South Dakota Consumer s Guide to Medicare Supplement Policies

Transcription

1 Year 2016 South Dakota Consumer s Guide to Medicare Supplement Policies SD DEPT OF SOCIAL SERVICES OFFICE OF ADULT SERVICES AND AGING EASTERN SD CENTRAL SD WESTERN SD SHIINE@activegen.org SHIINE@centralsd.org SHIINE@westriver.org

2 TABLE OF CONTENTS 4 Steps to Choosing a Medicare Supplement (Medigap) Policy PAGE 2 What Is a Medicare Supplement Policy? 3 What You Need to Know About Medigap Policies 3 What Types of Medigap Policies Are Available? 4 When Can I Sign-Up for a Medigap Policy? 5 Can I Change My Medigap Policy? 6 How Do Insurance Companies Set Prices for Medigap Policies? 6 Can My Medigap Insurance Company Drop Me? South Dakota Medigap Providers 8 Standardized Medicare Supplement Plans 19 1

3 4 STEPS TO CHOOSING A MEDICARE SUPPLEMENT (MEDIGAP) POLICY Step 1 Decide which benefits you want, then decide which of the Medigap plans A N meet your needs. Decide which benefits you need and want while considering your current and future health care needs. You might not be able to switch policies later. Select which type of Medigap plan (A-N) will meet your needs. Step 2 Find out which insurance companies sell Medigap policies in your state. Do any of the following: Use this guide to view the companies that offer plans in South Dakota. Consider any complaints against the insurance company when deciding which Medigap policy is right for you. To view the complaints filed against insurance companies visit the Consumer Information Source at or call the South Dakota Division of Insurance for assistance (605) Look online for information about the insurance companies. Talk to someone you trust, like: A family member Your insurance agent A friend who has a Medigap policy from the same Medigap insurance company Call the insurance companies. Step 3 Learn about the insurance companies that sell the Medigap policies you re interested in and compare costs. The costs listed in this guide are estimates; companies can change their rates at any time. Plan to contact more than one insurance company that sells the Medigap plan you are interested in. Before you contact any insurance companies, figure out if you're in your Medigap open enrollment period or if you have a guaranteed issue right. Step 4 Buy the Medigap policy. Once you decide on the insurance company and the Medigap policy you want, you should apply. The insurance company must give you a clearly worded summary of your Medigap policy. Make sure you read it carefully. If you don't stand it, ask questions. 2

4 WHAT IS A MEDICARE SUPPLEMENT POLICY? Medicare Supplement Insurance, or Medigap, is sold by private insurance companies and their designated agents throughout South Dakota. Original Medicare (Parts A and B) pays about 80 percent of Medicare s expenses including hospital, doctor bills, lab tests and more. Medicare Supplement plans help pay all or a portion of the remaining 20 percent of health care costs, excluding prescription drugs and the costs associated with them. Medigap plans vary of what each one covers. If you have Original Medicare and you buy a Medicare Supplement policy, Medicare will pay its share of the Medicare-approved amount for each covered health care cost and then your Medicare Supplement policy pays its share, if your company has crossover. If your Medigap plan does not pay all of the costs after Medicare has paid its share, you will be billed directly by the provider. WHAT YOU NEED TO KNOW ABOUT MEDIGAP POLICIES You must have Medicare Part A and Part B to obtain a Medigap plan. During your first six months of enrollment in Medicare Part B, you have an Open Enrollment period (also called a Guaranteed Issue Right) where all companies selling Medigap plans must accept you regardless of your health history. If you are not buying a Medigap plan during your Open Enrollment period, companies may ask health questions or require a physical by a physician. The insurance company can legally deny your application outside of your Open Enrollment period. You may obtain a Medigap policy whenever a company offers an open enrollment period for Medigap even if it is during a time that is different than your Guaranteed Issue Right. Not all companies offer additional Open Enrollment periods. You pay the private insurance company a monthly premium for your Medicare Supplement policy in addition to the monthly Part B premium you pay to Medicare. 3

