Fax completed applications to: (847) 220-9280 or email [email protected]
BCBSAZ Medicare Supplement – High Deductible Plan F
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BCBSAZ Medicare Supplement Application
Fax completed applications to: (847) 220-9280 or email [email protected]
High Deductible Plan F
High Deductible Plan F covers 100% of costs once the $2,240 annual deductible met:
- Your Part A deductible and coinsurance
- Your Part B coinsurance and the cost of the first three pints of blood
- Benefits from High Deductible Plan F will not begin until your out-of-pocket expenses total $2,240.
- Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy.
- These expenses include the Medicare deductibles for Part A and B.
- These expenses do not include Plan F’s separate foreign travel emergency deductible.
- Medicare Part A hospital deductible and copayments
- Skilled nursing facility copayment
- $240 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
Benefit Summary
| Benefit | What High Deductible Plan F Covers |
|
Part A Deductible You may need this benefit if you have to stay in the hospital. This amount can change every year. You have to pay this deductible for each benefit period. |
HD-F covers 100% of the costs after reaching the $2,240 HD-F plan deductible |
|
Part B Deductible You may want to consider this benefit if you have Medicare Part B. Each year you must pay the Part B deductible before Medicare starts to pay its share. If you have this benefit, the Medigap plan would pay this amount each year. |
HD-F covers 100% of the costs after reaching the $2,240 HD-F plan deductible |
|
Part B Coinsurance Without this benefit, you generally pay 20% of the Medicare-approved amount for Medicare Part B covered services and supplies (like doctor services and outpatient hospital care). This benefit will help you to reduce your out of pocket after Part B deductible. |
High Deductible Plan F covers all of the 20% remainder costs |
|
365 Extra Days of Hospital Stay After you use all Medicare hospital benefits, you can receive up to 365 more days for hospital stays during your lifetime. |
High Deductible Plan F covers all of the costs for an additional 365 additional hospital days |
|
3 Pints of Blood The first 3 pints of blood or equal amounts of packed red blood cells per calendar year, unless this blood is replaced. |
High Deductible Plan F covers all of the costs of 3 pints of blood per calendar year |
|
Part B Excess Charges Under federal law, doctors who don’t accept “assignment” (take Medicare’s approved amount as payment in full) may charge up to 15% more than the approved amount. You might want to think about this benefit if your doctors don’t accept assignment. You may also want this benefit if you have to stay in the hospital and can’t control whether the doctors you see accept assignment. |
High Deductible Plan F covers 100% of the excess charges |
|
Foreign Travel Emergency If you travel outside the United States, this benefit could save you money for emergency care. |
High Deductible Plan F covers 80% (after a $250 deductible) to a lifetime maximum benefit of $50,000. |
|
Skilled Nursing Coinsurance Medicare pays for the first 20 days of a skilled nursing facility. If you need to go to a Skilled Nursing Facility (SNF) after a hospital stay and stay in the SNF longer than 20 days, this benefit begins. |
High Deductible Plan F covers up to $296 per day for days 21-100 and 100% for days 101 and after. |
|
Home Health Care Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. |
High Deductible Plan F covers the 20% remainder not paid by Medicare Part B. |
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