Medicare Supplement Insurance (Medigap) Plan Details

Utah

Supplement Plan K

 

Monthly Premium
$36-$277

 

Covered Benefits
  • Skilled nursing facility
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergency

 

*Monthly costs shown do not include the standard Part B premium. 2021 Medicare Part B premium is $148.50 per month.


Coverage Overview

Part A - Hospital - Deductible

$742

(what you pay)
Part B - Medical - Deductible

$203

(what you pay)
Part B - Medical - Coinsurance

10%

(what you pay)

Coverage Details

Part A Coinsurance

(what you pay)

Hospital stays
Days 1-60: $742 (Part A deductible)
Days 61-90: $0
Days 91-150: $0 while using your 60 lifetime reserve days
Additional 365 days: $0 for Medicare-eligible services
After the additional 365 days: All costs
Skilled nursing facility (for Medicare-covered stays)
Day 1-20: $0
Days 21-100: $92.75 per day
After 100 days: All costs
Blood (during a hospital stay)
First 3 pints: 50% of cost
After 3 pints: $0
Hospice care
50% of Medicare copay/coinsurance

Part B Coinsurance

(what you pay)

Covered Part B services
First: $203 (Part B deductible)
Then: Generally 10% until you pay a total of $6,220. Then, you'll pay $0 for the rest of the year.
Preventive services
All costs above Medicare-approved amounts
Part B excess charges
All costs (and they do not count toward annual out-of-pocket limit of $6,220)
Blood (outside a hospital stay)
First 3 pints: 50% of cost
After 3 pints: $203 (Part B deductible), then generally 10%
Tests for diagnostic services
$0

Home Healthcare - Part A & B Services

(what you pay)

Home health care (for Medicare-approved services)
$0
Durable medical equipment (covered by Medicare)
First: $203 (Part B deductible)
Then: 10% of cost

Extra Benefits

(what you pay)

Foreign travel emergency
All costs

Insurance Companies Offering This Plan



 

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