5 A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you ll each need to buy separate policies. Medicare Supplement plans DO NOT include prescription drug coverage. You must purchase a Medicare Part D plan for drugs. Your SHIINE (Senior Health Information and Insurance Education) office can help enroll you into a Part D plan when you first turn 65, during Part D Open Enrollment (Oct 15-Dec 7) and other specific circumstances. You can buy a Medigap policy from any insurance company and/or their local agent who is licensed to sell one in South Dakota by the Division of Insurance (DOI). This guide lists the premium rates for companies that agreed to have their rates in South Dakota published for Before you sign the application, make sure it is complete and accurate. The insurance company could deny or cancel your policy if you omit requested information. Companies may change their prices at any time, if approved by the South Dakota DOI. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can t cancel your Medigap policy as long as you are current in paying your monthly premium. You may NOT have a Medigap policy and a Medicare Advantage plan at the same time. WHAT TYPES OF MEDIGAP POLICIES ARE AVAILABLE? There are currently 10 nationally standardized Medicare Supplement Plans available in South Dakota in The plans currently offered include A, B, C, D, F, (also a High Deductible F), G, K, L, M and N. Standardized means a Plan A from one company must offer the same benefits as Plan A from all other companies, and so forth for each respective plan type. Each Medigap plan offers specific benefits and coverage listed in the chart on the back of this guide. Cost is usually the most significant difference between Medigap policies with the same letter sold by different insurance companies but some may offer discounts or other coverage. 4

6 eligible for an open enrollment period when you turn 65. In South Dakota, individuals 65 and eligible for Medicare Part A and Part B because of a disability or End- Stage Renal Disease are able to obtain at least one kind of Medigap policy from the insurance companies selling Medigap in our state. WHEN CAN I SIGN-UP FOR A MEDIGAP POLICY? Every new Medicare beneficiary who is age 65 or older with Part A and B has a guaranteed right to buy a Medigap policy during Open Enrollment. An insurance company cannot reject you for any policy it sells and it cannot charge you more than anyone else your age. Your Open Enrollment period starts when you enroll in Medicare Part B (at age 65 or older) and ends six months later. If you continue working past age 65 and have credible health coverage from your employer, you do not have to enroll in Part B or get a Medigap policy when turning 65. When you retire, do not have employerpaid health coverage for you or your spouse, and start paying for Medicare Part B premiums, your six-month Open Enrollment for a Medigap policy begins. If you apply for a policy after the six-month window, companies may legally refuse coverage. If you had Medicare Part B coverage prior to age 65 (e.g., Medicare due to a disability or End-Stage Renal Disease), you will be While the insurance company can t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition. A preexisting condition is a health problem that occurred before the date a new policy starts. In some cases, the insurance company can refuse to cover out-of-pocket costs for these pre-existing health problems for up to six months. This is called a preexisting condition waiting period, or lookback period. After six months, the Medigap policy will cover the pre-existing condition. It would be wise to find out if there is a pre-existing clause with your Medigap policy and how long that waiting period lasts before deciding on which insurance company to purchase a Medigap policy. Coverage for a pre-existing condition can only be excluded if the condition was treated or diagnosed within six months before the coverage starts the Medigap policy. This is called the lookback period. For Medicare covered services, Original Medicare will still cover the condition even if the Medigap policy won t, but you are responsible for the Medicare coinsurance or copayment. 5

7 of the year and a Medigap policy can be issued or changed to anyone who applies during that timeframe. HOW DO INSURANCE COMPANIES SET PRICES FOR MEDIGAP POLICIES? Each insurance company decides how it will set the price, or premium, for its Medigap policies. It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced in three ways: CAN I CHANGE MY MEDIGAP POLICY? Unless you move to another state, or the insurance company no longer sells the Medigap policy in your state, you can keep the same company and policy for the rest of your life. You may apply for another Medicare Supplement policy at any time if you choose. However, after the six-month open enrollment timeframe has expired, companies will likely require the applicant to go through writing, a process where a person s health history is examined. A company may deny an applicant for any reason. DO NOT CANCEL your current Medigap policy until officially accepted by the new company and have the policy in-hand. Some companies MAY have an open enrollment during a certain period Community-rated, also called no-age rated. Generally, the same monthly premium is charged to everyone who has the Medigap policy, regardless of age. Premiums may go up because of inflation and other factors but not because of your age. Issue-age rated, also called entry agerated. The premium is based on the age you are when you buy, or are issued, the Medigap policy. Premiums are lower for people who buy at a younger age and won t change as you get older. Premiums may go up because of inflation and other factors but not because of your age. 6

