Security Overview

If you’re 65 or older or receive Social Security disability benefits,  Security℠ can help pay for covered services after you use your Medicare benefits.

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Choosing a Medigap Program Booklet

Medicare (Part A)

Hospital Services—Per Benefit Period

Hospitalization1

Semi-private room and board, general nursing and miscellaneous services and supplies

Plan A

Services
 Medicare Pays
 Plan Pays
 You Pay
First 60 days
 All but $1288
 $0
 $1288 (Part A Deductible)
61st through 91st day
 All but $322 a day
 $322 a day
 $0
91st day and after:
Services
 Medicare Pays
 Plan Pays
 You Pay
While using 60 lifetime reserve days1
 All but $644 a day
 $644 a day
 $0
Once lifetime reserve days are used:1
Services
 Medicare Pays
 Plan Pays
 You Pay
Additional 365 days
 $0
 100% of Medicare Eligible Expenses
 $02
Beyond the additional 365 days
 $0
 $0
 All Costs

Plan B

Services Medicare Pays Plan Pays You Pay
First 60 days All but $1288 $1288 (Part A Deductible) $0
61st through 91st day All but $322 a day $322 a day $0
91st day and after:
Services Medicare Pays Plan Pays You Pay
While using 60 lifetime reserve days1 All but $644 a day $644 a day $0
Once lifetime reserve days are used:1
Services Medicare Pays Plan Pays You Pay
Additional 365 days $0 100% of Medicare Eligible Expenses $02
Beyond the additional 365 days $0 $0 All Costs

Plan C

Services Medicare Pays Plan Pays You Pay
First 60 days All but $1288 $1288 (Part A Deductible) $0
61st through 91st day All but $322 a day $322 a day $0
91st day and after:
Services Medicare Pays Plan Pays You Pay
While using 60 lifetime reserve days1 All but $644 a day $644 a day $0
Once lifetime reserve days are used:1
Services Medicare Pays Plan Pays You Pay
Additional 365 days $0 100% of Medicare Eligible Expenses $02
Beyond the additional 365 days $0 $0 All Costs

Plan F

Services Medicare Pays Plan Pays You Pay
First 60 days All but $1288 $1288 (Part A Deductible) $0
61st through 91st day All but $322 a day $322 a day $0
91st day and after:
Services Medicare Pays Plan Pays You Pay
While using 60 lifetime reserve days1 All but $644 a day $644 a day $0
Once lifetime reserve days are used:1
Services Medicare Pays Plan Pays You Pay
Additional 365 days $0 100% of Medicare Eligible Expenses $02
Beyond the additional 365 days $0 $0 All Costs

Plan N

Services Medicare Pays Plan Pays You Pay
First 60 days All but $1288 $1288 (Part A Deductible) $0
61st through 91st day All but $322 a day $322 a day $0
91st day and after:
Services Medicare Pays Plan Pays You Pay
While using 60 lifetime reserve days1 All but $644 a day $644 a day $0
Once lifetime reserve days are used:1
Services Medicare Pays Plan Pays You Pay
Additional 365 days $0 100% of Medicare Eligible Expenses $02
Beyond the additional 365 days $0 $0 All Costs

Skilled Nursing Facility Care2

Per the Medicare requirement, you must have been hospitalized for at least three days and then entered a Medicare-approved facility within 30 days after leaving the hospital.

Plan A

Services Medicare Pays Plan Pays You Pay
First 20 days All approved amounts $0 $0
21st through 100th day All but $161 a day $0 Up to $161 a day
101st day and after $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care:
Services Medicare Pays Plan Pays You Pay
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

Plan B

Services Medicare Pays Plan Pays You Pay
First 20 days All approved amounts $0 $0
21st through 100th day All but $161 a day $0 Up to $161 a day
101st day and after $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care:
Services Medicare Pays Plan Pays You Pay
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

Plan C

Services Medicare Pays Plan Pays You Pay
First 20 days All approved amounts $0 $0
21st through 100th day All but $161 a day Up to $161 a day $0
101st day and after $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care:
Services Medicare Pays Plan Pays You Pay
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

Plan F

Services Medicare Pays Plan Pays You Pay
First 20 days All approved amounts $0 $0
21st through 100th day All but $161 a day Up to $161 a day $0
101st day and after $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care:
Services Medicare Pays Plan Pays You Pay
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

Plan N

Services Medicare Pays Plan Pays You Pay
First 20 days All approved amounts $0 $0
21st through 100th day All but $161 a day Up to $161 a day $0
101st day and after $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care:
Services Medicare Pays Plan Pays You Pay
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

Medicare (Part B)

Medical Services—Per Calendar Year

Medical Expenses

In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.

Plan A

Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 All costs $0
Next $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Clinical Laboratory Services:
Services Medicare Pays Plan Pays You Pay
Tests for Diagnostic Services 100% $0 $0

Plan B

Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 All costs $0
Next $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Clinical Laboratory Services:
Services Medicare Pays Plan Pays You Pay
Tests for Diagnostic Services 100% $0 $0

Plan C

Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 All costs $0
Next $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Clinical Laboratory Services:
Services Medicare Pays Plan Pays You Pay
Tests for Diagnostic Services 100% $0 $0

Plan F

Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts Generally 80% Generally 20% $0
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 All costs $0
Next $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Clinical Laboratory Services:
Services Medicare Pays Plan Pays You Pay
Tests for Diagnostic Services 100% $0 $0

Plan N

Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. 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. Up to $20 per office visit and up to $50 per emergency room visit. 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.
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
Blood:
Services Medicare Pays Plan Pays You Pay
First 3 pints $0 All costs $0
Next $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Clinical Laboratory Services:
Services Medicare Pays Plan Pays You Pay
Tests for Diagnostic Services 100% $0 $0

Parts A & B

Home Health Care

Medicare Approved Services

Plan A

Services Medicare Pays Plan Pays You Pay
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment:
Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0

Plan B

Services Medicare Pays Plan Pays You Pay
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment:
Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0

Plan C

Services Medicare Pays Plan Pays You Pay
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment:
Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $166 (Part B Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0
Foreign Travel—Not Covered by Medicare

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.

Services Medicare Pays Plan Pays You Pay
First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

Plan F

Services Medicare Pays Plan Pays You Pay
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment:
Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $166 (Part B Deductible) $0
Remainder of Medicare Approved Amounts 80% 20% $0
Foreign Travel—Not Covered by Medicare

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.

Services Medicare Pays Plan Pays You Pay
First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

Plan N

Services Medicare Pays Plan Pays You Pay
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment:
Services Medicare Pays Plan Pays You Pay
First $166 of Medicare Approved Amounts3 $0 $0 $166 (Part B Deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
Foreign Travel—Not Covered by Medicare

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.

Services Medicare Pays Plan Pays You Pay
First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

BlueReliance Medically Underwritten 2010 Standardized Medicare Supplement plans are issued by Capital Advantage Insurance Company®, a subsidiary of Capital Blue Cross. Independent licensees of the Blue Cross Blue Shield Association. Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies. You must be enrolled in Medicare Parts A and B. Please refer to the BlueReliance Medicare Supplement Outline of Coverage for actual premiums and costs.

1A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

2When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's 'core benefits'. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

3Once you have been billed $166 of Medicare Approved Amounts for covered services, your Part B deductible will have been met for the calendar year.