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Highlight of benefits for Medicare Supplement Plans D, G and G+

Benefit Category With Original Medicare alone in you pay With Plan D you pay With Plan G you pay With Plan D you pay With Plan G you pay With Plan D you pay With Plan G you pay With Plan D you pay With Plan G you pay With Plan D you pay With Plan G you pay With Plan G+, After $2,370 Deductible Is Met, you pay With Plan G+, After $2,370 Deductible Is Met, you pay With Plan G+ you pay With Plan G+ you pay With Plan G+ you pay
Part A Deductible $1,484 $0 $0 $0 $0 $0 $0
Part B Deductible $203 $203 $203 $203 $203 $203 $203
Part B Excess Charge * All Costs All Costs $0 All Costs $0 $0 $0
Inpatient Hospital Care (per benefit period)

Days 1 - 60: $1,484 deductible

Days 61 - 90: $371 Per Day

Days 91 and after: $742 Per Day

$0

$0

$0

$0

$0

$0

Doctor Office Visits (primary care and specialists) 20% after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0 $0
Skilled Nursing Facility Care (per benefit period)

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

$0

$0

$0

$0

$0

$0

Clinical Laboratory Service 100% $0 $0 $0 $0 $0 $0
Emergency Care 20% after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible $0 $0
Foreign Travel Emergency Care All Costs $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum
Durable Medical Equipment

$203 Part B Deductible toward the Medicare-approved amount.

20% of the remaining Medicare-approved amount.

$0, after you pay your Part B Deductible

$0

$0, after you pay your Part B Deductible

$0

$0

$0

Monthly Premium $183.80 $184.70 183.80 $184.70 $183.80 $184.70 $183.80 $184.70 $58.80 $58.80 $58.80 $58.80

Get Started

Enroll Online

Get help from a dedicated Medicare Sales Adviser by calling:

1-800-671-6081
TDD/TTY: 1-800-662-1220

Monday - Friday, 8 a.m. - 8 p.m.

From Oct. 1 - Dec. 30:
advisors are also available weekends 8 a.m. to 8 p.m.

Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day

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Highlight of benefits for Medicare Supplement Plans N, A, and B

Benefit Category With Original Medicare alone in you pay With Plan N you pay With Plan A you pay With Plan B you pay With Plan N you pay With Plan A you pay With Plan B you pay With Plan N you pay With Plan A you pay With Plan B you pay With Plan N you pay With Plan A you pay With Plan B you pay With Plan N you pay With Plan A you pay With Plan B you pay
Part A Deductible $1,484 $0 $1,484 $0 $0 $1,484 $0
Part B Deductible $203 $203 $203 $203 $203 $203 $203
Part B Excess Charge * All Costs All Costs All Costs All Costs All Costs All Costs All Costs
Inpatient Hospital Care (per benefit period)

Days 1 - 60: $1,484 deductible

Days 61 - 90: $371 Per Day

Days 91 and after: $742 Per Day

$0

$0, after you pay your Part A Deductible

$0

$0

$0, after you pay your Part A Deductible

$0

Doctor Office Visits (primary care and specialists) 20% after you pay your Part B Deductible No more than $20 for each covered health care provider office visit, including visits to medical specialists $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible No more than $20 for each covered health care provider office visit, including visits to medical specialists $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible
Skilled Nursing Facility Care (per benefit period)

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

$0

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

$0

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

Clinical Laboratory Service 100% $0 $0 $0 $0 $0 $0
Emergency Care 20% after you pay your Part B Deductible No more than $50 for each covered emergency room visit after Part B Deductible is met $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible No more than $50 for each covered emergency room visit after Part B Deductible is met $0, after you pay your Part B Deductible $0, after you pay your Part B Deductible
Foreign Travel Emergency Care All Costs $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum All Costs All Costs $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum All Costs All Costs
Durable Medical Equipment

$203 Part B Deductible toward the Medicare-approved amount.

20% of the remaining Medicare-approved amount.

$0

$0, after you pay your Part B Deductible

$0, after you pay your Part B Deductible

$0

$0, after you pay your Part B Deductible

$0, after you pay your Part B Deductible

Monthly Premium $215.06 $213.08 $275.25 $196.82 $195.01 $251.92 $177.81 $176.15 $227.57 $182.33 $180.63 $233.34

Plan C, F and F+ will no longer be available for enrollment to those first eligible for Medicare on or after January 1, 2020.

Benefit Category With Original Medicare alone in you pay With Plan C you pay With Plan F you pay With Plan F+, After $2,370 Deductible Is Met, you pay With Plan C you pay With Plan F you pay With Plan F+, After $2,370 Deductible Is Met, you pay With Plan C you pay With Plan F you pay With Plan F+ you pay With Plan C you pay With Plan F you pay With Plan F+ you pay With Plan C you pay With Plan F you pay With Plan F+ you pay
Part A Deductible $1,484 $0 $0 $0 $0 $0 $0
Part B Deductible $203 $0 $0 $0 $0 $0 $0
Part B Excess Charge * All Costs All Costs $0 $0 All Costs $0 $0
Inpatient Hospital Care (per benefit period)

Days 1 - 60: $1,484 deductible

Days 61 - 90: $371 Per Day

Days 91 and after: $742 Per Day

$0

$0

$0

$0

$0

$0

Doctor Office Visits (primary care and specialists) 20% after you pay your Part B Deductible $0 $0 $0 $0 $0 $0
Skilled Nursing Facility Care (per benefit period)

Days 1 - 20: $0 per day

Days 21 - 100: $185.50 per day

$0

$0

$0

$0

$0

$0

Clinical Laboratory Service 100% $0 $0 $0 $0 $0 $0
Emergency Care 20% after you pay your Part B Deductible $0 $0 $0 $0 $0 $0
Foreign Travel Emergency Care All Costs $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum $250 Deductible, 20% of remaining costs, and any amount over $50,000 lifetime maximum
Durable Medical Equipment

$203 Part B Deductible toward the Medicare-approved amount.

20% of the remaining Medicare-approved amount.

$0

$0

$0

$0

$0

$0

Monthly Premium $339.07 $363.78 $67.97 $310.34 $332.96 $62.22 $280.34 $300.76 $56.20 $287.44 $308.39 $57.63

*Some healthcare providers charge more than the approved Medicare payment for services. The excess charge is the difference between the healthcare providers actual charge and Medicare's approved amount for payment

To learn about which plans are right for you, get help from a dedicated
Medicare Sales Advisor by calling: 1-800-671-60811-844-596-0345. TDD/TTY: 1-800-662-1220.


The Medicare Supplement plans described are underwritten by Excellus Health Plan, Inc., which does business as Excellus BlueCross BlueShieldUnivera Healthcare.

The purpose of this website material is the solicitation of insurance.

These policies (EXC-83, EXC-85, EXC-86, EXC-87, EXC-88, EXC-89, EXC-100, EXC-101, EXC-104)  meet the minimum standards for MEDICARE SUPPLEMENT INSURANCE as defined by the New York State Department of Financial Services. The expected benefit ratio for the policies is 85.5%. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy.

IMPORTANT NOTICE - A CONSUMER'S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY OFFICE OR FROM THIS INSURER.

A CONSUMER'S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICAREOpen a PDF

Excellus BlueCross BlueShieldUnivera Healthcare is not connected with or endorsed by the State of New York, the federal government or the federal Medicare program.

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