8 Attained-age rated. The premium is based on your current age, the age you have attained, resulting in your premium increasing as you get older. Premiums are low for younger buyers but increase as they age. They may be the least expensive at first, but they can eventually become the most expensive. Premiums may also go up because of inflation and other factors. The cost of the Medigap policy may also depend on whether the company offers discounts such as discounts for women, non-smokers, people who are married, those who pay yearly, pay premiums using electronic funds transfers or other reasons. CAN MY MEDIGAP INSURANCE COMPANY DROP ME? In most cases, a Medigap insurance company cannot drop you as the policy is guaranteed renewable. Your insurance company can only drop you if one of these happens: You are delinquent in paying your premium. You were not truthful on the Medigap application. The insurance company becomes bankrupt or insolvent or no longer sells policies in your state through no fault of you own. You then have the right to buy Medigap Plan A, B, D, F, K, or L sold in South Dakota by any insurance company. NOTE: If this is the case, you must get a new policy no later than 63 calendar days from the date your coverage ended. 7

9 2016 SOUTH DAKOTA MEDIGAP PROVIDERS Below is a list of insurance companies licensed by the SD Division of Insurance (DOI) that sell Medicare Supplement plans in South Dakota for Prices can change at any time with approval by DOI so always check rates with the company or agent and get your questions answered. In many policies, rates are lower for non-smokers and females. All companies listed have crossover where after Medicare reviews and pays a claim, it is automatically submitted to the Medicare Supplement insurance company for processing. If rates are not provided for a company (X), that company chose not to have their rates made public. Monthly premium rates are provided for the standardized plans each company offers in South Dakota. Rates listed are for a male, non-smoker in 5- year increments. Standardized Medicare Supplement Plans Available - Monthly Premiums AARP United 65 X X X X X X X Community Rated Healthcare Company 65 $67 $109 $139 $140 $48 $80 $96 Must join AARP $ $81 $132 $169 $170 $58 $97 $117 Members have 75 $105 $171 $218 $220 $75 $125 $151 many discounts Age enrollment discounts 80 $105 $171 $218 $220 $75 $125 $151 and services may have writing 85 $105 $171 $218 $220 $75 $125 $151 discounts for multi rates for 75 and older coverage 90 $105 $171 $218 $220 $75 $125 $151 insured, annual pay, for 6 or more years 95 $105 $171 $218 $220 $75 $125 $151 electronic pay American Continental 65 X X X X X X Attained Age Insurance Company 65 X X X X X X an Aetna Company 70 X X X X X X Responded with X X X X X X medigap information 80 X X X X X X but did not want rates 85 X X X X X X published. Call company 90 X X X X X X for information. 95 X X X X X X

10 Standardized Medicare Supplement Plans Available - Monthly Premiums American Republic Corp 65 $182 $255 $79 $109 $148 Attained Age Insurance Company 65 $134 $188 $58 $80 $ $150 $211 $65 $90 $ $182 $255 $79 $109 $ $210 $294 $91 $125 $ $238 $333 $103 $142 $ $255 $358 $111 $153 $ $255 $358 $111 $153 $208 Avera Health Plans Select 65 $134 $150 $156 $167 $146 $81 $121 Attained Age $82 $91 $95 $102 $89 $49 $ $104 $116 $121 $129 $113 $63 $94 No age banded 75 $134 $150 $156 $167 $146 $81 $121 increases past 80 $163 $182 $190 $203 $177 $99 $147 age $163 $182 $190 $203 $177 $99 $ $163 $182 $190 $203 $177 $99 $147 Rates effective $163 $182 $190 $203 $177 $99 $147 Avera Health Plans Standard 65 $204 $236 $275 $293 $256 $142 $212 Attained Age $146 $169 $196 $209 $183 $102 $ $168 $195 $226 $241 $211 $117 $175 No age banded 75 $204 $236 $275 $293 $256 $142 $212 increases past 80 $241 $279 $325 $347 $303 $168 $251 age $241 $279 $325 $347 $303 $168 $ $241 $279 $325 $347 $303 $168 $251 Rates effective $241 $279 $325 $347 $303 $168 $251 9

