Page 13 - MedigapFreedom Plan Information

Your MedigapFreedom Plan Choices
Plan G/
Plan G High Deductible* You pay:
$233** Part B deductible (Plan pays 20% coinsurance)
$0
$0
Plan N
You pay:
$233** Part B deductible;
up to a $20 copay for doctor visits; up to a $50 copay for emergency room (waived if admitted)‡
(Plan pays all other Part B coinsurance)
$0
100% Prescription Drug coverage is not included
*Plan G High Deductible pays the same benefits as Plan G after members have paid a $2,490 calendar year deductible. Benefits from Plan G High Deductible will not begin until out-of-pocket expenses exceed $2,490. Rates for Plan G High Deductible are approximately 50% lower than Plan G. The calendar year deductible is subject to change in 2023.
**These are the 2022 amounts and may change on January 1, 2023. Each year, Social Security
notifies all Medicare beneficiaries of the new Part A deductible and coinsurance, Part B deductible, and Part B premium amount.
†If the amount a doctor or other health care provider charges is higher than the Medicare-approved amount, the difference is called the excess charge.
‡The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.
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