above Medicare Approved Amounts) $0 100% $0
Service: BLOOD
First 3 pints $0 All costs $0
Next $155 of Medicare Approved Amounts* $0 $155 (Part B Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0
Service: CLINICAL LABORATORY SERVICES
Tests for Diagnostic Services 100% $0 $0
 
PARTS  A & B
Service: HOME HEALTH CARE
Medicare Approved Services:
  MEDICARE PAYS PLAN PAYS YOU PAY
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable medical equipment:        
First $155 of Medicare Approved Amounts* $0 $155 (Part B Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0
Service: AT HOME RECOVERY SERVICES - Not Covered by Medicare
Home care certified by your doctor, for personal care during recovery from an injury or sickness for which Medicare approved a Home Care Treatment Plan:
Benefit for each visit
$0
Actual charges up to $40 per visit
Balance
Number of visits covered (must be received within 8 weeks of last Medicare approved visit) 0 Up to the number of Medicare approved visits, not to exceed 7 each week Balance
Calendar year maximum $0 $1,600 Balance
OTHER BENEFITS - NOT COVERED BY MEDICARE
Service:
FOREIGN TRAVEL NOT COVERED BY MEDICARE
Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA:
First $250 each calendar year $0 $0 $250
Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum
Service:
***PREVENTIVE MEDICAL CARE
-NOT COVERED BY MEDICARE

Some annual physical and preventive tests and services administered as ordered by your doctor when not covered by Medicare.
First $120 each calendar year $0 $120 $0
Additional charges $0 $0 All costs
***Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare and the latest Medicare Handbook.
Insurance benefits are underwritten by AEGON companies including: Transamerica Life Insurance Company and Transamerica Financial Life Insurance Company (for New York Residents)
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