| (B) Standardized Medicare supplement benefit Plan B
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible as defined in subsection (b)(3)(A)(i) of this section.
(C) Standardized Medicare supplement benefit Plan C
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, skilled nursing facility care, 100 percent of the
Medicare Part B deductible, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(i), (B), (C),
and (E) of this section, respectively.
(D) Standardized Medicare supplement benefit Plan D
must include only: The basic (core) benefits (as defined in subsection
(b)(2) of this section), plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(i), (B), and
(E) of this section, respectively.
(E) Standardized Medicare supplement (regular) Plan
F must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, the skilled nursing facility care, 100 percent
of the Medicare Part B deductible, 100 percent of the Medicare Part
B excess charges, and medically necessary emergency care in a foreign
country as defined in subsection (b)(3)(A)(i), (B), (C), (D), and
(E) of this section, respectively.
(F) Standardized Medicare supplement Plan F with High
Deductible must include 100 percent of covered expenses following
the payment of the annual deductible set forth in clause (ii) of this
subparagraph.
(i) The basic (core) benefits as defined in subsection
(b)(2) of this section, plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, 100 percent of the Medicare Part B
deductible, 100 percent of the Medicare Part B excess charges, and
medically necessary emergency care in a foreign country as defined
in subsection (b)(3)(A)(i), (B), (C), (D), and (E) of this section,
respectively.
(ii) The annual deductible in Plan F with High Deductible
must consist of out-of-pocket expenses, other than premiums, for services
covered by regular Plan F, and must be in addition to any other specific
benefit deductibles. The basis for the deductible is $2,240 for 2018,
and will be adjusted annually by the Secretary to reflect the change
in the Consumer Price Index for all urban consumers for the 12-month
period ending with August of the preceding year, and rounded to the
nearest multiple of $10.
(G) Standardized Medicare supplement benefit Plan G
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, skilled nursing facility care, 100 percent of the
Medicare Part B excess charges, and medically necessary emergency
care in a foreign country as defined in subsection (b)(3)(A)(i), (B),
(D), and (E), respectively. Effective January 1, 2020, Plan G with
a High Deductible, as described in subsection (c)(5)(H), may be offered
to any individual who is eligible for Medicare before January 1, 2020.
(H) Standardized Medicare supplement Plan G with High
Deductible must include 100 percent of the covered expenses following
the payment of the annual deductible set forth in clause (ii) of this
subparagraph, but will not provide coverage for any portion of the
Medicare Part B deductible. The Medicare Part B deductible paid by
the beneficiary will be considered an out-of-pocket expense in meeting
the annual high cost deductible.
(i) The basic (core) benefits as defined in subsection
(b)(2) of this section, plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, 100 percent of the Medicare Part B
excess charges, and medically necessary emergency care in a foreign
country as defined in subsection (b)(3)(A)(i), (B), (D), and (E),
respectively.
(ii) The annual deductible in Plan G with High Deductible
must consist of out-of-pocket expenses, other than premiums, for services
covered by regular Plan G, and must be in addition to any other specific
benefit deductibles. The basis for the deductible is $2,240 for 2018,
and will be adjusted annually by the Secretary to reflect the change
in the Consumer Price Index for all urban consumers for the 12-month
period ending with August of the preceding year, and rounded to the
nearest multiple of $10.
(I) Standardized Medicare supplement Plan K must include
only the following:
(i) Part A hospital coinsurance, 61st through 90th
days: Coverage of 100 percent of the Part A hospital coinsurance amount
for each day used from the 61st through the 90th day in any Medicare
benefit period;
(ii) Part A hospital coinsurance, 91st through 150th
days: Coverage of 100 percent of the Part A hospital coinsurance amount
for each Medicare lifetime inpatient reserve day used from the 91st
through the 150th day in any Medicare benefit period;
(iii) Part A hospitalization after 150 days: On exhaustion
of the Medicare hospital inpatient coverage, including the lifetime
reserve days, coverage of 100 percent of the Medicare Part A eligible
expenses for hospitalization paid at the applicable PPS rate, or other
appropriate Medicare standard of payment, subject to a lifetime maximum
benefit of an additional 365 days. The provider must accept the issuer's
payment as payment in full and may not bill the insured for any balance;
(iv) Medicare Part A deductible: Coverage for 50 percent
of the Medicare Part A inpatient hospital deductible amount per benefit
period until the out-of-pocket limitation is met as described in clause
(x) of this subparagraph;
(v) Skilled nursing facility care: Coverage for 50
percent of the coinsurance amount for each day used from the 21st
day through the 100th day in a Medicare benefit period for posthospital
skilled nursing facility care eligible under Medicare Part A until
the out-of-pocket limitation is met as described in clause (x) of
this subparagraph;
(vi) Hospice care: Coverage for 50 percent of cost
sharing for all Part A Medicare eligible expenses and respite care
until the out-of-pocket limitation is met as described in clause (x)
of this subparagraph;
(vii) Blood: Coverage for 50 percent, under Medicare
Part A or B, of the reasonable cost of the first three pints of blood
(or equivalent quantities of packed red blood cells, as defined under
federal regulations) unless replaced in accordance with federal regulations
until the out-of-pocket limitation is met as described in clause (x)
of this subparagraph;
(viii) Part B cost sharing: Except for coverage provided
in clause (ix) of this subparagraph, coverage for 50 percent of the
cost sharing otherwise applicable under Medicare Part B after the
policyholder pays the Part B deductible until the out-of-pocket limitation
is met as described in clause (x) of this subparagraph;
(ix) Part B preventive services: Coverage of 100 percent
of the cost sharing for Medicare Part B preventive services after
the policyholder pays the Part B deductible; and
(x) Cost sharing after out-of-pocket limits: Coverage
of 100 percent of all cost sharing under Medicare Parts A and B for
the balance of the calendar year after the individual has reached
the out-of-pocket limitation on annual expenditures under Medicare
Parts A and B of $5,240 in 2018, indexed each year by the appropriate
inflation adjustment specified by the Secretary.
(J) Standardized Medicare supplement Plan L must include
only the following:
(i) the benefits described in subparagraph (I)(i),
(ii), (iii), and (ix) of this paragraph;
(ii) the benefit described in subparagraph (I)(iv),
(v), (vi), (vii), and (viii) of this paragraph, but substituting 75
percent for 50 percent; and
(iii) the benefit described in subparagraph (I)(x)
of this subsection, but substituting $2,620 for $5,240.
(K) Standardized Medicare supplement Plan M must include
only the following: The basic (core) benefit as defined in subsection
(b)(2) of this section, plus 50 percent of the Medicare Part A deductible,
skilled nursing facility care, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(ii), (B),
and (E) of this section, respectively.
(L) Standardized Medicare supplement Plan N must include
only the following: The basic (core) benefit as defined in subsection
(b)(2) of this section, plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(i), (B), and
(E) of this section, respectively, with copayments in the following
amounts:
(i) the lesser of $20 or the Medicare Part B coinsurance
or copayment for each covered health care provider office visit (including
visits to medical specialists); and
Cont'd... |
