Page 115 - Cover Letter & Evaluation for Carol Evans

Plans C and N are the
only Medicare Select
Original Medicare doesn’t cover all your health care costs. That’s an important fact to know before you
plan that BCBS of AZ
need help with those expenses. That’s also the reason why many people with original Medicare enroll in
sponsors
supplemental health plans, like those offered by Blue Cross Blue Shield of Arizona. Senior Security plans
A, C, F, G and N and Senior Preferred Medicare Select plans C and N, help cover those gaps by paying
for some of the expenses that original Medicare does not cover.

Senior Security Plan F and Senior Preferred Plan C:

These two plans offer the most comprehensive coverage of Medicare approved charges. As a member,
your Part A and Part B deductibles are covered, as well as your Part B coinsurance. See the chart below
for details on what is covered and what you will pay as a member.
2017 Plan What Original What Senior Security What Senior Preferred What You
Information Medicare Pays Plan F Pays Plan C Pays Pay
Monthly plan $0 $0 $0 Plan F $159*
premium* Plan C $102*
Annual deductible $0 $1,316 - Part A deductible $1,316 - Part A deductible $0
for medical services $183 - Part B deductible $183 - Part B deductible

Inpatient hospital
care
• Days 1–60 100% after $1,316 $1,316 $1,316 $0
• Days 61–90 100% after $329 per day $329 per day $329 per day $0
• Days 91–150 100% after $658 per day $658 per day $658 per day $0
• Additional 365 days $0 100% of Medicare-eligible 100% of Medicare-eligible $0
after lifetime reserve expenses expenses
days are used

Skilled nursing
facility care
• Days 1–20 100% of approved amounts $0 $0 $0
• Days 21–100 100% after $164.50 per Up to $164.50 per day Up to $164.50 per day $0
day
Outpatient care
• First $183 of $0 $183 $183 $0
Medicare-approved
amounts
• Remainder of 80% of costs 20% of costs 20% of costs $0
Medicare-approved
amounts
• Medicare Part B $0 100% $0 $0**
excess charges

Foreign Travel
Emergency
• First $250 each $0 $0 $0 $250
calendar year
• Remainder of $0 80% to a lifetime 80% to a lifetime 20% and
charges maximum benefit of maximum benefit of amounts over
$50,000 $50,000 $50,000 life-
time benefit