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Compare Plans

Following is information on the Comprehensive, Plus and Premium Medicare Supplement Health Plans offered by the Medical Trust.

With each plan, you are responsible for some out-of-pocket expenses, up to certain annual out-of-pocket maximums. Please note that your vision care, and copayments do not count toward the annual out-of-pocket maximums.

Compare your out-of-pocket costs for all three plans.

Your Monthly Costs 2019

Below are your monthly costs if you decide to purchase one of the Medicare Supplement Health Plans.

Plan With Pharmacy  Without Pharmacy 
  2019 2019
Comprehensive $370 $205
Plus $500 $240
Premium $585 $295

Your Monthly Costs 2020

Below are your monthly costs if you decide to purchase one of the Medicare Supplement Health Plans.

Plan With Pharmacy  Without Pharmacy 
  2020 2020
Comprehensive $380 $210
Plus $505 $245
Premium $590 $295

*If you enroll in a Medicare Supplement Health Plan, select the added pharmacy benefit unless you are already enrolled in Medicare Part D.

Your Out-of-Pocket Costs

2019 Out-of-Pocket Costs

Benefits What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Annual
Out-of-Pocket
Maximums
No maximum limit For Part A and Part B benefits: Individual: $2,000 For Part A and Part B benefits: Individual: $1,750 For Part A and Part B benefits: Individual: $1,500
Medicare Limitations Expenses are approved when Medicare deems the benefits to be medically necessary. Care not covered/approved by Medicare will not be covered. All medical benefits are limited to expenses approved by Medicare.
Inpatient Days
1-60
For each benefit period, you pay the first $1,364. You pay up to $390 per benefit period. All other costs are covered at 100%. You pay up to $150 per benefit period. All other costs are covered at 100%. You pay nothing.
Inpatient Days
61-90
$341 per day You pay nothing.
Inpatient Days
91-150
$682 per day You pay nothing.
Skilled Nursing Facility Days
1-20
You pay nothing. You pay nothing.
Skilled Nursing Facility Days
21-100
$170.50 per day You pay nothing.


Benefits
What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Home Healthcare You pay nothing. You pay nothing for services approved by Medicare.
Durable Medical Equipment You pay 20% of the Medicare-approved amount You pay nothing.
Medicare Part B Physician Office Visits You pay 20% after the $185 deductible. You pay up to $20 per office visit. You pay up to $15 per office visit. You pay up to $15 per office visit.
Clinical 
Laboratory Services
You pay nothing for Medicare-approved services after the annual Part B deductible. You pay nothing.
Other Medicare Part B Services You pay a coinsurance or copayment amount, which may vary according to the service. You pay 30% of the remaining Medicare coinsurance. You pay 20% of the remaining Medicare coinsurance. You pay 20% of the remaining Medicare coinsurance.
Outpatient Hospital Services You pay a coinsurance or copay amount, which may vary according to the service. You pay up to $275 of any Medicare coinsurance or copayment. You pay up to $275 of any Medicare coinsurance or copayment. You pay up to $175 of any Medicare coinsurance or copayment.
Routine Physical Exam Office Visit Some services associated with physical exams are not covered. You pay nothing up to $200.

 


Benefits
What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Routine Clinical Laboratory Services & Diagnostic Tests (Performed With Your Routine Physical) You pay a coinsurance or copayment amount, which may vary according to the service and may or may not be subject to the Part B deductible. You pay nothing for clinical laboratory services associated with your routine physical, including, but not limited to, bone mass measurements, colorectal screening, mammograms, Pap smears, pelvic exams, and prostate cancer screening.
Medicare-Approved Chiropractic Services You pay 20% of the Medicare-approved amount. You pay 30% of the remaining Medicare coinsurance (i.e., 6% of the total Medicare-approved amount). You pay 20% of the remaining Medicare coinsurance (i.e., 4% of the total Medicare-approved amount). You pay nothing.
Outpatient Therapy (occupational, speech, cardiac, pulmonary) You pay 30% of the Medicare-approved amount. You pay 30% of the remaining Medicare coinsurance (i.e., 6% of the total Medicare-approved amount). You pay 20% of the remaining Medicare coinsurance (i.e., 4% of the total Medicare-approved amount). You pay nothing.
Prescription Drugs: Express Scripts See Medicare prescription drug plan information. See page 122 of the 2019 Medicare Supplement Handbook
Vision: EyeMed Not covered (You pay 100%). 12-month benefit for:
  • Eye exam—$0 copayment
  • Lenses—$10 copayment
  • Frames—$130 allowance, plus 20% off balance

