| Plan 65 Plan A |
Plan B | Plan 65 Plan C/Select |
Plan D | F*† Plan F/Select |
|---|---|---|---|---|
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| Plan G | Plan 65 Plan K**/Select |
Plan L** | Plan M | Plan 65 Plan N |
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Plan 65-Select affects Plans C, F & K only.
* Plan F also has an option called a High Deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year deductible of $2,110. Benefits from High Deductible Plan F will not begin until out-of-pocket expenses exceed $2,110. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductible for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.
†High Deductible Plan F is not available.
** Plans K and L provide for different cost-sharing for items and services than Plans A-G and M-N. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges". You will be responsible for paying excess charges.
*** The out-of-pocket annual limit will increase each year for inflation.