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| Benefits | Plan A | Plan D | Plan N | Plan G | Plan C | Plan F |
|---|---|---|---|---|---|---|
| Medicare Part A Coinsurance and Hospital Costs (Up to an additional 365 days after Medicare benefits are used up) | ||||||
| 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 | ||||||
| Medicare Part B Deductible |
Medicare Part A Coinsurance and Hospital Costs (Up to an additional 365 days after Medicare benefits are used up)
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
Medicare Part B Deductible
1 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:
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. 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. Renewal premiums may increase periodically depending on your age. Policy coverage's, exclusions and limitations may vary in some states. For exact terms and conditions see: Medicare Supplement Insurance Policy series 97037HTN, 97038HTN, 97039HTN, 97067TN, 97068TN, and 97069TN. For additional details on coverage and cost, contact a State Farm agent/insurance producer.
State Farm Mutual Automobile Insurance Company
Bloomington, IL
MSI-TN.3