2020 Out-of-Pocket Costs

Benefits What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Annual
Out-of-Pocket
Maximums
No maximum limit For Part A and Part B benefits: Individual: $2,000 For Part A and Part B benefits: Individual: $1,750 For Part A and Part B benefits: Individual: $1,500
Medicare Limitations Expenses are approved when Medicare deems the benefits to be medically necessary. Care not covered/approved by Medicare will not be covered. All medical benefits are limited to expenses approved by Medicare.
Inpatient Days
1-60
For each benefit period, you pay the first $1,408 You pay up to $390 per benefit period. All other costs are covered at 100%. You pay up to $150 per benefit period. All other costs are covered at 100%. You pay nothing.
Inpatient Days
61-90
$352 per day You pay nothing.
Inpatient Days
91-150
$704 per day You pay nothing.
Skilled Nursing Facility Days
1-20
You pay nothing. You pay nothing.
Skilled Nursing Facility Days
21-100
$176 per day You pay nothing.


Benefits
What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Home Healthcare You pay nothing. You pay nothing for services approved by Medicare.
Durable Medical Equipment You pay 20% of the Medicare-approved amount You pay nothing.
Medicare Part B Physician Office Visits You pay 20% after the $198 deductible. You pay up to $20 per office visit. You pay up to $15 per office visit. You pay up to $15 per office visit.
Clinical 
Laboratory Services
You pay nothing for Medicare-approved services after the annual Part B deductible. You pay nothing.
Other Medicare Part B Services You pay a coinsurance or copayment amount, which may vary according to the service. You pay 30% of the remaining Medicare coinsurance. You pay 20% of the remaining Medicare coinsurance. You pay 20% of the remaining Medicare coinsurance.
Outpatient Hospital Services You pay a coinsurance or copay amount, which may vary according to the service. You pay up to $275 of any Medicare coinsurance or copayment. You pay up to $275 of any Medicare coinsurance or copayment. You pay up to $175 of any Medicare coinsurance or copayment.
Routine Physical Exam Office Visit Some services associated with physical exams are not covered. You pay nothing up to $200.

 


Benefits
What Medicare
Asks You to Pay
What You'll Pay in the
Comprehensive
Plan
What You'll Pay in the Plus Plan What You'll Pay in the Premium Plan
Routine Clinical Laboratory Services & Diagnostic Tests (Performed With Your Routine Physical) You pay a coinsurance or copayment amount, which may vary according to the service and may or may not be subject to the Part B deductible. You pay nothing for clinical laboratory services associated with your routine physical, including, but not limited to, bone mass measurements, colorectal screening, mammograms, Pap smears, pelvic exams, and prostate cancer screening.
Medicare-Approved Chiropractic Services You pay 20% of the Medicare-approved amount. You pay 30% of the remaining Medicare coinsurance (i.e., 6% of the total Medicare-approved amount). You pay 20% of the remaining Medicare coinsurance (i.e., 4% of the total Medicare-approved amount). You pay nothing.
Outpatient Therapy (occupational, speech, cardiac, pulmonary) You pay 30% of the Medicare-approved amount. You pay 30% of the remaining Medicare coinsurance (i.e., 6% of the total Medicare-approved amount). You pay 20% of the remaining Medicare coinsurance (i.e., 4% of the total Medicare-approved amount). You pay nothing.
Prescription Drugs: Express Scripts See Medicare prescription drug plan information. See page 92 of the 2020 Medicare Supplement Handbook
Vision: EyeMed Not covered (You pay 100%). 12-month benefit for:
  • Eye exam—$0 copayment
  • Lenses—$10 copayment
  • Frames—$130 allowance, plus 20% off balance

Notes:

  1. The Prescription Drug Benefit information is only applicable to the Medicare Supplement Health Plans with the pharmacy benefit option.
  2. This vision information describes the network benefit. See the plan's Summary of Benefits and Coverage for details about out-of-network vision benefits.
  3. Vision copayments and the prescription drug copayments do not apply to the annual out-of-pocket maximum.

 

Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.

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