Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 270 - MEDICARE SUPPLEMENT INSURANCE RULE - REVISED › Appendix 031-270-A

Current through 2024-29, July 17, 2024
[COMPANY NAME]
NOTICE OF CHANGES IN MEDICARE
AND YOUR MEDICARE SUPPLEMENT COVERAGE -- 1990
THE FOLLOWING CHART BRIEFLY DESCRIBES THE MODIFICATIONS IN
				  MEDICARE AND IN YOUR MEDICARE SUPPLEMENT COVERAGE. PLEASE READ THIS
				  CAREFULLY!
[A BRIEF DESCRIPTION, IN SUBSTANTIALLY THE FOLLOWING FORMAT,
				  OF THE REVISIONS TO MEDICARE PARTS A & B, WITH A PARALLEL DESCRIPTION OF
				  BENEFITS PROVIDED BY THE MEDICARE SUPPLEMENT COVERAGE AND SUBSEQUENT CHANGES,
				  INCLUDING DOLLAR AMOUNTS.]
SERVICES
MEDICARE BENEFITS
YOUR MEDICARE SUPPLEMENT COVERAGE
In 1989 Medicare Pays per calendar Year
Effective January 1, 1990, Medicare Will pay
In 1989 Your Coverage Pays
Effective January 1, 19990, Your Coverage Will Pay
MEDICARE PART A SERVICES SUPPLIES
In patient Hospital Services
Unlimited number of hospital days after $560
							 deductible
All but $592 for first 60 days/benefit period
Semi-private Room & Board
All but $148 a day for 61st-90th days/benefit period
Misc. Hospital Services & Supplies, such as Drugs,
							 X-Rays, Lab Tests & Operating Room
All but $ 296 a day for 91st-10th days(if individual
							 chooses to use 60 non renewable lifetime reserve days)
BLOOD
Pays all cost except payment of deductible(equal to
							 costs for first 3 pints) each calendar year. Part A blood deductible reduced to
							 the extent paid under Part B
Pays all cost except nonreplacement fees(blood
							 deductible for first 3 pints in each calendar year
SKILLED NURSING FACILITY CARE
There is no prior confinement requirement for this
							 benefit
100% or cost for 1st 20 days (after a 3 day prior
							 hospital confinement)/benefit period
First 8 days - All but 25.50 a day
All but $74.00 a day for 21st -100th days/benefit
							 period
In 1989 Medicare Pays per Calendar Year
Effective January 1, 1990, Medicare Will Pay
In 1989 Your Coverage Pays
Effective January, 1 1990 Your Coverage Will Pay
9th thorough 150th day - 100% of costs
Beyond 100 days - Nothing/Benefit period
Beyond 150 days -- Nothing
Medicare B Services And Supplies
80% Of Allowable Charges (After $ 75
							 Deductible/calendar year
Prescription Drugs
Inpatient prescription drugs. 80% of allowable charges
							 for immuno - suppressive drugs during the first year following covered
							 transplant (after $74 deductible/calendar
BLOOD
80% of all costs except not - replacement fees (blood
							 deductible for first 3 pints in each benefit period (after $75 deductible /
							 calendar year
80% of all cost as except nonreplacement fees (blood
							 deductible) for first 3 pints (after $ 75 deductible/calendar year)
[Any other policy benefits not mentioned in this chart should
				  be added to the chart in the order prescribed by the outline of coverage. If
				  there are corresponding Medicare benefits, they should be shown.]
Describe any coverage provisions changing due to Medicare
				  modifications.] [Include information about premium adjustments that may be
				  necessary due to changes in Medicare benefits will be effective.]
THIS CHART SUMMARIZING THE CHANGES IN YOUR MEDICARE BENEFITS,
				  AND IN YOUR MEDICARE SUPPLEMENT PROVIDED BY [COMPANY], ONLY BRIEFLY DESCRIBES
				  SUCH BENEFITS. FOR INFORMATION ON YOUR MEDICARE BENEFITS CONTACT YOUR SOCIAL
				  SECURITY OFFICE OR THE HEALTH CARE FINANCING ADMINISTRATION. FOR INFORMATION ON
				  YOUR MEDICARE SUPPLEMENT [POLICY] CONTACT:
[COMPANY -- OR FOR AN INDIVIDUAL POLICY NAME OF AGENT]
				  [ADDRESS/PHONE NUMBER]