Company Name Plan G High Deductible - Medicare Supplement
Annual Deductible
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Monthly Premium
Highlights
$2,700
$59.12
In-network: $0 copay
Out-of-network: $0 copay
In-network: $10 copay
Out-of-network: $35 copay
Inpatient hospital acute
In-network
- Up to 90 days covered
- $340 per day for days 1 - 4
- $0 per day for days 5 - 90
Out-of-network
40% coinsurance
Inpatient hospital psychiatric
In-network
- Up to 90 days covered
- $250 per day for days 1 - 6
- $0 per day for days 7 - 90
Out-of-network
40% coinsurance
$300 (applies to Tier 3 ,4 and 5)
Highlights
$2,500
$54.12
In-network: $0 copay
Out-of-network: $0 copay
In-network: $10 copay
Out-of-network: $35 copay
Inpatient hospital acute
In-network
- Up to 90 days covered
- $340 per day for days 1 - 4
- $0 per day for days 5 - 90
Out-of-network
40% coinsurance
Inpatient hospital psychiatric
In-network
- Up to 90 days covered
- $250 per day for days 1 - 6
- $0 per day for days 7 - 90
Out-of-network
40% coinsurance
$300 (applies to Tier 3 ,4 and 5)
Highlights
$1,700
$29.12
In-network: $0 copay
Out-of-network: $0 copay
In-network: $10 copay
Out-of-network: $35 copay
Inpatient hospital acute
In-network
- Up to 90 days covered
- $340 per day for days 1 - 4
- $0 per day for days 5 - 90
Out-of-network
40% coinsurance
Inpatient hospital psychiatric
In-network
- Up to 90 days covered
- $250 per day for days 1 - 6
- $0 per day for days 7 - 90
Out-of-network
40% coinsurance
$300 (applies to Tier 3 ,4 and 5)
