Home : Members : Resources : Pharmacy Services

Horizon Medigap 50 to 64

Introduction

Overview

Benefits
Pricing Guide
Contact Us
Privacy Policy
Enroll
Home

Benefits

Services	Medicare pays	Medigap Plan C pays	You pay
Medicare (Part A) Hospital Services - per benefit period
Hospitalization¹ Semiprivate room and board, general nursing and miscellaneous services and supplies.
First 60 days	All but $1,608	$1,608 (Part A deductible per benefit period)	$0
61st through 90th day	All but $267 a day	$267 a day	$0
91st day and after:
While using 60 lifetime reserve days	All but $534 a day	$534 a day	$0
Once lifetime reserve days are used:
Additional 365 days	$0	100% of Medicare-eligible expenses	$0
Beyond the additional 365 days	$0	$0	All costs
Skilled Nursing Facility Care¹ You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days	100%	$0	$0
21st through 100th day	All but $133.50 a day	Up to $133.50 a day	$0
101st day and after	$0	$0	All costs
Blood
First 3 pints	$0	3 pints	$0
Additional amounts	100%	$0	$0
Hospice Care
Available as long as your doctor certifies you are terminally ill and you elect to receive these services.	95% for inpatient respite care 100% for hospice care All but $5 for prescription drugs	$0	5% for inpatient respite care $0 for hospice care $5 copay for prescription drugs
Medicare (Part B) Physician Services - per calendar year
Medical Expenses In or out of the hospital and outpatient hospital treatment, such as physicians' services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.
First $135 of Medicare-approved amounts²	$0	$135 (Part B deductible)	$0
Remainder of Medicare-approved amounts	80%*	20% of Medicare-approved amounts*	$0
Part B excess charges (above Medicare-approved amounts)	$0	$0	All costs
Blood
First 3 pints	$0	All costs	$0
Next $135 of Medicare-approved amounts²	$0	$135 (Part B deductible)	$0
Remainder of Medicare-approved amounts	80%	20% of Medicare-approved amounts	$0
Clinical Laboratory Services
Blood tests for diagnostic services	100%	$0	$0
Parts A & B
Home Health Care Medicare-approved services:
Medically necessary skilled care services and medical supplies	100%	$0	$0
Durable medical equipment:
First $135 of Medicare-approved amounts²	$0	$135 (Part B deductible)	$0
Remainder of Medicare-approved amounts	80%	20% of Medicare-approved amounts	$0
Other benefits - not covered by Medicare
Foreign Travel Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.
First $250 (deductible)	$0	$0	$250
After the first $250	$0	80% to a lifetime maximum benefit of $50,000	20% and amounts over the $50,000 lifetime maximum
Non Medicare-covered Preventive Care: Routine checkups and screening tests	$0	$0	All costs

Note: Deductibles and coinsurance are 2009 amounts.

¹ A benefit period begins on the first day you receive services 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 consecutive days.

² Once you have been billed $135 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.

NOTICE: When 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.

If you have any questions about Plan C, please call us at 1-800-224-1234.

Last Updated: December 30, 2008