11 Standardized Medicare Supplement Plans Available - Monthly Premiums Central States Indemnity 65 $142 $166 $201 $205 $158 $136 Attained Age of Omaha 65 $100 $117 $141 $146 $124 $97 a Berkshire 70 $120 $140 $167 $172 $133 $114 Offers policies on Hathaway Company 75 $142 $166 $201 $205 $158 $136 hearing aides $161 $188 $228 $232 $178 $ $175 $205 $249 $253 $193 $ $185 $216 $262 $264 $203 $ $191 $223 $270 $271 $208 $179 Colonial Penn/Bankers Life 65 Attained Age $126 $133 $173 $32 $120 $48 $103 $119 $ $155 $162 $209 $38 $149 $58 $122 $148 $107 Dental plan available 75 $188 $195 $254 $46 $183 $72 $149 $185 $138 to purchase 80 $218 $227 $302 $55 $222 $86 $176 $221 $ $248 $259 $355 $65 $264 $103 $207 $258 $ $282 $296 $418 $76 $313 $124 $244 $301 $ $300 $317 $453 $82 $342 $136 $264 $325 $281 Combined Insurance 65 X X X X Attained Age Company of America 65 X X X X X X X X Responded with 75 X X X X medigap information 80 X X X X but did not want rates 85 X X X X published. Call company 90 X X X X for information. 95 X X X X 10

12 Standardized Medicare Supplement Plans Available - Monthly Premiums Equitable Life and 65 $133 $191 $139 $127 Attained Age Casualty Insurance 65 $95 $134 $104 $89 Company 70 $115 $164 $118 $ $133 $191 $139 $ $146 $210 $161 $ $157 $228 $186 $ $165 $241 $213 $ $170 $252 $234 $167 Everence Financial - 65 Attained Age Everence Medical 65 $182 $99 Supplement 70 $215 $ $135 $ $147 $ $277 $ $292 $ $308 $179 Everence Financial - 65 Issue Age Everence Medicare 65 $121 $207 $106 Supplement 70 $131 $224 $ $138 $238 $ $146 $258 $ $152 $278 $ $152 $278 $ $152 $278 $145 11

13 Standardized Medicare Supplement Plans Available - Monthly Premiums Gerber Life Insurance Co. 65 $181 $268 $219 Attained Age $138 $200 $ $163 $237 $ $181 $268 $ $192 $291 $ $200 $311 $ $207 $330 $ $215 $351 $291 Globe Life and Accident 65 Attained Age Insurance Company 65 $63 $100 $118 $ $86 $134 $152 $153 Discount for paying 75 $92 $147 $174 $175 via bank draft 80 $93 $150 $189 $ $93 $150 $189 $ $93 $150 $189 $ $93 $150 $189 $190 Government Personnel Mutual 65 $143 $198 $203 $148 $130 Attained Age Life Insurance Company 65 $117 $158 $162 $118 $ $128 $174 $178 $129 $ $143 $198 $203 $148 $ $156 $221 $227 $166 $ $166 $241 $247 $181 $ $174 $258 $264 $194 $ $182 $277 $283 $209 $187 12

14 Standardized Medicare Supplement Plans Available - Monthly Premiums Humana Preferred 65 Attained Age $104 $124 $148 $151 $55 $67 $96 $105 Discount for paying 70 $126 $151 $180 $184 $61 $81 $116 $128 via bank draft 75 $153 $183 $219 $223 $74 $98 $141 $155 Discount for multiple 80 $181 $216 $258 $263 $87 $115 $166 $183 enrollees in house 85 $209 $250 $299 $305 $101 $133 $192 $211 Member discounts 90 $209 $250 $299 $305 $101 $133 $192 $211 and services 95 $209 $250 $299 $305 $101 $133 $192 $211 Humana Standard 65 $228 $272 $326 $332 $110 $145 $209 $230 Attained Age $155 $185 $221 $225 $75 $99 $142 $156 Discount for paying 70 $188 $224 $268 $274 $90 $119 $172 $190 via bank draft 75 $228 $272 $326 $332 $110 $145 $209 $230 Discount for multiple 80 $269 $321 $385 $392 $129 $171 $247 $272 enrollees in house 85 $311 $372 $446 $455 $149 $198 $286 $315 Member discounts 90 $311 $372 $446 $455 $149 $198 $286 $315 and services 95 $311 $372 $446 $455 $149 $198 $286 $315 Individual Assurance 65 $157 $186 $149 $126 Attained Age Company 65 $121 $143 $111 $ $136 $160 $126 $106 Ask for regional sales dept 75 $157 $186 $149 $ $175 $214 $172 $ $192 $246 $199 $ $211 $280 $228 $ $223 $307 $251 $220 13

