Benefits of the Medicare Supplement Insurance Plans
If you like the idea of having a plan that gives you the freedom to choose any doctor and hospital that accepts Medicare and lessens your exposure to out-of-pocket expenses, a Medicare Supplement Plan might be right for you. These plans do exactly what their name says: they supplement Original Medicare — or in other words, make the coverage provided by Original Medicare more complete. The extra benefits of Medicare Supplements make these plans less affordable than Medicare Advantage Plans, so you should compare your needs and options carefully before joining.
Basic Benefits
All four Plans offered by EmblemHealth cover the following basic benefits:
- Hospitalization: EmblemHealth pays Part A coinsurance* plus coverage for 365 additional days in your lifetime after Medicare benefits end
- Medical Expenses: EmblemHealth pays Part B coinsurance* (20 percent of Medicare-approved expenses); Medicare pays 80 percent
- Blood: First three pints of blood each year
- Hospice Part A coinsurance
- Plan A - Plan A consists of Basic Benefits only, as described above
- Plan B - In addition to the Basic Benefits, Plan B covers 2013 Part A inpatient deductible** per benefit period: $1,184
- Plan C - In addition to the Basic Benefits, Plan C covers coinsurance* for skilled nursing facility care
- 2013 Part A inpatient deductible** per benefit period: $1,184
- 2013 Part B annual deductible: $147
- Emergency care rendered during the first 60 days of foreign travel
- Plan F - In addition to the Basic Benefits, Plan F covers coinsurance* for skilled nursing facility care
- 2013 Part A inpatient deductible** per benefit period: $1,184
- 2013 Part B annual deductible: $147
- Emergency care rendered during the first 60 days of foreign travel
- 100% of Part B excess charges (above Medicare-approved amounts)
* Coinsurance is the portion or percentage of the cost of a Medicare covered service that you are responsible for paying.
** Part A inpatient deductible is the dollar amount of costs for covered services you would be expected to pay for Medicare Part A hospitalization services, including semi-private room and board, and general nursing and miscellaneous services and supplies during the first 60 days of a covered admission.
Quarterly Premium Rates (Effective January 1, 2013)
| Region | Plan A | Plan B | Plan C | Plan F |
|---|---|---|---|---|
|
Albany Albany, Clinton, Columbia, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington |
$483.87 | $649.41 | $786.93 | $794.79 |
|
Buffalo Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming |
$457.71 | $614.46 | $744.33 | $751.77 |
|
Downstate Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk and Westchester |
$508.35 | $678.42 | $820.50 | $828.72 |
|
Mid-Hudson Delaware, Dutchess, Orange, Putnam, Sullivan and Ulster |
$483.87 | $649.41 | $786.93 | $794.79 |
|
Rochester Livingston, Monroe, Ontario, Seneca, Wayne and Yates |
$457.71 | $614.46 | $744.33 | $751.77 |
|
Syracuse Broome, Cayuga, Chemung, Cortland, Onondaga, Schuyler, Steuben, Tioga and Tompkins |
$473.19 | $635.13 | $769.32 | $777.00 |
|
Utica/Watertown Chenango, Franklin, Hamilton, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, Otsego and St. Lawrence |
$457.71 | $614.46 | $744.33 | $751.77 |
Each rating region consists of the noted counties. Rates and benefits are subject to change. Please refer to your Certificate of Insurance, or contact EmblemHealth for additional information, including limitations and exclusions.
When Medicare Supplement Benefits Begin
Your coverage will begin on the effective date of the contract as shown on the contract schedule page which you will receive after we have processed your first payment. A waiting period of six months is required for pre-existing conditions. The waiting period will apply to conditions for which medical advice was given to you, or for which a doctor provided or recommended treatment within six months of your effective date of coverage. The waiting period may be reduced if you are replacing an existing plan. Your EmblemHealth Medicare Supplement contract will describe the circumstances under which your EmblemHealth plan's waiting period may be reduced by the period of time you have been covered under your existing plan.
EmblemHealth Medicare Supplement Insurance Plans are underwritten by Group Health Incorporated ("GHI"), an EmblemHealth company