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Benefits | Basic Plan | Extended Basic Plan | $20 and $50 Par B Co-Payment Policy (Plan N) |
---|---|---|---|
Medicare Part A Coinsurance and Hospital Costs | |||
Medicare Part B Coinsurance or Copayment* | |||
Blood (first 3 pints) | |||
Part A Hospice Care Coinsurance or Copayment | |||
Medicare Part A Deductible | |||
Skilled Nursing Facility Care Coinsurance (for days 21-100) | |||
Foreign Travel Emergency (up to plan limits) | |||
Medicare Part B Excess Charges (up to plan limits) | |||
Medicare Part B Deductible | |||
State-Mandated Benefits |
*$20 and $50 Part B Co-Payment Medicare Supplement Policy (Plan N) pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Note:
This is a marketing tool intended for use in the sale of insurance. Completion of an application for a State Farm insurance policy will require contact with a State Farm agent/insurance producer.
In some states coverage is available if you are under age 65 and are Medicare eligible due to disability and/or End Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). These policies are not connected with or endorsed by the U.S. Government or the Federal Medicare program. This information is only a general description of coverage. A complete statement of coverage is found only in the policy. Policy coverage's, exclusions and limitations may vary in some states. For exact terms and conditions see: Medicare Supplement Insurance Policy series 97049HMN2, 97050HMN2 and 97069MN. For additional details on coverage and cost, contact a State Farm agent/insurance producer.
State Farm Mutual Automobile Insurance Company
Bloomington, IL
MSI-MN.5