15 Standardized Medicare Supplement Plans Available - Monthly Premiums Medico Corp 65 $313 $401 $284 Attained Age Insurance Company 65 $108 $139 $99 Discount if person option 3 70 $119 $153 $108 lives with another 75 $131 $168 $121 person over $156 $200 $ $182 $233 $170 Additional policy covers 90 $202 $259 $189 dental, vision, hearing 95 $202 $259 $189 exams and supplies Omaha Insurance Company 65 $120 $189 $62 $130 $115 Attained Age $96 $151 $50 $104 $92 70 $103 $162 $54 $111 $99 Household discount 75 $120 $189 $62 $130 $115 of 12% 80 $141 $222 $73 $152 $ $159 $251 $83 $172 $ $175 $276 $91 $189 $ $191 $300 $99 $206 $183 Physicians Mutual 65 $155 $283 $65 $205 $180 Attained Age Insurance Company 65 $118 $207 $41 $150 $124 Dental policies $139 $242 $51 $175 $151 available 75 $155 $289 $65 $209 $184 Preventative services Offers 3 F plans. F and F(HD) 80 $169 $335 $80 $242 $218 for eye and hearing listed. Call for F Innovative 85 $181 $378 $98 $274 $247 exams plus discounts rates and description. 90 $192 $418 $119 $302 $273 for glasses and hearing 95 $201 $461 $143 $333 $301 aides 14

16 Standardized Medicare Supplement Plans Available - Monthly Premiums Physicians Mutual 65 $155 $283 $65 $205 $180 Issue Age Insurance Company 65 $134 $241 $51 $174 $150 Dental policies $150 $279 $63 $202 $178 available $163 $319 $76 $231 $207 Preventative services Offers 3 F plans. F and F(HD) 80 $175 $360 $92 $260 $231 for eye and hearing listed. Call for F Innovative 85 $187 $402 $109 $291 $256 exams plus discounts rates and description. 90 $196 $436 $128 $315 $281 for glasses and hearing 95 $203 $471 $148 $341 $304 aides. Reserve National Insurance 65 $180 $268 $215 $50 $169 $156 Attained Age Company 65 $129 $192 $154 $35 $121 $ $153 $228 $183 $42 $143 $132 Offers dental and 75 $180 $268 $215 $50 $169 $156 vision plans at 80 $209 $311 $249 $57 $195 $180 additional cost 85 $231 $343 $275 $63 $216 $ $237 $352 $282 $65 $221 $ $243 $360 $289 $67 $227 $209 Sanford Health Plan 65 $171 $239 $256 $115 Issue Age Traditional 65 $105 $146 $177 $ $141 $195 $210 $94 Available in all 75 $171 $239 $256 $115 South Dakota 80 $187 $259 $280 $126 counties 85 $192 $269 $287 $ $193 $270 $289 $ $193 $270 $289 $130 15

17 Standardized Medicare Supplement Plans Available - Monthly Premiums Sanford Health Plan 65 $149 $208 $222 $100 $166 Issue Age Select 65 $91 $127 $136 $61 $ $122 $170 $182 $82 $136 Available in 75 $149 $208 $222 $100 $166 counties of 80 $163 $225 $243 $109 $182 Sanford service area 85 $167 $234 $250 $112 $187 Call company for 90 $168 $235 $251 $113 $188 counties in plan 95 $168 $235 $251 $113 $188 Standard Life and 65 $295 $335 $381 $230 $314 $46 $232 $151 Attained Age Accident Insurance 65 $222 $252 $287 $173 $236 $34 $174 $114 Discount for annual Company 70 $256 $292 $332 $200 $273 $40 $201 $132 payment ext $295 $335 $381 $230 $314 $46 $232 $ $354 $403 $458 $276 $377 $55 $278 $182 Member discounts zip codes starting $445 $507 $576 $347 $474 $69 $350 $229 and services have higher rates 90 $445 $507 $576 $347 $474 $69 $350 $ $445 $507 $576 $347 $474 $69 $350 $229 State Farm Mutual 65 $118 $198 $200 Attained Age Insurance Company 65 $81 $135 $ or 70 $102 $171 $172 Discount for Local agent 75 $118 $198 $200 annual payment statefarm.com/insurance/health 80 $133 $222 $ $138 $232 $ $138 $232 $ $138 $232 $234 16

