medical benefits ceases because the individual is no longer eligible. For the purpose of this paragraph 8 programs providing coverage for medical benefits include programs that reimburse for medical expenses or Medicare copayments, coinsurance, and deductibles. Programs that provide only premium assistance or limited benefits such as vision or immunization are not considered programs that provide coverage for medical benefits. C. Products to Which Eligible Persons are Entitled Eligible persons described in Section 12(B) are entitled to any Medicare supplement policy offered by any issuer, except that if the Medicare supplement policy in which an eligible person described in Section 12(B)(5) was most recently enrolled did not have an outpatient prescription drug benefit, guaranteed issue is limited to plans with equivalent or lesser benefits as determined by the table in Subsection D. Continuity Rights The issuer shall waive any medical underwriting for an individual replacing another Medicare supplement policy, whether from the same issuer or another issuer, if the individual meets the requirement to have continuous coverage since the end of the open enrollment period as specified in 24-A M.R.S.A. § 5002-B(1)(A), and the replacement plan satisfies the following criteria: (1) The plan applied for is currently offered by the issuer and is one of the replacement plans indicated in the table below for all of the applicant’s prior plans. Issuers may allow transfers to additional plans not noted below. The 1990 and 2010 standardized Medicare supplement benefit plans of the same letter are considered comparable for continuity purposes.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after: ---While using 60 lifetime reserve days ---Once lifetime reserve days are used: ---Additional 365 days ---Beyond the additional 365 days All but $[1340] All but $[335] a day All but $[670] a day $0 $0 $[1340] (Part A deductible) $[335] a day $[670] a day 100% of Medicare eligible expenses $0 $0 $0 $0 $0** All costs SKILLED NURSING FACILITY CARE* You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after All approved amounts All but $[167.50] a day $0 $0 $0 $0 $0 Up to $[167.50] a day All costs BLOOD First 3 pints Additional amounts $0 100% 3 pints $0 $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness. All but very limited copayment/coinsurance for out-patient drugs and inpatient respite care Medicare copayment/coinsurance $0 (continued) ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN B MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR * Once you have been billed $[183] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible. SERVICES MEDICARE PAYS [AFTER YOU PAY $[2240] DEDUCTIBLE,**] PLAN PAYS [IN ADDITION TO $[2240] DEDUCTIBLE,**] YOU PAY MEDICAL EXPENSES - IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment, First $[183] of Medicare approved amounts* Remainder of Medicare approved amounts $0 Generally 80% $[183] (Part B deductible Generally 20% $0 $0 Part B Excess Charges (Above Medicare approved amounts) $0 100% $0 BLOOD First 3 pints Next $[183] of Medicare approved amounts* Remainder of Medicare approved amounts $0 $0 80% All costs $[183] (Part B deductible) 20% $0 $0 $0 CLINICAL LABORATORY SERVICES-- TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 (continued) PLAN F or HIGH DEDUCTIBLE PLAN F PARTS A & B SERVICES MEDICARE PAYS [AFTER YOU PAY $[2240] DEDUCTIBLE,**] PLAN PAYS [IN ADDITION TO $[2240] DEDUCTIBLE,**] YOU PAY HOME HEALTH CARE MEDICARE APPROVED SERVICES ---Medically necessary skilled care services and medical supplies ---Durable medical equipment First $[183] of Medicare approved amounts* Remainder of Medicare approved amounts 100% $0 80% $0 $[183] (Part B deductible) 20% $0 $0 $0 OTHER BENEFITS - NOT COVERED BY MEDICARE
PLAN L MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR **** Once you have been billed $[183] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY* MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment, First $[183] of Medicare Approved Amounts**** Preventive Benefits for Medicare covered services Remainder of Medicare Approved Amounts $0 Generally 75% or more of Medicare approved amounts Generally 80% $0 Remainder of Medicare approved amounts Generally 15% $[183] (Part B deductible)**** ♦ All costs above Medicare approved amounts Generally 5% ♦ Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs (and they do not count toward annual limit of [$2620])* BLOOD First 3 pints Next $[183] of Medicare Approved Amounts**** Remainder of Medicare Approved Amounts $0 $0 Generally 80% 75% $0 Generally 15% 25%♦ $[183] (Part B deductible) ♦ Generally 5%♦ CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0 (continued) * This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $[2620] per year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. PLAN L PARTS A & B SERVICES MEDICARE PAYS PLAN PAYS YOU PAY*