18 Standardized Medicare Supplement Plans Available - Monthly Premiums Thrivent Financial for 65 $134 $156 $183 $164 $184 $59 $165 $118 $153 Attained Age Lutherans 65 $98 $110 $130 $112 $131 $39 $113 $80 $ $117 $132 $154 $136 $155 $48 $136 $97 $128 Issue Age rates 75 $134 $156 $183 $164 $184 $59 $165 $118 $153 available 80 $143 $173 $215 $195 $216 $72 $196 $140 $180 Christianity is common bond 85 $146 $184 $245 $224 $246 $86 $225 $161 $205 of the fraternal benefit 90 $148 $193 $268 $246 $269 $94 $247 $177 $222 society 95 $149 $202 $282 $260 $283 $99 $261 $188 $234 Transamerica Premier Life 65 Issue Age Insurance Company 65 X X X X X X X X X X Responded with X X X X X X X X X X medigap information 75 X X X X X X X X X X but did not want rates 80 X X X X X X X X X X published. Call company 85 X X X X X X X X X X for information. 90 X X X X X X X X X X 95 X X X X X X X X X X Discount for auto pay USAA Life Insurance 65 $174 $180 $137 Attained Age Company 65 $144 $150 $ $159 $165 $ $174 $180 $137 Offers dental and Available to military and non- 80 $186 $192 $146 vision plans at military medicare eligible 85 $201 $209 $158 additional cost individuals 90 $201 $209 $ $201 $209 $158 17

19 Standardized Medicare Supplement Plans Available - Monthly Premiums Wellmark Blue Cross and 65 $179 $247 $278 $139 $198 Attained Age Blue Shield 65 $121 $167 $188 $94 $134 of South Dakota 70 $151 $208 $235 $118 $167 Standard Plan 75 $179 $247 $278 $139 $ $198 $273 $307 $154 $ $215 $296 $333 $167 $ $215 $296 $333 $167 $ $215 $296 $333 $167 $237 Wellmark Blue Cross and 65 $193 $218 $109 $155 Blue Shield 65 $131 $147 $74 $105 Attained Age of South Dakota 70 $163 $184 $92 $131 Preferred Plan 75 $193 $218 $109 $155 Auto enrolled in $213 $240 $120 $171 Blue 365 for 85 $232 $261 $130 $185 member discounts 90 $232 $261 $130 $185 and services 95 $232 $261 $130 $185 18

20 STANDARDIZED MEDICARE SUPPLEMENT PLANS How to read this chart: If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn t cover that benefit. NOTE: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible). Medicare Supplement - Medigap Plans Medigap Benefits A B C D F* G K L M N 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 50% 75% *** Blood (First 3 Pints) 50% 75% Part A Hospice Care Coinsurance of Copayment 50% 75% Skilled Nursing Facility Care Coinsurance 50% 75% Medicare Part A Deductible 50% 75% 50% Medicare Part B Deductible Medicare Part B Excess Charges Foreign Travel Emergency**** (Up to Plan Limits) 80% 80% 80% 80% 80% 80% Out-of-Pocket Limit** $4,960 $2,480 *Plan F(HD) offers a high-deductible plan. If you choose this option, you must pay Medicare-covered costs up to the deductible amount of $2,180 in 2016 before your Medigap plan pays anything. **After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), your Medigap plan pays 100% of covered services for the rest of the calendar year. ***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don't result in inpatient admission. ****Pays 80% of certain medically necessary emergencies after you pay a yearly $250 deductible. The Senior Health Information and Insurance Education (SHIINE) program is a service of the South Dakota Department of Social Services, Office of Adult Services and Aging. 700 Governors Drive - Pierre, SD This publication was made possible by Grant Number 90MP , 90SA , 14AASDMAAA, 14AASDMADR, and 14AASDMSHI from Administration for Community Living. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services. EASTERN SD CENTRAL SD WESTERN SD SHIINE@activegen.org SHIINE@centralsd.org SHIINE@westriversd.org